I’ve recently experienced symptoms which made me think of Pred-induced diabetes. In particular, my metabolism does not seem to adjust properly to food, with post-prandial dips and especially waking up at 3-4am with uncomfortable overheating. But my HbA1c measurement remains around 41, which is just outside the borderline pre-diabetes figure.
So my question is whether this is just another early symptom of steroid reduction? I am a long timer with PMR, since 2017, and flares have kept my Pred dose 7-9mg for most of the time. My taper is always gradual (0.5 every 1-2 months). Currently, I’ve just reached 6mg Pred (which if it lasts will be lowest ever). I am already experiencing quite extreme fatigue in the second half of the day, which is likely to be related to Pred reduction. What about the overheating at night? These disturbing bouts last less than 30 minutes and are worse if I’ve eaten more the day before. Grateful for any thoughts.
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dmart7
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It’s difficult to say exactly what’s going on but there are a few things to mull over.
Firstly, steroids cause your liver to randomly release its glycogen stores that convert to glucose in your blood with obvious consequences for your readings. Since your body doesn’t like raised sugars it will put out insulin in accordance with the glucose spike and depending how much you went up, it can produce a corresponding low.
If you eat carbs, particularly refined ones, this process is accentuated. This is why many of us have to eat a very low carb diet when on steroids in order to avoid persistently raised sugars, insulin swings, weight gain and potential eventual diabetes or insulin resistance. It might be you are suffering from this and if so, your HbA1c can look a bit raised but you are having hidden hypos in between the spikes of glucose. It depends how it averages out.
With steroids this problem is dose related and I certainly found it was a huge issue at 60mg and improved at 20mg. However, I still found under 10mg I had to watch my diet all the way to zero, but we are all different.
Your other issue is adrenal function needing to come back. Have you read about it in the FAQ’s? It is essential reading for those under 10mg. Up to about 8mg (roughly) your adrenal glands have been shut down because the steroid has meant they don’t need to produce their own cortisol. By 6mg they really do need to make their own to make up the shortfall. For many this isn’t seamless and it can take months for them to realise the steroid is actually too low for daily needs. This can cause fatigue, weakness, emotional ups and downs, sweats, upset gut and low blood sugar.
Another thing to know is that around 3-4am the body naturally produces a batch of pro-inflammatory cytokines. If there is any kind of inflammation in the body of any kind it can give one middle of the night feeling worse and also sweats. It can be a sign of PMR being close to the surface and you are nearing the lowest dose for you for now.
One’s metabolism can be all over the shop in this transition period and it can be a devil of a job working out what is going on because of the crossover in symptoms. You might need to consider slowing down your reduction, perhaps check your blood sugars during these episodes to know for sure if it is an hypo and having a look at your diet for triggering carbs.
Thanks Snazzy. This is very helpful. I am pretty well read, including the adrenals FAQs, but you’ve gone above and beyond to try to explain my particular symptoms. I just didn’t expect the 3am “heat” to be the second symptom after exhaustion. And your words are a reminder that I am not very disciplined about carbs. Despite regular exhortations from you, PMPro and others, I’ve been at best complacent and at worst sceptical about avoiding carbs. I need to read some studies which will persuade me to do better!
This is really helpful! I’m reducing from 1mg and have woken up from time to time at around 3.00 feeling hot or uncomfortable but haven’t given it much thought. Seems like I need to beware lest the cytokines are making their presence felt.
If you want more information on how your blood sugar is operating, see my recent post on tackling prediabetes with a continuous glucose monitor. I use one for a fortnight every few months to see how things are going. Knowledge is power!
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