I have GCA and have been tapering the pred dose using DSNS methods as recommended by most on this group.I am at the moment alternating 7/8 mg of Pred. However for the first time I have a high post prandial hyperglycaemia reading of 160 . The Hb1ac is normal and the fasting sugar level is also normal.
My question is
1) Is this status reversible once I go down enough on the pred dose ?
2) Should I be worried even if the Hb1Ac levels and fasting sugar levels are normal ?
3) Is it important to immediately go onto diabetes drugs ?
4)Does it help reducing carbs in the morning breakfast such that no medication status for diabetes will be required ?
5) Most important ------will it help me to avoid the hyperglycemia problem if I start going down much faster on the pred step down ?
Too many questions perhaps ......... but this group is super supportive and most reliable in terms of real-time information !
Regards and Thankyou
Written by
Iwillwin123
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Pred triggers the liver to release random spikes of glucose into the blood. If you happen to measure BS at a point soon after a meal that coincides with this sort of release it will appear unusually high. As long as the Hba1c is within range and isn't creeping up there little to be concerned about. That is why we recommend cutting your carb intake drastically when you are on pred, it reduces the risk of the Hba1c rising to problematic levels and it is a far better indicator when you are on pred. It will not rise immediately anyway, it reflects the average BS level over the previous 3 months so will start to increase if you have a lot of such spikes that last a long time.
It will improve as the pred dose gets lower and you should look at your diet before going on to diabetes drugs. Reducing carbs in general will help and there is a lot of discussion on the forum about it.
And no, it is unlikely you will help the hyperglycaemia by reducing the pred faster - it is more likely that you will either experience either GCA-related or steroid withdrawal symptoms or, at this stage, adrenal insufficiency problems. Just keep on the way you have been doing successfully. And reduce your carb intake - especially sugars and simple carbs and processed foods with hidden sugars.
This input from you reassured me very much . I was worried about adding one more medication - now for diabetes , to the already weird cocktail of drugs that I am taking I am taking ......... What can I say except a heartfelt Thankyou for your detailed answer ...... I can say I would be completely lost without the support of this wonderful group here .
This side effect of prednisolone in raising serum glucose because of the liver is interesting. In early December, after an Hb1ac test my GP informed me that my level was 43 mmo/mol and I should adjust lifestyle etc. (no mention of prednisolone lol). "At risk" range is 42mmol/mol to 47mmol/mol.
After Christmas I went on a very low probably ketogenic diet which has lowered my fasting serum glucose levels but it's the variability that I didn't understand. The readings can vary from 33 mmol/mol to 39 mmol/mol.
After reading your comments about liver raising serum glucose because of pred I have also researched the effect of statins. I take 20mg simvastatin each night and I have discovered that this can also raise serum glucose.
Forgot to say - the variability is because we aren't machines! When there are carbs in food your blood glucose level shoots up and triggers insulin production which then brings the spike of BS down. More carbs will mean a higher peak and a slower fall in the level and so will inadequate insulin. The real test for diabetes in the glucose tolerance test - you drink a measured amount of glucose and then blood samples are taken over the following few hours.
So true ! Nothing is simple.......in fact if something is OK I start wondering if I must check and recheck facts. Having said that, the doctors also seem pretty much at sea to me regarding the finer issues in GCA/PMR. That is where this group of GCA warriors is priceless.
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