GCA and type 2 diabetes

[Groda]

Hi all Warriors

Since being on prednisone (since July 2023 at 60mg, now at l6mg) my A1C has slowly crept up.

Had blood work yesterday and A1C is now at 7.1. I have been told by my rheumy this is steroid induced and will start going down as I taper. Even though I have been tapering by 1mg every 2 weeks from 20mg my A1C creeps up marginally which is evident after every monthly blood test.

Rheumy says he is not treating this now with metformin. He believes A1C will come down. Has anyone experience with this and does the A1C eventually come down to more normal levels?

I weigh 127 lbs. Have gained only 2 lbs since the beginning of this journey. I do not eat sugar, avoid carbs and my fruit is berries only. What else can I do to keep that A1C down? thanks for your input.

Groda

[SnazzyD]

Not sure but you used the word “avoid” regarding carbs. Do you mean you try to avoid but still eat some? If so, keep a food diary for a couple of typical weeks and see if your carb intake is actually higher than you think; it’s easy to take in more than one realises.

[Groda in reply to SnazzyD]

Sorry SnazzyD. I should have said I have cut out carbs and sugar about 2 months ago. I have only 1/2 slice of low carb bread (5 grams carb) each morning. No rice of any color, no potatoes, no pasta, no sweet treats of any kind. My protein is grilled chicken, fresh salmon/trout and sometimes pork, I have natural unsweetened yogurt, cottage cheese, cheddar cheese, milk in tea. I eat nuts as a snack and have berries only topped with yogurt. I eat my salad and fibrous vegs first, then protein. I don't know what else to do. thank you for your advice.

[PMRpro Ambassador in reply to Groda]

The Hba1c reflects the last 3 months blood sugar levels so it does take 3 or 4 months to fall significantly after changing what you eat. But remember there are carbs in yoghurt and cottage cheese, nuts and berries, Not sure about our BS levels, but Snazzy and I needed to be practically keto to manage weight.

[SnazzyD in reply to Groda]

You need a clear 3 months of this before the HbA1c will show your efforts if it’s going to because it averages the last 3 months at a time.

[Groda in reply to SnazzyD]

Thanks for clarifying that the A1C is tracking the last 3 months. I will keep on doing what I am doing and see where I am with this at end of Feb.

[PMRpro Ambassador]

If you really are eating a low carb diet there probably isn't much you can do extra and the rheumy is right, it will resolve as your pred dose lowers.

When you say you avoid carbs - what do you eat? We recommend low carb to help with the weight gain that often accompanies pred and when people complain they are eating low carb but still gain weight it is very often because they are eating a lot of fruit - and a lot of carb hides there, healthy carbs possibly but still carbs. And as Snazzy says - often you are eating a lot more carbohydrate than you think.

[tangocharlie]

I've written a few posts recently about what I learned about controlling blood sugars from wearing a continuous glucose monitor. The main things I found were to avoid sugar and carbs in the 3-6 hour window after taking the Pred, eat later, in the evening, combine carbs and protein, exercise before or shortly after eating. Every body is different though so it might be worth asking your GP for a trial of the Libre 2 or doing the ZOE program to find what works for you. Pred defintely causes a blood sugar rise no matter what the dose

[Koalajane]

I also have type 2 diabetes but mine was treated. I was diagnosed 3 months after my PMR diagnosis when on 10mg. I am on 4.5mg and the prednisolone is still spiking my sugars. I do test even though I am not n any medication due to being in remission. This happened 6 months after diagnosis. I was put on gliclazide which I found to be very effective.

I know when the steroids spike my sugars so I don’t eat in that window.

Good luck to you and take care

[Hidden]

Hello Groda!What a shame you have this worry and problem. 💐

When I wore a blood glucose sensor for a fortnight I could see how elevated the pred and eating raised my glucose. The way I try to manage it (I'm not always feeling well enough) is by exercise. Walking is good and I've tried the static bike now it's been adjusted to reduce the extra shoulder pain it was giving me. Being mindful of what and when I eat too. I avoid lunch and wait at least 7 hours before eating. 8 hours is better. I'm not suggesting you do this. This is how i try and manage raised glucose.

I hope you get lots of advice and things improve for you.

A blood glucose sensor might be useful.

Best wishes

x

[DorsetLady PMRGCAuk volunteer]

Rheumy says he is not treating this now with metformin. He believes A1C will come down. Has anyone experience with this and does the A1C eventually come down to more normal levels?

He’s correct, and yes it usually does… mine did…

[Groda in reply to DorsetLady]

Such a relief to hear that. Thank you DorsetLady

[Merryfield]

I would not reject Jardiance and/or Metformin out-of-hand if the A1c is not down at your next 3-month blood draw.

[PMRpro Ambassador in reply to Merryfield]

I don't see why when the Hba1c level is still well within the target range using medication but is being achieved WITHOUT medication.

[Merryfield in reply to Merryfield]

7.1 is still a bit high, considering the strong low-carb diet being followed.

[PMRpro Ambassador in reply to Merryfield]

Not when you include the fact the patient is on pred, With a non-low carb diet it would probably be far worse.

[Merryfield in reply to PMRpro]

Totally concur that low carb diet is essential to avoiding diabetes. If one already is diabetic, a target of below 7 is ok. If one is not diabetic, a lower A1c is preferred. That said, my point is not to avoid pre-diabetic meds as a matter of principle.

[PMRpro Ambassador in reply to Merryfield]

Fair enough - but there is a balance and at that sort of Hba1c that is due to steroids, I think it is justifiable to wait and see,

[Slowday]

I was on Prednisilone for about two and a half years from 2019 to 2021 for GCA tapering slowly from 60mg. It knocked me into steroid induced diabetes and so I was put on Metformin and Gliclazide. Sadly my sugar levels have never recovered to 'normal' and I am still on those tablets. Apparently this is not uncommon.

[Merryfield in reply to Slowday]

Sorry the blood sugar is not responding to meds.

[winfong]

Steroid-induced diabetes here. Tried metformin and it did wonders for my daily blood sugar. Unfortunately, it had terrible GI side effects (I also have IBS). Tried farxiga, but it just made me super tired, without much effect on the blood sugar. My endo decided to just try diet and exercise as my a1c is just over the borderline. We'll see how that does.

[tangocharlie in reply to winfong]

Try low-carb eating, especially in the 7 hour window after taking Pred, and exercise before or after eating definitely helps. Also a big plate of salad or vegetables first before any carbs seems to lower GI. These are things I discovered that worked for me anyway when I tried a continuous blood sugar monitor

[Groda in reply to tangocharlie]

Thanks Tangocharlie. I am doing what you say. I am eating food in a particular order--salad and veg first, followed by protein. I don't have any starchy food on my plate. Your method is the same as in this book I just read titled 'Glucose Revolution" by Jessie Inchauspe. It is a method of eating that should help balance blood sugar. But I only started this new way of eating about l0 days ago so don't expect much to change in such a short time.

However my GP has put me on metformin anyway based on A1C of 7.1. because I am going to Florida for 3 months. (I am not overweight at 127 lbs. )Having blood work this coming Monday. By then I will have been on metformin for only 6 days so doubt there will be much change in A1C as it is based on 3 months.

Am down to l6mg of pred for GCA and will taper by 1mg each month until I get back.I have a appt with rheumy as soon as I get back in April.

[tangocharlie]

Interesting to hear you're getting good results from the way of eating. My GP is delighted that my Hba1c is below 50 considering I'm on steroids. People with diabetes and on metofrmin get a pat on the back if they get into the 60s! I working on getting it down further by eating the right things at the right time. My rheumatologist is fascinated by my CGM results. When I wore the CGM the green zone I tried to keep blood sugars in was about 4.5 to 11.5, (can't remmber exactly I'd need to look it up) and I was in range about 95% of the time. So 7 sounds fine to me without any need for meds. I was adamant I didn't want to be on meds unless the CGM revealed a need but I seem to be doing OK without them

[PMRpro Ambassador in reply to tangocharlie]

My Hba1c even on pred in the mid-teens was 37/5.1. Never been above 40.

[tangocharlie in reply to PMRpro]

Wow, do you think it's due to low carb eating?

[PMRpro Ambassador in reply to tangocharlie]

Combination of factors I imagine - I take my pred before bed and it releases at 2am-ish and I rarely eat before lunchtime so adhering to that 7 hour window you mentioned as well as normally eating little in the way of carbs, Hate to think what its been like since October as I really haven't bothered much, just eaten what was on offer!! And there has been quite a lot of traditional South Tirol stodge ...

[Groda in reply to tangocharlie]

Hi. You say your Hba1c. is below 50. What does the 50 refer to? I get only only one number (7.1). And you say those on metformin get pat on back for getting into 60's. Don't know what that means. Thanks for any explanation.

[PMRpro Ambassador in reply to Groda]

There are two different sets of units used to express the levels - it's been in a state of flux since 2011 but the mills of god and the healthcare system grind slow ...

diabetes.co.uk/hba1c-units-...

[Groda in reply to PMRpro]

Thank you PMRpro Just converted my 7.1 A1c. converts to 54.1mmol/mol.

How good or bad is that?

[PMRpro Ambassador in reply to Groda]

Higher than it should be but it depends on the situation - as TC says, diabetic patients on metformin which is to lower blood sugar levels are praised for being in the 60s. Are you on medication for diabetes?

[Groda in reply to PMRpro]

yes, just started metformin on this last Wed. As I said in my post I am at 7.1/54 mmol/mol. Hope to see better numbers in a week or so.