On top of everything else I'm now pre-diabetic. I wasn't prior to starting the steroids but as I'm now on 2 mg of Prednisolone a day and have been on 5 mg or less for over a year I suspect that Prednisolone is not the culprit.
I've been looking at a diabetic website and it says that low carb is less than 130 mg a day. As a medium sliced piece of bread is 15 to 20 mg that doesn't seem too restrictive. I do eat a sandwich several days a week and potatoes twice a week but, apart from that, I've pretty much cut out all carbs and sugary snacks, I do still drink wine though.
Is this enough? I'm a bit concerned that by replacing carbs with fats I'm raising my Cholesterol but I do need to feel full and my priority is the blood sugar.
If I can't get my blood sugar under control in the next couple of months I think that I will - reluctantly - have to start on Methotrexate. I really don't want to develop Diabetes.
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Siena62
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Shortly after my PMR diagnosis and taking prednisolone I was diagnosed with steroid induced diabetes. I cut my carbs drastically and was put on gliclazide. I started walking a lot more and 6 months later went into remission. Six years later and on 4mg pred I am still in remission. It can be done. I think there are others on here who have been diagnosed as prediabetic and not gone to diabetic. It can be done. I eat low carb healthy fats and my cholesterol is good.
We always recommend a low carb diet for people on pred to reduce the weight gain and reduce the risk of developing steroid induced diabetes. How much you have to reduce depends on you - Snazzy and I had to reduce almost to keto to lose weight, maintaining is easier,
Keep a diary and weigh the food for a week or two. You might be surprised how much you are eating. Once you can get used to a low carb diet the hunger pangs do fade as you reduce the roller coaster of high BS, insulin secretion in response and plunging BS levels that make you crave carbs to get it back up.
I'm one of those who have had to go just about keto with less than 30g carb/day to lose weight and get out of the pre-diabetic phase. It very much depends on your body make-up. I have a waist that is only 2" smaller than hips - whatever weight I am. So in other words a male body shape and it's my belief that this also predisposes you to diabetes.
I am pre diabetic as well. I was diagnosed with PMR nearly 8 years ago, and am still on 5mgs of Pred. However, I am not panicking, but gradually changing my diet to included less of the stuff I really love ( cakes etc) with more veg, especially broccoli and kale. I have several diabetic friends who have recommended this approach. Try not to over worry as this can only make things worse. Good luck
Following keto strictly I was able to reduce from the pre-diabetic range in three months - so it definitely works - but I do think the body shape pre-disposes us. When my waist was 25" my hips were 27" and I can't change that. I never need to undo jeans to get them off!
Others with more knowledge and experience than myself have already responded to your post.
I would just like to offer a gentle reminder that cutting out the obvious carbs such as bread, pasta, potatoes, cakes etc, is of course helpful, but don't forget the less obvious carbs found in things like root vegs, and fruit.
A general rule of thumb is if it grows under the soil it will generally have a higher carb content. Vegs grown above the soil are a better option. I tend to eat veg such as broccoli, cauliflower, green beans.
I also avoid bananas, grapes, apples, and tend to eat mainly berries... although I do eat oranges also.
I take statins for high cholesterol so I'm constantly trying to battle avoiding too much saturated fat with keeping my carb intake as low as is sensible.
I eat plenty of healthy fats in the form of nuts,seeds, avocado, linseeds etc but it's definitely a balancing game and you will have to work out what levels of food categories works for you.
Feel free to blame your pre-diabetes on pred, because that’s probably what caused it. My pre-diabetes turned into full-blown diabetes shortly after I started on pred. (And two trips which sent my a1c sky high—8.4.). The tips above for what to cut out are the ones to follow and cut way back on wine.
I was lucky - I managed to step back from the pre-diabetic brink and lose some weight over a year by reducing my carbs. I cut out the high sugar carbs (cake, biscuits) which I call “empty carbs” almost completely. With regret, I stopped baking; and I reduced what I call “nutritional carbs”: cereal, bread, root veg. I still weigh my breakfast cereal, to be sure I’m keeping on track. I’ve continued to eat quite a lot of fruit, but with an eye on the quantity and type. It’s whatever works for you. As I said, I was lucky: the diet hasn’t really impacted on my quality of life, in fact I feel better.
I don’t know if this helps, but my mantra is: if you can’t eat as much as you want to of what you like, make sure what you do eat is nice. So, e.g., it was easy for me to cut down on plain potatoes because I find them rather boring; whereas, if I’m going to have an occasional biscuit as a treat, I make sure it’s a premium hand-baked one, rather than one from a packet, full of additives and refined fats and sugars.
The main problem, as I see it, with being pre-diabetic and on pred for PMR, is that the two things that will normally help most are extra hard i.e. exercise (which may be hard with PMR) and weight loss (when the pred has a tendency to have the opposite effect).
If you are significantly overweight, then the fastest way to get your hbac1 down (regardless of diet) is to lose weight. Though a weight loss programme will most likely result in naturally lowering sugar and carb intake anyway.
The main thing is to try to smooth out the spikes in blood sugar, so focussing on foods that have a low glycaemic index means that the carbs in your diet will be absorbed more slowly and this will naturally smooth out the spikes. A diet that is high in protein will help to reduce carb intake as the protein will help keep you satisfied for longer. Extreme hunger was a real problem for me when I first went on pred, but avoiding foods with added sugar made me feel less hungry almost right away. Having vegetables with each meal helps to slow down absorption of carbs. I even have some salad with my scrambled egg in the morning. It is the white starchy carbs that are the ones to watch. You can also get carbs for energy from other sources, such as legumes, root veg, and small amounts of nuts. Watch the fat content of meals as this adds extra unwanted calories, though you need some fats in your diet and I use some olive oil, which is also supposed to have some anti inflammatory properties. Don't forget that alcohol has a tendency to raise blood sugar, even if it is a dry white wine, for example. Too much fruit can have a lot of sugar, so go easy on using fruit as a snack. Though if I follow the above, I tend not to need to snack. If I am really extra hungry, I find some fat free natural Greek yoghourt will keep me going and also provides some extra calcium, which is good on pred. The NHS runs a diabetes prevention programme, which is free, and helps with dietary advice for those who are pre-diabetic.
Under normal circumstances, exercise also has an important role in the body's ability to metabolise carbs. There have been a number of studies in pre-diabetes in women in recent years that have been shown to help control blood sugar. In particular, weight training, which helps to build muscle and regulate metabolic rate. Though, it is difficult to advise on exercise for an individual with PMR, as how the illness affects is very different and our capacity for exercise varies enormously. I'm lucky in that I have been able to swim throughout my PMR, even though I find other forms of exercise quite difficult. Other people seem to find walking a lot easier than I do. The charity have recently brought out a booklet on exercising with PMR and I think it has been stored in the FAQs for this group. Though increasing exercise doesn't necessarily have to involve going mad at the gym. Even trying to move around the house more will help. I will admit that my PMR has made me reluctant to move more than I have to, due to stiffness, managing that habit that is a work in progress.
have you looked at the FAQs? There’s info in there about diet, as it comes up so regularly, as does prediabetes. I reversed mine within 3 months by going on the keto diet!
Thank you everyone for your thoughts and suggestions. I don't think that I could manage the keto diet as it's so restrictive and I live (and want to eat) with two other people. My problem is going to be to keep fats under control as they do make you feel full. I read somewhere that wine can reduce your blood sugar, which did surprise me.
I used to do some exercise (swimming and the gym) but never enjoyed it. I only did it for health reasons. Some people get a buzz from doing exercise but I didn't and I was always counting down the laps (swimming) or minutes (gym). I don't think that I could manage the gym now but I might start swimming again but coming out of the gym to get onto a bus isn't very appealing in the winter
I'm feeling rather down now. It seems that vigilance about my diet and focus on exercise is going to be my life going forward and that's not very enticing. I've always disliked people adopting 'faddy' diets and fussing about what they eat (had that with my MIL for years) and now I'm going to be one of those people. Having a nice meal out or having a glass or two of wine in the evening or a nice cake was a part of my life that I'm going to have to give up and I find that rather dreary. I admit that I got into some bad habits but I'm going to be punished for the rest of my life by not being able to eat freely. We have some nice holidays planned for this year but I'm not going to enjoy them as much now.
I hope that my post doesn't offend anyone but, right now, I feel quite depressed.
I think you are being a bit dramatic in terms of what you expect about the effect on your lifestyle - I eat relatively low carb and it has NEVER stopped me going out for a meal and I live in Italy, the land of pizza and pasta! It isn't what you eat for one meal that is the problem . it is all the rest, the processed packaged foods that you don't really know what is in them. And portion size,
Keto is not really healthy for most and not necessary - lower carb is almost certainly enough. And it isn't a case of no carbs ever again, it is managing the total amount over a few days - so you can go out for a meal and have a pizza one evening having been parsimonious on the carbs during the day and again the next day. I can't actually manage a whole slice of cake here - they tend to be enormous - so what I do at home is buy myself a piece of lovely cake and cut it in 2 or 3 bits to spread the pleasure over a few days. Some freeze beautifully.
I plain CAN'T exercise - so it isn't an option. But there are many lovely meals that are perfectly appropriate for low carb eating simply by asking to have the carb component replaced with salad or veggies. When I eat out here and want a local speciality that is carby (all of them are!) I ask for a starter size portion or a doggy bag - it will come in a proper container like takeaway - and enjoy it for another meal without cooking. With pizza I have a half and half, usually eat half of each and take the rest home in a pizza box - just like half the other guest in our pizzeria!
It is all about looking at what you CAN eat, not what you can't. And it very soon becomes automatic to leave the bread, eat the salad, veggies and meat/fish first having ordered exactly what you would have ordered anyway.
I read somewhere that wine can reduce your blood sugar, which did surprise me.
Don't understand how anyone could say that wine can reduce your blood sugar when it comes from grapes which are high in sugar. I did hear a nutritionist say recently that if you are going to drink wine then red is best because white has 5 times the amount of sugar as compared to red.
I have given the wine up altogether as the hangovers were too much as I got older (even after two glasses) and it has reduced the sugars a lot. G.P. insists that a few days gap is needed and that is why hubby restricts his to week-ends only.
I've mentioned books by Dr. David Cavan on this forum before as he is a diabetes specialist and I have borrowed a few of his books from the local library and have found them to be excellent. Dr. David Unwin is another good read.
I have found its all about breaking bad habits which can be hard to do.
That is all generalisations about wine really. The sugar in the grapes is used up in fermentation to make the alcohol and whether white has more residual sugar than red all depends on the process. In Germany they label low residual sugar wines as such and "suitable for diabetics". Sweet wines have more sugar than dry wines and some of the driest wines are white so what that says about the nutritionist's nutritional knowledge I'm not sure!
I agree with you that 2mg of pred is probably not the problem now. And well done for getting down to such a low dose. Not sure why you are thinking of Methotrexate - can't see how it would help at this level.
I have come out of being prediabetic as have others on the forum. The thought of change is depressing at first and it involves some adjustments but for most people prediabetes is reversible and there is no need to go hungry or have boring food. If you think about it, there are few people who are able to 'eat freely' as we age without impunity.
My aim was to have a healthy lowish carb diet for the long term because this is an investment in future health, but also to be able to have occasional treats and meals out without feeling guilty and I have achieved this.
If you click on my name you'll find a recent post about how I used a continuous glucose monitor for a short time to see the impact of various foods, their timing and the relationship with exercise. I absolutely recommend this because it provides evidence about what is happening to your blood sugar. You can buy one which lasts two weeks, or people are increasingly going on the zoe trial which is free but with more conditions. As you probably know, Michael Mosely is excellent on 'diabetes' too.
My post also covers cholesterol - I had high cholesterol but I didn't go low fat because I couldn't face that as well as lowish carb. Plant sterols and losing a bit of weight seem to have done the trick.
Hi Siena62, I also have been told I am prediabetic after a number of years on steroids for PMR, despite having lost over 3 stone recently. I also have high cholesterol for which I am now on statins. But my GP enrolled me on the Momenta course for prediabetic people and it has been great so far - great information about what causes pre-diabetes and about the importance of exercise and eating healthily. it's a weekly Zoom type call with 18 other people in the same boat. I have increased my steps considerably and being more careful about portion size and eating more veg than fruit and although the weight loss is slow, I feel so much better because of the exercise. I am not keen on it, but I know it's doing me good - so I'm out walking and doing dance exercises (when nobody's looking!) and I am hoping to turn things around gradually. The course is 9 months long and I've only done 5 weeks so far but I feel like it's making a difference.
I did it six years ago and lost three stone. I am now on the maintenance diet and have kept my weight at the same level, even with PMR. It took a month or so to adjust to it. You can do it online with other people via the above website.
His radio series is also excellent and includes a lot that’s really useful for PMR, including an inflammation special, diet, sleep, stress ( I think) weight loss, exercise, vitamins and being kind ( reduces inflammatory markers):
That's very interesting. The 800 calories a day diet seems really tough but is obviously very effective. I can't imagine me doing it more than the minimum of two weeks. It really isn't compatible with having a normal social life or a normal holiday though but I suppose that it's a temporary thing. I will think about trying this after my break in The Netherlands later this week and before my holiday in Rome in April. I wouldn't see the point of going on holiday if I was trying to follow this. Part of the pleasure of holidays is eating nice food.
Did you use the recipes or just adapt what you would normally eat? We eat bean / pulse based recipes quite often. I wonder how they would fit into that diet. I assume that I would have to be making separate meals some of the time (I live with my husband and adult daughter).
And what about taking Pred with this? Normally you're advised not to take it on an empty stomach and I take it first thing in the morning.
Yes, good idea not to start w(en your going away. I didn’t do the fast 800, I did the 5:2, which is not so drastic. I think it’s described on the same page link I sent you. On this diet, I ate a Mediterranean/ blood sugar diet, but only reduced the calories on two days and I think it was 1200 calories. After two to three months, we had got so used to it, that we changed to 4:3. We still went out for a meal once a week and had meat or fish with low carb veg. I did a lot of swimming and meditating, as he recommends exercise and meditation as well. He’s done more research on exercise since then and you’ll hear in the inflammation podcast that walking so may steps a day is very beneficial. The exercise bit will be limited for PMR people.
Regarding recipes I used a combination of my own and those from the BSD books and from the Sugar free Londoner website. Beans and pulses are great. I only eat meat once a week now and so I eat loads. I did the diet with my partner, Ron, who lost one and a half stone, but it’s quite easy just to give him/them what you’re having and ask beforehand if they want potato/ parsnips/ pasta/ bread/ with it, then it’s not to cumbersome for you. I have done this with my partner since we came off the weight loss diet. He’s put on weight, but he enjoys his beer/wine every night and a baked potato two or three times a week! Better still, get them to cook their own sometimes! We have one day a week of something on toast( I use sugar free Londoner low carb bread recipes). Ron does his own with floured bread.
I bought some empty enteric coated capsules from capsuline Uk:
They were recommended by people on this site who buy them in North America. I put my preds in them and have them around 11pm. The delayed release with them is 2-3 hours, I believe. So they come into the system to coincide with the cytokines (anti inflammatory proteins). As they’re enteric coated, no need to have food with them. My GP said I still had to take omeprazole for some reason. I went on a mediation retreat recently, with supper at 530 and breakfast at 730-8, so there was still a good enough gap, if you want to stick to having them with your breakfast.
Im only three months into my diagnosis and this is what works for me at the moment.
All the best and have a great weekend I’ve on holiday.
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