treatment of prednisone side affects

[GMA74]

I live in the USA

I’ve posted before but have a question . My rheumatologist has not agreed to taper my 20:mg dosage of prednisone yet , ( 6 months on this dose) Ive had two doses of Kevzara and all labs are normal,but IL-6 is increasing . He says soon we will taper slowly . In the meantime my FBS are averaging in the 130 to 145 range and my diastolic B/P is in the 90s. . Weight gain and all the other SE are happening . I see my NP in a couple weeks for my annual “ Wellness check “

I have not seen her since being diagnosed in January . Is it standard to treat the hyperglycemia and B/p this soon or see if tapering the prednisone will improve the side affects ? I’m on a low carb diet but sometimes I falter Lol .

Don’t want to go on metformin if I can avoid

Would appreciate what others have experienced

[SnazzyD]

It does depend on what you mean by “low carb” and what you actually mean by “sometimes I falter”. It may be that actually you are taking in quite a lot of carbohydrate. In some ways that would be good because it means there is the possibility of change before having to take meds. Can you say what you mean by these terms; it might give you the answer to your problems with hyperglycaemia and weight gain. A really honest food diary for a week might help get to the bottom of it.

The trouble with Pred is that it really does demand a more severe approach than just eating better for health. It isn’t good just to ride high blood sugars now in the hope it’ll go down later when you get to low doses (well under 10mg). It does get better as you reduce the dose but 20mg is still well up there and you need to grab the bull by the horns now to avoid insulin resistance just for starters. It also helps to cut down salt quite heavily to avoid the fluid retention.

I had to cut down carbs quite a bit and had no pasta, potato, maize, rice or flours. I didn’t put on weight and my blood sugar average (HbA1c test) stayed normal even when starting on 60mg. Salt really affected me so I couldn’t even have sauces ,condiments or use stock cubes. For a while it was quite boring but I’m so glad I did it. Some here have lost weight and normalised their blood sugars from the position of already having gained weight. There is hope!

[PMRpro Ambassador]

Because of the way Kevzara works, the ESR and CRP WILL appear normal because the IL-6 cannot create inflammation because it can't attach to the receptors and so the IL-6 will rise in the blood as it hasn't a home to go to, I assume Kevzara is like Actemra in that it takes some time to really take effect and my rheumy encouraged me to not rush as the reduction.

I know it is difficult - but you do have to be consistent with low carb in order to reduce the weight gain and the development of steroid-induced diabetes and some of us need to be at lower carb than others. Snazzy and I both have to be at very low levels to lose weight - almost keto which is very low carb.

[GMA74 in reply to PMRpro]

Thankyou both. I’ve been doing keto but may be having too much salt in the recipes. Do you have a sodium goal ? . Staying lower than 50 carbs but some days I can stay below 30. I’ve gained 7 lbs but have moon face , swollen ankles etc . Did not think about the CRP and ESR being normal as IL 6 increases . IL 6 went from 2 to 4.3 in two weeks since starting Kevzara

Would that indicate the Kevzara is working ?

[PMRpro Ambassador in reply to GMA74]

Well it is certainly stopping the IL-6 attaching to the receptors that allow it to create inflammation!!!

Snazzy and I had to get down to 20 carbs to lose weight! 50 isn't always keto!

healthline.com/nutrition/5-...

As Snazzy says, keep a diary. Are you eating fruit? If I eat out my feet swell up like footballs because of the salt they use. I use none at home. But everyone is different - it is a tricky balance.

[SnazzyD in reply to GMA74]

I didn’t have a sodium measurement to go by but I went by bodily signs like puffy eyes a general swelling that disappeared if I stopped eating salt within a few days. Fat doesn’t do that so rapidly. I didn’t eat anything processed at all, nothing with any added salt. I was particularly sensitive especially in the eyes and face. The effect of Pred on the veins does make the legs prone to swelling so I routinely wore light compression (class 1) knee high socks.

[papadapadoo]

You might consider berberine instead of metformin for blood glucose and weight gain. It has been a huge help to me. Please look at this:

ncbi.nlm.nih.gov/pmc/articl...

[GMA74]

so my rheumy says I can reduce from 20 to 17.5

So we will see !