Pmr and diabetes

[Suet3942]

I am asking this question on behalf of my friends husband. A month ago he woke up with pain and stiffness all over. Went to see his gp who prescribed painkillers. No relief. Went back to see another gp and asked if he could possibly have pmr. The doc was very short with him and asked him in a bullish manner where he’d heard about polymyalgia. He then said it wasn’t possible that he had it but would prescribe pred to see how he reacted. The pain and stiffness disappeared. When he went back a week later he saw a different gp who said he could only have 10mg pred every other day because he has diabetes. Obviously he is in terrible pain again, so much so,that his wife has to feed him. Is it correct that having diabetes means no steroids? Sorry this post is so long .

[SnazzyD]

Hmm, well why say PMR isn’t possible and then hedge bets and prescribe Pred anyway? Doesn’t make sense. If the second GP thinks it is PMR but isn’t confident enough to follow PMR treatment guidelines with a diabetic then I’d say a referral needs to be made to a specialist who is and even an endocrinologist too. Many people who have diabetes have steroids and some become diabetic because of steroids but strict control of carbohydrate intake can usually control it. He needs someone to advise for the way his diabetes takes him. Half baked control of systemic inflammation could end up with GCA or widespread large vessel vasculitis which could be very bad for a diabetic, not least because of the high doses of Pred involved rather than lower starting doses for PMR. Here is an article to get started with, tell them to look at page 4 for an idea of what the treatment should be. I think they need to get a bit more insistent.

rcpe.ac.uk/sites/default/fi...

[Suet3942 in reply to SnazzyD]

Thanks Snazzy. They are not very pushy. He has an appointment with a rhueumy but it’s in mid June. Too long a wait.

[Hidden]

What a load of rubbish. Yes it spikes blood sugar and ut may impact hba1c, but low carb diet can help control it. He needs to be referred to the local.diabetes clinic - get advice re good control. I have had type 2 for years, i have been prescribed insulin until off steroids. Tbere was a discussion about the impact of pred but its cruel to leave him in pain. I will try and find a link. There is a pdf file too that has a booklet.

diabetes.org.uk/professiona...

[Suet3942 in reply to Hidden]

Thanks Poopadoop. I’ll get him to read the link.

[PMRpro Ambassador]

Absolute drivel on the part of both those doctors - obviously on the defensive. And the doctor has actually done the worst of all worlds - not enough pred to control the PMR means he has the downsides with no benefits.

Snazzy has saved me most of my comments - insist on a referral if there isn't a sensible option within the practice. There are loads of diabetics on the forums, yes it may be more DIFFICULT to control the Hba1c and it may require insulin - but it doesn't rule out pred for PMR.

[Suet3942 in reply to PMRpro]

Thanks pmrpro. That’s what I thought.

[Soraya_PMR]

The doctor is talking out of his backside. Patients, particularly elderly, don’t come with just one problem, they have Co-morbidities, and the skill required of the GP is managing the full patient, holistically, to give best quality of life. Being unable to feed himself is undignified, being in dreadful pain is psychologically damaging, this doctor is nothing short of neglectful.

I wonder if he could be persuaded to treat the PMR and not the diabetes? OF COURSE NOT! That would cause ill health........and the difference is?

I think in the short term he needs to see GP number one who at least gave him 15mg (although it sounds to me as if he was hoping it wouldn’t work!!!) Maybe take the treatment guidelines along for his edification. They’re only too happy to quote guidelines when it suits them!

Exactly the conversation SnazzyD and I were having, tell the evils of pred but don’t teach a patient how to manage life whilst on pred.

[Hidden in reply to Soraya_PMR]

I wanted a moving gif style shaking my head and fist emoji

[Soraya_PMR in reply to Hidden]

I can’t tell you the gif I wanted, it might have involved your cattle prod 😮

[Hidden in reply to Soraya_PMR]

😂😂😂

[Hidden in reply to Soraya_PMR]

Can't decide on the stick one or the tazer style. One you can sneak up with...the other makes them wonder what you have and by the

time they realise ⚡......if only i had 62£

fearing.co.uk/cattle/handli...

[Suet3942 in reply to Hidden]

That conjures up a picture! My own gp needs a prod to galvanise him into action. (See my post to Soraya).

[Suet3942 in reply to Soraya_PMR]

You wonder how some gp’s ever qualified. My own gp is about 75 and can’t even use a computer. He writes things on torn scraps of paper and the patient gives them to the receptionist to type up. And this man is running 2 practices!!! Luckily he has taken on a nice lady doc but sometimes I have booked an appt to see her and when I walk in, he’s sitting there and my heart sinks!

I agree with you Soraya. They should manage the whole condition and not treat us as ignoramuses.

[PMRpro Ambassador in reply to Suet3942]

Makes a change from heart-sink patients!

(Which is a recognised term by the way ncbi.nlm.nih.gov/pmc/articl... )

themighty.com/2017/04/heart...

And there are a few links about doctors who understand that the problem lies with them - and not necessarily with the patient (although there are patients who push their luck).