I posted recently about the "Prednisolone jitters" and quite a lot of people seem to have responded with similar experiences.
I think I might have some insight which might be useful to someone out there...
Before being diagnosed with PMR I used to get episodes of low blood sugar. I know this because my wife and 2 grown-up kids are all type 1 diabetic and blood-sugar testing is a regular daily practice here. Years ago I did a test when I was feeling particularly weird one day and found that my blood-sugar level was very low. This helped explain a lot and I began to deal with it in the same way that my wife and kids do, by eating a few dextrose tablets or half a banana.
In the few months before my PMR diagnosis I didn't have any low blood-sugar episodes, then, a few days after I was diagnosed with PMR and given an intramuscular steroid jab, they started up again...until the effect of the steroid wore off.
A week ago I started on oral Prednisolone (15mg) because my PMR had relapsed. To begin with I thought that the tablets would not cause my low blood-sugar but then, this morning after my breakfast and Prednisolone I had an episode. For anyone who knows about blood-sugar readings 2.5 mmol/l is fairly low and I felt pretty weird and discombobulated. Fortunately, I knew what was going on and I knew what to do about it and I was back to myself again quite quickly.
The point of my post, however, is to highlight the fact that this was an unexpected consequence of Prednisolone. Because of my diabetic family it didn't freak me out and I could cope with it. But if I didn't know what was going on it could have been terrifying. Low blood-sugar is not nice!
Low blood-sugar affects people in different ways. Some peoples' bodied have the logical response that makes them feel hungry and want to eat...which will, of course, correct the issue. With me (and my diabetic family) it creeps up on us and by the time we have noticed it is almost too late, we feel so weird that the last thing we want to do is eat. It is counterintuitive and unhelpful.
I wonder if the hunger and desire to eat that many people feel when they experience low blood-sugar may be the reason that people put on weight when on steroids. They feel hungry and they eat rather more than they actually need to correct the low blood-sugar. Diabetics make this mistake sometimes and will get into a panic and "overshoot". Eating a little bit and then waiting for it to take effect is the best way.
Low blood-sugar makes me feel jittery in its early stages but, as it progresses it leads to visual disturbance, confusion and a sense of panic. I wonder how many people are experiencing this potentially frightening phenomenon without knowing what causes it, let alone what to do about it?
If this is you, here is what I do...I always carry a pack of dextrose tablets with me and I eat 3 or half a banana if I am feeling weird. Then I sit down and wait 10 minutes. If I am still not ok then I do it again. This may not work for you but it sorts me out. Just to be clear, I am not diabetic myself but I have a very good working knowledge of the condition.
I was the same and did the same all through my 20’s and 30’s until I realised that my cure was just causing an over-reaction in insulin output in order to deal with the spike caused by a Dextrose tablet. It was easy to end up on a roller-coaster. I was prone to insulin surges it seemed and so I watched refined carbohydrates. In between meal sweet pickmeups were a no no and a protein snack took their place. Once my pancreas wasn’t triggered to over cook it, I remained on a even keel most of the time.
On Pred my insulin output ramped up again in that the Pred caused glucagon conversion to cause sugar spikes followed by a corresponding low blood sugar. This time I had to outlaw carbs almost completely while the dose was low enough to stop this reaction so much.
I think it is called reactive hypoglycaemia or something like that. I experience this too and have to watch out for carbs. Sugar would be a problem...but I don't use it unless I am very sure it will be ok. As a diabetic household we have very little of it in our diet. You mention the spike caused by the dextrose...my diabetic family have had to learn to use the minimum possible...then wait...to avoid yo-yoing high to low. I do likewise and have had no problem with it. But if I were to eat a whole bar of chocolate it would be a problem. Oddly I have found that an in-between meal snack such as a handful of almonds can cause a low blood-sugar...almost as if my body was expecting the snack to contain sugar/carb and sends off a surge of insulin to greet it...but then it never arrives. I seldom eat snacks between meals.
Analogue to Snazzy's dextrose reaction and your almonds, pred triggers the liver to release spikes of glucose from the body stores in muscle and liver. That in turn triggers a release of insulin to deal with it, in the expectation this is the precursor to a meal arriving. However - there is no meal and the massive overproduction of insulin results in the blood sugar level plunging. In most people that results in a craving for carbs to bring the blood sugar level back up but in some it results in a hypo reaction - low blood sugar and jitters etc.
I agree...except I don't think it is a massive overproduction of insulin. I see that when my wife forgets that she has already had an insulin injection and ends up with having 2 jabs in short succession and a double dose by mistake. What I find is that I seem to have a relatively small overproduction of insulin which can be easily managed so long as you know what is going on.
"Massive" overproduction in the sense it is the amount expected to be required to deal with a large meal - which doesn't then materialise. and it doesn't take a lot of extra insulin produced as a spike to send the blood sugar level plummeting for a short time when there isn't enough sugar to take it up.
It's strange how posts come up at relevant times. I was at the end of fighting off a grotty cold, which both I and the surgery nurse thought was probably Covid even though the rests were negative, when last Monday I felt really grotty with it, so I took my BS reading earlier than usual and it was down to 3.1, it's usually very stable and well within normal parameters 4-7 mmol/L's. I have an OH who is type 2 a grandson type 1 and I'm also a qualified first aider, so sorting it was no problem. It was back down to 4.0mmol/L's the following morning but been perfectly OK since. I don't think it was anything to do with my Pred which I'd had at around 02:00. Interestingly I didn't feel hungry then and I've put it down to not being interested in food and not eating as well as I should during and since my "cold". Had my twelve month review just after and Hba1c came back at 36 again which was pleasing and reassuring.
As I'm sure you know, blood-sugar usually rises with infection, at least it does in diabetics. But I think Prednisolone really plays tricks with the normal functioning of our (certainly my) metabolism. I couldn't work out whether you are diabetic or not? Unexpected changes in blood sugar are often the result of the immune system successfully fighting off "silent" infections, ones that cause no symptoms but they are there in the background.
Thankyou for your help in this, I too suffer from reactive hypoglycaemia which at present I have under control by eating 6 small meals a day rather than the usual 3 … under the guidance of the specialist at the hospital.
I see from your profile that you have epilepsy...so do I. When I was younger I used to think that the disorientation from hypoglycaemia was something to do with the epilepsy...but it didn't seem quite the same. When my wife (who is diabetic) got a finger-prick blood-sugar monitor I found that I was having hypos, not epileptic episodes and I discovered that I could deal with them relatively easily.
it’s a continuous roller coaster of which illness is causing which problem, over the last 40 years I’ve gotten quite good at it, then just as I thought the prednisolone was going to be a problem with high sugar, it bats me a curve ball and causes more hypos than normal….. the middle of the night ones are the scariest… now having a couple of glucose tabs during the night just to keep me level….. fortunately the epilepsy is only triggered by sounds and lights so easy to tell the difference…. Love to you and your family xxx
I think I must have misinterpreted your previous question. Fluctuating blood sugar can increase restlessness and agitation in susceptible individuals, so I would not be surprised if some people feel this effect. And quite a lot of people in the group already control their diet to avoid spikes in blood sugar by following low GI diets, limiting carbs and avoiding foods with added sugar. However, raised anxiety is also a very common side effect of prednisolone, due to an excess of cortisol, which affects the neurotransmitters in the brain and the hyocampus. In sensitive individuals it can cause considerable agitation and being on higher doses of pred can feel pretty miserable for them. When you first asked about jitteriness, I had thought you were referring to the latter effect.
Like you I have had episodes of low blood sugar throughout my life and have always needed to carry some food. In recent years this has been oatcakes, although these days I tend to carry a banana in the morning because it doesn't prevent the absorption of the calcium tablet that I take mid-morning. February this year I was diagnosed with PMR & GCA and put on 60 mg prednisolone. I had occasional attacks of jitteriness and feeling faint, but in May (6 days after reducing to 30 mg pred) I had an attack of diarrhoea and for some time after that I found that instead of feeling hungry I just suddenly felt faint and had to have something to eat. The rheumatologist told me I should be on a high protein diet, so I changed my diet and this reduced the attacks of faintness. I still get the occasional weird symptoms of low blood sugar that I have always experienced and need to eat to fix the problem. It's hard to say whether they are connected with the prednisolone. I am now on 17mg and take it with food about 15 minutes after getting up in the morning.
I am not diabetic but my rheumatologist said prednisone can raise blood sugar. Mine was on the higher end of the range so she put me on Hydroxychloroquine to help me get off steroids faster and to lower blood sugar. That was about a year ago and I am off steroids but still taking the Hydroxy. I started an anti inflammatory diet around the same time. My blood sugar readings have dropped consistently since then. My latest reading put me at the lowest end of the range. I have that shakey feeling and feel disoriented. I have experienced double vision and have twice almost fainted. I feel great with the foods I’m eating and love that I’ve dropped 20lbs! I’d rather get off the Hydroxy than eat more.
For myself, whenever I've had 'the shakes' as I call them, I've found that eating some form of protein is what stabilises my system. Carbs don't seem to cut it for me, so now, if I feel 'the shakes' coming on, I raid the fridge for some ham or corned beef, and eat that. Then I sit and wait to see if it works, and it normally settles my system within 5 - 10 minutes or so.
The Jitters/shakes and low blood-sugar are two separate things. I have done a blood-sugar test when I have the jitters and my blood is perfectly normal. What worried me was that low blood-sugar can be a very frightening experience, especially if you don't know what is going on or how to stop it. Interesting that you found that protein helps with the shakes...I must try it. For me, the jitters settles down soon after I start to get moving and doing things.
A lightbulb moment! I think I have finally understood what is going on here...and it now seems pretty obvious.
In all of my reading about the effects of Prednisolone it always says that it raises blood-sugar yet I have been experiencing what appears to be the opposite, my blood-sugar falls and I have episodes of hypoglycaemia.
The penny has finally dropped...silly me! I have always experienced reactive hypoglycaemia. This means that a sweet snack will trigger an excessive production of insulin in response to the rise of blood-sugar caused by the sweet snack. This excessive production of insulin causes a drop in blood-sugar and an episode of hypoglycaemia. I avoid sweet snacks, in fact I avoid snacks of any sort because of this.
Prednisolone causes a rise in blood sugar, this is well documented. However, because I experience reactive hypoglycaemia, my body reacts to the rise in blood-sugar as though I had just had a sweet snack and it sends out its usual rather excessive burst of insulin...resulting in an episode of hypoglycaemia.
So the Prednisolone does not directly cause the hypoglycaemia, it is my bodies reaction to the blood-sugar raising effect of Prednisolone that causes it.
I hope this makes sense to someone...I am afraid I muddied the already murky waters of the effects of Prednisolone by suggesting that it lowered blood-sugar...it doesn't but in my case it appears to do so...
Er - I thought that was what I had explained several days ago ... Pred triggers the liver to release glucose from the body stores in liver and muscle, the body responds with more insulin that will be required and sends the blood sugar level crashing and causes a hypo episode.
The body only responds with an overproduction of insulin if you have reactive hypoglycaemia. Er...I didn't need to have the release of glucose from the liver etc explained...I am fully aware of that mechanism...
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