PREDNISONE AND DIABETES TYPE 2

[Oztrax]

My GP doesnt like prescribing prednisone high dose as I am TYPE 2. Started OZEMPIC 0.5 mg once a week a number of months ago. My BS ended up very low and stable. Started 25mg PRED few days ago, blood sugar rises from 7-8 to 15 a few hours after dinner each night. Next morning when I wake up its down to 7-8 again. I am not the first TYPE2 to take PRED so was wondering what experiences other TYPE 2 s have had taking steroid medications.

I really need to increase dose but without a positive diagnosis my GP is very cautious.

[DorsetLady PMRGCAuk volunteer]

Your question has brought up related posts - and others will be along as well-and  Koalajane will be along with her story

[Zareda]

I am type 2 diabetic and the prednisone has raised my bs also. I am currently on 1mg and it has not returned to previous levels so I have to be very careful with food choices. I eat low carb as much as possible and stay hydrated.

[Oztrax in reply to Zareda]

Zareda what amount of prednisone are you on ?

[Zareda in reply to Oztrax]

I am currently on 1mg

[Oztrax in reply to Zareda]

36 is 5.4% that’s excellent for A1C

[Zareda in reply to Oztrax]

That s not my A1C…….mine is 7.5

[Oztrax in reply to Zareda]

7.5 is reasonable, i was at this level 4 years ago when i didnt have it under control, better than 12 when i wasnt on medication

[JaiSea]

Perhaps the more extreme circumstance, I had been a diet and exercise disciplined T2 for nearly 20yrs but after starting prednisolone at 70mg with the usual rapid taper my BS started rising and my monitor was unable to give me a reading as the max calibration was passed. My diabetes nurse thought temporary insulin injections would suffice and as the steroid use came down i could revert to oral medication. I struggled to reduce the prednisolone to less than 25mg and my BS started to rise again until i was maxing the monitor again, and using an increasing amount of insulin. I’m now stable on 100 units of biphasic insulin every day (x2 self administered injections), but still on 9mg prednisolone/15mg methotrexate, and my Rheumy considers it unlikely that I’ll ever be free of the steroids. It was my long term concern that i should need to inject, not being ‘good’ with needles. I have experimented with different diets and exercise regimes to combat weight gain, but it has become a complex ‘balance’ involving both prednisolone and insulin, and PMR/GCA relapses. I have discovered there is a direct response in my BS, in consideration of the prednisolone I have to take, and consequently the insulin injected. It’s a juggling game, where dropping any ball has consequences! An extreme situation but most certainly a response to Prednisolone.

I do hope you don’t have to walk this path in your diabetic experience, but routine and discipline stay the key!

Wishing you a ‘low’ HbA1c!

[Oztrax in reply to JaiSea]

My son is 33 and a full on type 1 , came out of nowhere when he was 28. He manages it quite well with a pump and a number of injections before main meals. He also is a power lifter at gym which is pretty amazing really

[JaiSea in reply to Oztrax]

Just goes to prove that diabetes cannot prevent a sufferer from achieving any goal. Even so a remarkable response to T1. Not that I would say I envy T1s as I have had many friends, and a son-in-law with T1, but the control is more direct! T2 being insulin resistance (generally) can be more complicated when the response goes ‘off track.’ The old adage that ‘you can follow a discipline routine, but T2 will do something different each time,’ I have discovered to be very true. Being T2 but injecting, just requires a greater level of vigilance, and I still dislike the needles! All the best!

[Koalajane]

I was diagnosed with type 2 (steroid induced) I was put on gliclazide and after 6 months of taking it and reducing carbs drastically I got my hba1c to 36 and was taken off gliclazide. I am still in diabetic remission 7 years later. I have found at 3.5mg my sugars don’t rise as much as they did so hoping my next hba1c will still be good. I did start walking a lot as well and do at least 10,000 steps each day.

[Oztrax]

36 is very good that’s like less than 6.5% for the Australian test scale. My next A1C test is due now and I see diabetic doctor next month hope myA1C is still OK, BS bit over double but only for 8~9 hours as in it goes up from normal and back to normal in 9 hours tops. So after my main meal at night, I have a very light breakfast and lunch.

Am on 0.5 mg OZEMPIC which has given me rock steady levels till I started taking prednisone 25mg.

[Oztrax]

I guess my GP's concerns are validated, if high dose PREDNISONE moved me to TYPE 1 that would mean "the cure is worse than the disease"

[DorsetLady PMRGCAuk volunteer in reply to Oztrax]

Type 2 diabetes does not “turn” into Type 1 as such -

medicalnewstoday.com/articl....

[PMRpro Ambassador in reply to Oztrax]

Type 2 diabetes or steroid induced diabetes don't turn into Type 1 - Type 1 diabetes is a totally different animal. Control of T2 may be a bit more difficult and maybe require insulin but that doesn't make you Type 1. You might become Type 1 as an adult but not because of pred. Type 1 is an autoimmune condition too.

Cutting your dietary carb intake as much as you can will usually make a significant difference - you can influence that, you can't influence the liver's release of glucose from body stores. It's like an overflow that can cope with the rainfall but if you then turn a hosepipe on full into the same drain it may not cope.

Some have checked to see when their BS rises relative to taking their pred and then avoid eating carbs in that window. Exercising in that window is also a way of lowering the BS level.

If you are going by finger prick levels they are just one-off pictures and unreliable - if you happen to take a sample just as the liver has released glucose it will tell you it is high. Had you taken it 10 mins earlier it might have been low. Some foods will send your BS higher than others - omit or restrict them and the problem improves. Take carbs out of the picture almost entirely and it will also improve the overall situation.

[Oztrax]

i hope so, but i guess it could make my Type 2 worse long term Pred. Takes a lot to get it undercontrol and stable.

[Oztrax]

will talk to diabets doctor next month, maybe could supplement OZEMPIC with metformin

[Oztrax]

OK after 5 doses of 25 mg Pred my BS is now 20 . Can’t really see myself staying on Prendisone at this stage, unless 5 mg or another low level dose has less effect on BS levels.

[Oztrax]

So the spike I have seems only to occurr after dinner at night, say 2-3 hours after eating. Didnt really rise much in the day, but I do have very small breakfast and lunch. Spike reaches 15 to 20. By the time I wake up next morning its 8-9. Really just a 6-8 hour spike. Dont feel thirsty or urinate anymore frequently like I used to when I first had diabetes not under control. Seeing my diabetes doctor in 3 weeks will talk about this. I guess a possibility would be to supplement with insulin injection to reduce spike (not on insulin ATM) if I did have to continue on a high dose of prednisone. Another way of looking at this is the high BS level is really only there for maybe 3-4 hours. A1C changes would need me to be on PRED longer eg month or 2 to accurately measure the change. Before OZEMPIC I was on metformin and started to have high BS in the mornings, sometimes 15, OZEMPIC took care of that and stabilized BS at 6.4 to 8.4 regardless of when I checked it.

[tangocharlie]

See my posts on what I learned from wearing a CGM. I have to avoid sugar and carbs in the 3-6 hours after taking steorids as they cause a blood sugar spike but have more flexibility in the evening.