Steroid-induced diabetes

[winfong]

Does anyone out there have it? How do you manage it, especially given the fact that many of are stuck on pred long-term?

[MrsNails]

Hi Winfong - My Hb1Ac shot up to 47mmol/mol & Type2 diabetes or Steroid Induced Diabetes is 48mmol/mol

If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. ***

I’ll attach you my Post from FAQ on how l reversed it.

healthunlocked.com/pmrgcauk...

MrsN

*** diabetes.org.uk/guide-to-di...

[Getwellsoon1 in reply to MrsNails]

Hi there Mrs Nails,

It is now a couple of years, if not more, since we met at a PMR (Shropshire) meet-up at Oswestry hospital.

I have followed your posts ever since. Along with other veterans in the PMR challenge, your comments always encourage me to keep going.

Your comments and photos with regard to pred induced diabetes are fabulous!!!Thank you so much.

My weight blossomed to 16.5 stone. I longed for the strength and energy of the Sumo wrestlers but had to be content with simply looking like one!!

It’s so heartwarming to see how the changes in diet can actually work and are so worthwhile. I tried a three month Keto diet last year and reduced down to 15 stone 4pounds. Once I stopped the Keto my weight slowly increased to 15st 10lbs. I can absolutely relate to the sugar craving which I have conquered with Rooibus n honey flavoured tea and Oat milk coffee - no sugar though!!! My pred is stuck at 6 mg and the weight is now a little less at 15st 7lbs and falling.

Q: Am I right in thinking that a permanent Keto diet may not be a good idea?

I have enjoyed learning to cook without potatoes, root veg, bread etc but my fruit intake has become almost nil. I take vitamin supplements in an effort to balance things out but I’m very uncertain as to whether these dietary restrictions have more harm than good. Do you have an opinion? I really want to do all I can to help the arthritic knees and ankles!!!!

Thanks again for your continued help and advice on this forum.

[MrsNails in reply to Getwellsoon1]

Will reply later GWS - on Nana Duty this morning so an early start by my standards 😉

[PMRpro Ambassador in reply to Getwellsoon1]

Make up for the fruit with above-ground veggies which are much lower in carbs. I eat almost no fruit - it is treated as a treat - but I do eat industrial quantities of a wide range of veggies! Keto diet has some downsides - but the biggest problem with any new way of eating is whether you can maintain it and that is harder the more extreme the rules are. As you discovered, you can't stop the successful weight loss programme and go back to the previous eating style without risking regaining the weight. You have to up the carb content slowly until you identify the point at which you stop losing weight - and you have to be honest. You can "sin" occasionally but you have to have the discipline to get back on the wagon for the majority of the time. That is why the interval fasting approaches often work well - you always know the period of denial is limited and later or tomorrow you will be able to eat the thing you want. But they also retrain your expectations of the amount you need to eat and over time you want less too.

[Getwellsoon1 in reply to PMRpro]

Thank you for that extremely wise and reasonable approach to diets. I’ve never tried the fasting. It sounds like a good idea. I have learned so much about my own body since getting PMR. I regret not taking more interest in my eating habits earlier in life. At least I can encourage my daughter to do things differently. Thank you for sharing your knowledge and experience. I looked at the link you provided earlier about diet. Really useful. Thank you. 🥰

[MrsNails in reply to Getwellsoon1]

Hi, the wee munchkin has gone down for his morning nap 😴 I didn’t do Keto as it would be a bit too extreme for me. Have you ever had your Hb1Ac tested? As if that is raised you might be eligible to attend a PreDiabetic (Type2) Course (via GP) which l mentioned in my post & l found it was really helpful for me.

I eat berry’s - strawberries, raspberries & have half an apple at some point during the day.

The winter is always harder as Potatoes are a bit of a weakness of mine, l’m not fond of pasta & can take or leave rice!!

I need to shake a bit of winter weight - l think the spring is often a good time to start.

Hopefully the Meetings will start again soon & hope we can catch up.

MrsN

[Getwellsoon1 in reply to MrsNails]

It’s great to hear that you are ‘Nana’. I love that term. I saw from the link that PMRPro shared that the berries you mentioned are better when dieting. I enjoyed the Keto and invested in a personalised 3 month plan. I can go back into it if I need to but I’ve just increased my recipe repertoire to increase the greens and protein and cut out the bread, pasta and potatoes. Your daily regime sounds perfect. I hope we get the chance to meet again soon and show off our ‘svelte-like’ figures!!😃

[MrsNails in reply to Getwellsoon1]

That would be great! x

[Koalajane]

I reversed mine by going low carb and walking

[DeepThought2]

Dear Winfong, I had also steroid induced diabetes at Pred levels higher than approx 12 mg. I strongly reduced carbohydrate intake but even then my blood glucose level was far to high (even without eating at all it was clearly higher than 200 mg/dl (11.1 mmol/l) at 14:00 when I took 35 mg pred. My HbA1c value was at 47 mmol/l at that time. Independent from carbohydrate intake there was a clear diurnal course with peak values at around 14:00 (I took my pred between 7 and 8 in the morning) - and certainly carbohydrates increased that peak. After consulting my doctor I injected daily (moderate amounts of) insulin and also took Metformin (together with the carbohydrate intake reduction) to control blood glucose. My doctor said that this might not be really necessary as I was on a fast tapering course - but I was a bit afraid of the very high peak glucose values. With decreasing the pred dose I could reduce the insulin dose and completely stopped below 12 mg. I started running and cycling (when I was at a pred dose of approx 15mg) and that also helped reducing the glucose levels. Cannot say anything about long-term management as I was luckily - with the help of Actemra - able to taper pred very quickly. The good news is that now everything is normal again and my HbA1c is 28 mmol/mol (4.7%).

[winfong]

Thanks all. I was pretty healthy, eating properly and exercising (when I can) before this. I do admit that that's always hard to do around the holidays, and there's always a little remainder of that for some weeks afterward.

That said, I have really gone into overdrive on cutting down / doing things right once before. I had had a previous diabetes scare, which actually turned out to be a bar lab result. But at least I know I can do it.

No more messing around. Thanks again for the advice and support.

[MrsNails in reply to winfong]

It was the treat of diabetes that made me get into action 😉 we don’t want another thing on top of the PMR & Steroids!

[Hacey]

Hello Winfong,My Hba1c went up to 47 because of the steroids, which frightened me to death. I’ve been working on it by eating a low carb diet and losing some weight, and trying to do modest exercise when I can. Together with reducing the pred very slowly I’ve now got it down to 43, so don’t panic. It should respond to the above measures.

Good luck!

[Hidden]

I have had type 2 and then it went away. It now changes often and I find that if my right foot gets flaky I have a flare of diabetes. I am on 6mg of prednisolone (down from 80mg) and still the type 2 comes and goes. Most annoying.

[PMRpro Ambassador in reply to Hidden]

How do they define that it is Type2 coming and going?

[Hidden in reply to PMRpro]

I don't know how they define it! All I can say is that my bloods show an HBA1c?? hovering around the 47 point??? D

[PMRpro Ambassador in reply to Hidden]

Hovering presumably means it occasionally hits 48 or dips to 46 (+ a bit) and they take that rather literallly ...

[Pixix]

Yes, reversed with keto diet in one month, & not risen since (2 years ago). Have you looked at the FAQs & searched on it? There’s a lot of info on there, Mrs Nails worked hard to get it all together. You may also want to look at the diet FAQs, too, as I think that’s how most people attack the problem.

[winfong in reply to Pixix]

I did. Very helpful, but it was almost all about HbA1c. I suppose I can look independently for info about diet. I just wish I could reduce pred more (I'm at 5 and don't seem to be able to go lower).

[PMRpro Ambassador in reply to winfong]

It's really just a case of cutting carbs as much as possible. A good basic info site is this one

dietdoctor.com/low-carb/foods

Once you learn where carbs hide, it is easy to adjust your meals to avoid them. The more you avoid, the closer you come to a keto diet. It is difficult to get fully into keto when you are on pred as the pred releases spikes of glucose from the body stores into the blood - and that takes you out of the state of ketosis. But very low carb also works.

[Pixix in reply to winfong]

Um. Well, this is a PMR/GCA forum, not a diet forum, nor a diabetes forum, so ‘I suppose’ you can look independently, yes!, I got all of my info regarding keto and other diets & diabetes info from other forums & web sites. I bought & read the Michael Moseley diet book, & I’m following one now. Naturally the subject of diet comes up as steroids increase your appetite & lots of sufferers put ion excess weight! But I value the huge amount of time the volunteers here give up & I research other things outside of PMR in other places, tbh, & involve my doctor rather than take up their time. It takes hours a day for them to help so many queries, I personally can’t believe it! It’s amazing, especially when, recently, there have been many topics unrelated (or barely so) to the actual diseases! Anyway, that’s my personal thoughts, not aimed at you specifically!! FYI, I got down to 3mg last July…spent August feeling dreadful, talked to my doctor, & agreed to go back to 5mg. I had quite a few new symptoms of adrenal insufficiency. Stayed on 5mg until Christmas. But I have side effects when it’s at that level, too. Then did one month at 4.5mg, and now I’m spending one month at 4mg. It’s not what I want but we don’t have all the choices we’d like. I’ve been on steroids before (lung issues) & put on 2 stone. Then with this session (2 years for me) I’ve put on another 2 stone, taken off a stone, put back half a stone. My doctor is trying to get me to accept that I may have to stay on a low dose permanently, especially as I have other diseases which are causing a problem right now. Good luck with reversing diabetes, it really is possible. I did it when I was taking 16mg a day.

[nallufl24]

I took Metformin on doses of prednisone higher than 10 mg

[tangocharlie]

Very low carb diet, almost keto (low carbs, moderate protein and fat), helps me and has done for about 4 years now. If I'm not careful with my diet the HbA1c drifts up to the pre-diabetic range, if I'm very careful it stays below 42. I'm on very high steroids. I rarely eat bread, pasta, rice, potatoes or sugar except on holidays etc. The Michael Mosley books are very good at explaining how insulin resistance develops and how low-carb eating works.

[Koalajane]

My hba1c has now been under 39 for the last 4 plus years.I take no meducation for my diabetes, eat a low carb diet and walk at least 10,000 steps a day.

When my type 2 was first diagnosed I was put on gliclazide but because my hba1c went so low I was taken off it.

I lost a fair bit of weight (3 stone) and feel a lot better for it. I still have the diabetic checks for which I am grateful.

Good luck