Blood Tests a Bit Alarming

[Stickgal316]

Glucose. 225. I’ve never been diabetic

A1c. 6.1

Neutrophils elevated

White blood cells slightly elevated.

I’ve only been on pred about 6 weeks. If my sugar has gone up this much this early, what does that mean if I’m on it a long time?

[PMRpro Ambassador]

Random BS testing can be very misleading in patients who are on pred. The pred triggers the liver to release random spikes of glucose from the body stores in muscle and liver. If they happen to take the blood test at the wrong moment - it can look horrendous.

Raised neutrophils is common effect when on pred - and if the neutrophils are raised, so is the total while count as they are one of the various types of white blood cell.

We do tell people to cut their carbs drastically when on pred - you can't influence the liver release of glucose but you can modify the contribution made by diet. For some of us we have to get very low indeed, almost keto diet levels of carbs, but it also helps reduce the pred-related weight gain.

This is a really helpful site:

dietdoctor.com/low-carb/foods

You do need a bit of discipline at first but it soon becomes a way of life and is worth it when you escape more medications!

[Stickgal316 in reply to PMRpro]

Yeah I was afraid of that. Been on a carb/sugar bender for a couple weeks and knew I was not headed in the right direction. Lost 30 lbs right before pmr hit doing low carb/low sugar. Motivation has become an issue since I got sick but this should kick me in the arse! Thanks Pro!

[PMRpro Ambassador in reply to Stickgal316]

If you had been low carb over some time pre-PMR that will also probably have influenced your body's response to the load of carbs in your bender. The pancreas isn't up to speed so the sudden shock of lots of carbs means you aren't making enough insulin to bring the level back down.

[pomeranion in reply to PMRpro]

As usual valuable information. I am also experiencing elevated glucose and neutrophils levels. My Drs. failed to mention this added concern. I learn more here. I will continue to try more discipline on diet. Weight gain a real concern as have been overweight all my life. Actually had gastric bypass 40 yrs. ago so I could get pregnant. Lost over 90#'s in 6 months and have had two beautiful sons for 30 some years. Probably my problems with high prednisolone dosage because of malabsorption. I continue to suffer with pain from both PMR and RA while slowly tapering from 45mgs. to currently working my way to 33mgs. Rheumatologist and Endro concerned because of osteoporosis diagnosis. Thanks again.

👍👍😀

[PMRpro Ambassador in reply to pomeranion]

Why haven't they offered liquid pred? Someone on the forum some time ago switched to that because of poor absorption after gut surgery - worked much better. Methyl prednisolone injections can also be used to manage both PMR and GCA if necessary - a lady used injections for GCA because she had such severe stomach damage that made pred very risky.

[pomeranion in reply to PMRpro]

I'm sorry I didn't make it clear that I am on liquid prednisolone. Started at 15mls. 45mgs. Now down to 11mls. 33mgs. I never experienced any relief of PMR and RA symptoms until I started on the liquid. You amaze me with your knowledge. I am struggling with the taper but need to reduce because of ongoing concerns about osteoporosis, glucose spikes and swelling of legs and feet. Staying optimistic.

[PMRpro Ambassador in reply to pomeranion]

It is a balance - if you go too low then you will have the PMR back. So the question is, which is more important. There are ways of mitigating the osteoporosis and the glucose spikes - less in the way of options for the PMR unless they approve TCZ. Which IS approved for RA in the UK without any messing about

[SnazzyD]

The tried and tested approach is to eat a really low carbohydrate diet unless your doctor thinks it is not advisable. Your liver is able to increase blood sugar by changing Glucagon into glucose. This is jolly useful when you need to do something energetic. Unfortunately Pred makes the liver do this at times whether you need it or not, giving you random glucose spikes. This is all before you even eat anything. So, if you then eat carbohydrate foods it just adds to the glucose load. The body reacts by pumping out insulin to get it back down leaving you with a low blood sugar. You then get the munchies and crave something sweet or carbs. It is especially bad if the carbohydrates you eat are simple carbs. When I started on Pred I cut out all pasta, bread, potato, rice, flours and sugars. Even with 60mg Pred my blood sugars averaged out nicely and I didn’t put on weight. Others have had the same success or were able to reverse their high sugars. When you are taking Pred it isn’t enough to just eat healthily, like wholemeal bread instead of white. Different people have to cut carbs by different amounts; I had to cut severely while others need a bit. Even a year off Pred I don’t notice not having pasta, rice or potato, though fries are unbeatable occasionally. I now eat like this through choice with the odd slice of cake if I fancy it. The rest of the diet needs oils, preferably mostly vegetable and a good amount of protein. I ate a lot of meat. You also need foods high in magnesium or to take a supplement because Pred makes you lose it. Food high in potassium too for the same reason. Lots of vegetables of all colours should help this and eat fruit in mode. Berries are best. I made sure I took B vitamins because it was missing out on wholemeal grains.

I have no idea why doctors don’t tell us this, it is usually accepted that those on Pred will put on loads of weight and have diabetic levels of blood sugar.

[Stickgal316 in reply to SnazzyD]

Thanks so much! I’m gonna give it a go

[PMRpro Ambassador in reply to SnazzyD]

"I have no idea why doctors don’t tell us this, "They simply don't know - I think it was Tim Spector in one of his food books said he'd been horrified to find that they do about 3 hours on nutrition during their entire training!!

[Stickgal316 in reply to PMRpro]

Docs think pills solve everything

[PMRpro Ambassador in reply to Stickgal316]

They don't here - Germanic trained docs are very into diet and alternative approaches. It's usually an advantage!

[cycli in reply to PMRpro]

are you serious!!!!! 3 hrs during 4 years or more training!!!!!! Food is the driving force of life and everything that goes in has some effect. I'm simply staggered at that revelation. Why don't they take an interest themselves?

[PMRpro Ambassador in reply to cycli]

FOUR? In SEVEN up to the end of their registration years. And nothing during specialist training either.Lack of curiosity really I think - there aren't many medical students who want to get involved in stuff not on the curriculum. To be fair, they don't have that much time I suppose.

[cycli in reply to PMRpro]

then the bl**dy curriculum needs altering so they damn well do. Plain stupid.

[PMRpro Ambassador in reply to cycli]

I'm told by a colleague in the USA that they don't even TEACH physiology in the sense of someone who knows what it's about standing up and teaching correct facts - at least, not in his Uni. They have "focus group seminars" and sit around discussing it. If you don't learn normal physiology properly - how can you understand it when it's gone wrong?

[Stickgal316 in reply to PMRpro]

Most of our docs are overweight…and nurses, so shy away from telling patients about proper diet

[PMRpro Ambassador in reply to Stickgal316]

Dunno - I've been on the receiving end of comments from healthcare staff who were noticeably fatter than me!

[cycli in reply to PMRpro]

you know, I think we have just triggered a salient fact here. Everything that fuels the body is significant in the wellbeing and therefore all round health of a person. You are what you eat is literally true. Pressure should be applied to the GMC to immediately consider this fact and set about modifying their curriculum in training and introduce some emergency structured seminars to get the ball rolling. Retraining or updating Dr.'s as a condition contractually to continue receiving their wage would also be an incentive.

[PMRpro Ambassador in reply to cycli]

They do have to complete CPD - continuing professional development. Some manage to do it as a tick box exercise - some do it properly

Oh - and Prof Sarah Mackie did wonder whether looking at dietary advice for PMR patients was an idea. I believe in France patients are advised about low carb eating when on pred - they don't like losing their baguettes

[agingfeminist]

After the 2 weeks PMR then presented its ugly sister GCA, 60 mg pred a day and within a month I was suddenly into diabetes. Cut out carbs...all flour products, potatoes, rice, and absolutely no sugars (or sugar substitutes). 2 years on it is a way of life...I have a great diet...and occasionally I use date syrup as a sweetener(low glycemic index) with finely ground nuts and coconut milk to make cakes and biscuits as treats. Also no added salt - to prevent any water retention. Loads of suitable vegetables in amazing soups (cold in summer, hot in winter), and in frittatas. Meat, fish, eggs, dairy. After 18months added small amounts of legumes and the odd spoonful of rice pasta. I can't do the exercise that is meant to help...but diabetes was chased away. Do try diet...but you have to be very strict. You get used to it surprisingly quickly. Goodbye diabetes.

[cycli in reply to agingfeminist]

brilliant post agingfeminist. can you skip across to my post food for thought and post a few ideas there for us. It has gone quiet on that one and was hoping for peoples ideas and contributions

[agingfeminist]

happily. how do I find 'food for thought' ?

[PMRpro Ambassador in reply to agingfeminist]

Look on cycli's profile at his posts - 6th one down at present

healthunlocked.com/user/cycli