PMR with type 2 diabetes

[Elmadon]

I had type two diabetes before I was diagnosed with PMR and I think this is why my GP wants me to get down as quickly as possible from prednisolone as it affects my blood sugar level. For the last three months I have been going up and down because I just cannot seem to get rid of the pain. I got as low as 7 mg and had another spike so now I’ve put myself onto 12 mg because I can’t stand the pain. If the pain goes I might inform my GP of what I have done. I have never seen a rheumatologist or specialist in this field. Should I ask my GP to refer me to one? Thanks For any suggestions

[SnazzyD]

Hello, the GP may want to get you down the Pred ladder quickly but my question to them would be, given that PMR is debilitating if not treated with Pred and can last for 5/6 years, what do they expect is going to happen to you? Perhaps they think normal pain relief in large doses will work but if so, they need to read up on PMR. Many GP’s manage PMR patients but perhaps this isn’t one of them.

Can you try another GP? A referral to a rheumatologist could take months and I would say that being crippled with pain also carries substantial risks and uncontrolled PMR runs a higher risk of developing GCA.

Regards your diabetes, have you implemented any of the suggestions in the replies to your last post? Even those not diabetic and on Pred have to really cut their carbs, or at the very least high glycaemic index foods like pasta, rice, potato, flours etc. If you truly have and your control still isn’t good, then perhaps you need a referral or return to a diabetes specialist who will advise on control during this necessary period on Pred.

[Elmadon in reply to SnazzyD]

Yes I’ve cut down on carbs.

[SnazzyD in reply to Elmadon]

How long for so far?

[PMRpro Ambassador in reply to Elmadon]

How MUCH have you cut down? Are you eating fruit still? Have you kept a food diary and been ruthlessly hoest about calculating how much carb?

However - timing of pred and food may also be crucial as Koalajane identified. Exercise soon after eating can also make a massive difference.

I would say that maybe referral to a specialist diabetic clinic may be as much use as a rheumatologist. The pred complicates the diabetes management. With a diagnosis of PMR, simply taking away the only option for pain management isn't going to achieve the desired result. The GP obviously doesn't understand the way PMR works, it is a chronic disorder, just like diabetes or hypertension. Both can be managed with medication - as long as you take it. You don't stop taking it because the condition is under control WHILE ON MEDS!!!!

[HeronNS]

Definitely diet will help you and if you can go cold turkey off carbs for even a few days or better yet about two weeks, you will probably afterwards find that you can go back to enjoying a few carbs. By carbs I mean all "white" carbs - grains, sweet treats, fruit, and even root vegetables, although you should soon be able to eat limited quantities of those again. I didn't have diabetes, but pred sent my blood sugar alarmingly high, so was threatened with pred induced diabetes. I was extremely strict with my carbs for some time, and filled up with high protein foods and a lot of salads. I was at my highest pred dosage during summer, and in February with less access to salad greens I discovered I was actually craving kale! My blood sugar didn't get properly back to normal until my pred dose was below 5, but it did stay in a safe range. More recently I had a serious flare and had to increase dose to about the 8 mg range again for a while and, conincidentally, or perhaps unsurprisingly, blood sugar increased again, once again to that level where the doctor says, any higher and we'll have to treat it. My pred dose is now down again, and so is blood sugar. So I believe sorting out diet will really help, perhaps even more than you expect, but you will have to be very strict with yourself at first. I believe this has something to do with the gut microbiome. When we feed carbs and sugars to our microbes certain kinds thrive and ask for more. If they get starved and more healthy food loving types are allowed to flourish you'll probably find your own food desires also change. My theory is when we crave a food it may be something our microbiome is asking for, and if it craves something not good for us, then time to take charge! Good luck! 🍀