Quick reduction .

[Auldcoo]

My gp started me on 10mgs prednisolone beginning of November and within 3 days the pain had gone and day by day I felt stronger - saw him again two weeks later and because of having type 2 diabetes he cut my dose to 5mgs - I was fine for two days then my shoulders, arms began to ache and my energy levels dropped - he did say that if I did not feel right to take 10mgs one day and 5mgs the next - have done for past two days but pain is still there -it’s as though I am back at square one again - please can I have some advice

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Hi auldcoo

That seems an awfully awfully quick taper. Bonkers. I have diabetes and was dx in June 2016. Yes pred will cause blood glucose to spike a bit but if you have PMR there is no point reducing with such haste. The general principle is you stay at lowest dose that manages symptoms. Your gp is setting you up for a deal of problems. Have a look on the forum for others tapering experience. Others will be along with good advice.

[DorsetLady PMRGCAuk volunteer]

Hi Auldcoo,

I can understand your GP’s reasoning for reducing you, but he obviously doesn’t understand PMR nor Pred very well. A reduction from 10mg to 5mg is way too much. The recommendation is not to reduce more than 10% of your existing dose - he has made you do 50% no wonder your poor body is objecting! And as for the 10mg/5mg alternative days - no good either.

Afraid you need to go back to 10mg and get rid of pain, hopefully should only take a few days, but it would be good idea to stay for a couple of weeks again to make sure, and then reduce by 1mg at a time.

The Pred may affect your diabetes, but there are patients on here in the same situation who seem to manage very well - I think your GP is reacting unduly about that, and his actions are likely to cause you more problems - which I’m sure he doesn’t want, but probably doesn’t realise.

Think you need to speak to GP tell him his reduction plan isn’t working and “request/suggest” a rethink.

Good luck, and let us know what happens

[SheffieldJane]

Hi Auldcoo,

My advice would be to change your doctor. The pattern of prescribing has made you feel the way you do. You are back to square one, literally.

It is marvellous that you obtained great relief on 10 mgs. Most of us need at least 15 - 20 mgs. Then you should stay on that dose for around 6 weeks. Any reduction should be done as a very gradual taper, no more than 10% of your dose at a time. There are examples of taper programmes pinned on this site.

I am aware that your doctor's concern about your type 2 diabetes is well founded. The development of it is one of the side effects of Pred. I believe that Pred changes the way that the body deals with sugar. So you are between a rock and a hard place. You cannot however, be expected to tolerate the pain and disability of PMR, not to mention the danger of unchecked inflammation in your body.

You are going to have to have a will of iron with your diet, cutting out carbs and sugars. Otherwise you will just balloon and become poorly.

I would also ask to be referred to a Rheumatologist so that your condition can be carefully managed by a specialist and here's hoping that you get an excellent one. Managed right this could even turn your life around.

Good luck! Let us know how you progress. 🌸

[PMRpro Ambassador]

The others have already said most of what I would have said - thanks all!

Go back to square one with the pred dose - i.e. 10mg a day until the symptoms have stabilised again. Hopefully they will. THEN try reducing just 1mg at a time at the most. Alternating 10 and 5mg is a big change day to day - and on the 5mg days you simply aren't getting enough to manage the inflammation. Pred comes in 1mg tablets - tell him to provide them so you can go about this in a sensible manner.

Yes, with other things you can start on 10mg and drop to 5mg and its fine. You have PMR. It doesn't work unless the lowest dose you require to manage the inflammation and, so, the symptoms, is below 5mg. And at this stage, it very rarely is. So you creep down to avoid the risk of a flare - which is what you have had. The most common cause of a flare is reducing too far or too fast.

If he is so scared about your diabetes then a GP should have consulted a specialist. It isn't the end of the world for a diabetic to have to take pred and there are plenty of them on the forums. It means it may be harder to manage your BS levels but lots do it quite well. The first thing he should have advised was that you should cut your carb intake as much as you can - even the American Diabetic Association now recommends it as a measure for managing Type 2 diabetes and I know Type 1 diabetics who manage their diabetes in this way. It was, after all, the only possible option prior to the availability of insulin.

That then leaves the problem with the pred causing random spikes of glucose to be released by the liver which is what leads to pred-induced diabetes - but someone on the forum has reduced her Hba1c level from 6.9% to 6.5% in a short time just by diet. And actually, being on pred doesn't ALWAYS do it - so what's the matter with crossing the bridge when he gets there?

[HeronNS]

What the others said. Pred did cause my blood sugar to spike (I don't have diabetes) but with a strong will I virtually eliminated grains and sugar and other carbs like potatoes and although my blood sugar wasn't really normal again until I got to about 5 mg it dropped out of the danger zone very quickly with the dietary change. My daughter, a dietitian, also advised me to be sure to eat some protein when I did have carbs (you can't eliminate them all) and told me this would help limit sugar spikes. Good luck! Make pred your friend.