Blood sugar levels

I've read that Prednisolone can spike blood sugar levels. I have a strong family history of late onset type 2 diabetes through the generations. I have ordered a blood glucose monitor, I thought it might be a good idea, like I monitor my blood pressure too.

[DorsetLady PMRGCAuk volunteer]

It can raise blood sugars and blood pressure -but both usually reduce as you get lower on the Pred. So keep an eye on them, but don’t get paranoid.

[Hidden in reply to DorsetLady]

Thanks, my BP is ok, heart rate a bit elevated. I will try not to get anxious.

[PMRpro Ambassador]

The problem is that pred makes the liver release random spikes of sugar from the body stores in muscle and liver. If you happen to measure round about then it can give you a false impression that it is high and that you are diabetic. You aren't - your pancreas is still working and producing insulin and that works, these extra spikes are like snacking on a really high sugar product, You may have Steroid induced diabetes but you don't necessarily have Type 2 diabetes. Don't panic!

[Hidden in reply to PMRpro]

Oh dear, it's all so scientific. I had no idea 🤔

[PMRpro Ambassador in reply to Hidden]

Oooh sorry - I thought that wasn't terribly scientific!!! Must try harder ...

The spikes of sugar in the blood are random, nothing to do with eating, and you can't control them. If you are unlucky when you measure, your BS may LOOK as if you have diabetes but you don't. It will get better when you get to less pred and in the meantime you can help yourself by cutting sugar and white carbs especially in your diet.

Is that better??

[Hidden in reply to PMRpro]

Yes thanks, ignore me, my neuro diverse brain is wired differently.

[PMRpro Ambassador in reply to Hidden]

Not going to ignore you - you need answers you can understand too. And actually, so do lots of others. Always tell me if what I say doesn't make sense to you. My sciency brain is wired differently too.

[Grammy80 in reply to PMRpro]

Can't help it you are a designated scientist💕

[AmberGamble in reply to PMRpro]

That is so much better explained than any interaction with the Diabetic team I am under👏 Thank you!

[Koalajane]

I would say the best way to check is to ask your doctor for the hba1c test which measures the average blood glucose over the previous 3 months

[Rugger in reply to Koalajane]

Agree. My GP checks mine every 6 months when I'm having routine bloods for the inflammation markers.

[tangocharlie in reply to Koalajane]

Hmmm I wouldn't rely solely on one test given my experience as a single number can be misleading. My HbA1C test was always high-ish - around 49-53 so the docs wanted to put me on diabetes meds. But when I did the Zoe program and wore a CGM my blood sugars were in the normal bands about 96% of the time. And the other times were known trigger events like afternoon tea and prosecco binges! I'm no Carol Vorderman but it must be something to do with averages being misleading? If I remember right you did the Zoe thing too and we found similar things, like BS rising about 3 hours after taking Pred and staying high for about 3 hours after that?

[Sillydogsmum]

The Pred causes weight gain in most people and can raise the blood sugar in some. If you are as strict as possible in reducing your intake of food containing flour or other cereals and sweet stuff, including some fruit you will go a long way to limiting your chance of putting on too much weight and of developing secondary diabetes at the same time. Its not easy but very worth doing. Measuring your blood sugars at home is not terribly useful if you are not diabetic and might just cause you unnecessary worry. Keep a stern eye on your weight every day........😇😇

[Gimme]

The problem with the glucose monitor is that it is a snap shot in time only and your blood sugar levels fluctuate up and down all day long, depending on when you eat, sleep, exercise etc. The hb a1c test is a much more reliable measure of how well your body is doing in keeping your blood sugar levels stable. Put simply, if your body is not managing your sugar levels well, the excess sugar sticks to the blood platelets and this is what a1c measures. The blood cells take approx 12 weeks to turnover, depending on the individual, so it can take some time for improvements in lifestyle to show up.

Both exercise and diet have their role in stabilising blood sugar. However, if your a1c is raised to pre diabetic levels or you have become Type II diabetic and you also happen to be overweight, the fastest way to reduce your a1c is to lose weight. Even losing a stone can make a big difference. Though it can be hard when you are on pred. I found that just excluding added sugar from my diet got rid of my pred munchies.

Exercise can also be hard if you have PMR, due to pain and fatigue, and your muscles may not respond to exercise in the same way as a healthy individual, so it is important to listen to your body and not over do it, and you may need more recovery time in between sessions. For many of us with PMR, just keeping gently moving throughout the day may be a more realistic aim. That will still have benefits for blood sugar control.

As for diet, current thinking on diabetes prevention tends towards a lifestyle that reduces blood sugar spikes. That means that you may not need to go completely carb free as you may need some carbs for the energy, if you are active. The diabetes prevention programme focuses on lifestyle changes, such as following a low GI diet (i.e. foods that are more slowly absorbed), eating fibre with every meal will slow down the absorption of carbs, avoiding white starchy sources of carbs, avoiding foods with added sugar and processed foods, plus being careful about saturated fats. Eating your carbs before you intend to exercise can be helpful, instead of when you are at rest. If you are reducing carbs, you may need to increase protein in your diet to help feel full for longer. I don't know if the NHS still runs the diabetes prevention programme for free, the course is offered by third party providers, but you could make an enquiry with the diabetes nurse at your GP practice. Also, the Diabetes UK website has lots of helpful information presented in an easily digestible form (pun intended )

[AmberGamble in reply to Gimme]

I would echo this as I have a monitor and it’s very odd at times. Very worrying too. However I was type 2 diabetic before high dosage Pred which sent me off the scale so I had to go onto insulin. I am pretty determined to get off it but have absolutely controlled my diet which has lost me plenty weight which is a bonus.

[Hugh_Marc]

I think worrying about the side effects of Pred ‘come with the territory’ unfortunately.

Always remember though T2 diabetes is entirely preventable & entirely reversible.

One of the best sources of advice is Dr David Unwin, who admirably swims against the tide of prescribing loads of drugs.

It’s worth checking him out.

[Tiggy70 in reply to Hugh_Marc]

I don’t agree that T2 diabetes is “entirely preventable or entirely reversible for everyone”. Believe you me I wish it was! Some people have other health issues which cause diabetes and it can’t be cured by diet and exercise.

[PMRpro Ambassador in reply to Hugh_Marc]

The side effect of pred is not Type 2 diabetes - it is steroid-induced diabetes which is a different thing. It is due to pred triggering random spikes of glucose to be released from body stores over which you have no control at all. And although you may be able to mitigate the effects, the only means of prevention or reversal is getting off pred. Which I'm sure you will agree, is not always that easy.

[JoannaERC in reply to Hugh_Marc]

T2 entirely reversible ? Theory for medical Nobel Prize. I have it 37 years already, very disciplined patient, being on 2 sorts of insulin, Ozempic, Forxiga and Metformin. Diet, physically fit, IMF and NOTHING so far reversed my diabetes. Doctors in 3 countries don't have any clou about the reason, but they say recently plenty of people have the same problem.......

[PMRpro Ambassador in reply to JoannaERC]

Caught in the early stages, Newcastle and Glasgow research showed that it can be pushed into remission with a short sharp ultra low calorie diet in the first few years after diagnosis. I believe at least one patient who had been Type 2 for some considerable time was also able to get into remission using the same approach.

ncl.ac.uk/magres/research/d...

ncbi.nlm.nih.gov/pmc/articl...

[JoannaERC in reply to PMRpro]

One patient - it's not an evidence AT ALL. My diabetes was caught very early, on the border of slightly elevated BS and treatment implemented straight away. Diabetes can be well maintained and controlled, but never reversed, so please be so kind and don't spread false hopes. With my 37 years of living with it I really know what I say.

[PMRpro Ambassador in reply to JoannaERC]

My post was about a clinical study showing reversal of Type 2 diabetes in a lot of patients in the first few years of diabetes. I mentioned as an aside that a single person with longstanding Type 2 had also managed to reverse their diabetes. There is absolutely nothing incorrect about my statement. Nor the research I quoted.

[Potemkin]

Nothing to do with Pred induced diabetes but so much you can do yourself as others have said.

One thing is to move after you've eaten. So go for a walk after a meal or clearing up the kitchen. We've a tendency to slump after we eat but just some movement helps. Apparently even sitting there bouncing your knees!

[Bcol]

Hi LJ, as DL has said, and the relevant word is "can" it won't automatically happen but there is a possibility it "might". I've been through four plus years of Pred with no effect on my BP, weight or rise in blood sugars. In fact during my time on Pred my HbA1c went down not up. It all can sound a bit scary, but even if you do get some of these side effects, they can be mitigated by life style and diet changes.

[abby78]

Yes Pred - can raise your levels - it did mine. They returned to normal when I was able to wean off of the steroid. Prednisone is great for reducing the inflammation but can trigger all sorts of other issues especially if you are someone who reacts to it.

[reefswimmer]

Hi there I have been on prednisolone for 9 months now. I started on 20mgs in January and I am now down to 5mgs daily. About a month ago I was told I was pre diabetic and was bombarded with information about losing weight, doing more exercise and eating less carbohydrates. I five feet two and a half inches tall and I weigh 120 pounds. I swim and walk (mostly 120,000 steps a week)and I do not eat loads of sweet food, so I must assume it is the steroids that have caused me to be pre-diabetic. Wouldn't it be nice if the doctor told you this might happen in advance. I saw a nurse after my blood test and all she said was it was 'probably because I was on steroids'. She didn't tell me why. I have found this information on this website. She just got me to sign up to an app which bombards me with information about healthy eating and exercise which I already know. This is the third time I have had PMR. The second time was during Covid and I had to diagnose myself and get steroids off the internet, before paying to see a rheumatologist who prescribed me steroids and wrote to my GP. I have to say that since becoming part of this group, I have learnt so much more about PMR THAN I HAVE EVER LEARNT FROM A DOCTOR!!

As I said this is the third time I have had this illness. The first time it took me six years to get off steroids, although for most of that time I was on a very, very low dose. The second time it took just a year. I am hoping this time it will be the same. So for all of you who are suffering out there, you will get better. I know how miserable it is to be in pain, but there is light at the end of the tunnel. Despite the pain in my hands and wrists being there in the morning, I have reduced my dose every month by one milligram and I am now on five mgs. When I forgot to take any, three days ago, the pain came back, but as soon as I took the steroids again, it went away.

I know we are all different, but don't lose heart. It is possible to get off steroids.

I used to flower arrange and garden. I now know that doing this could cause a flare. I now realise I can't do the things any more.

Steroids also caused me to have raised blood pressure, but that is managed with medication.

Steroids are far from perfect, but having looked at the alternatives, the side effects don't seem any worse. Keeping active for me has been a real help. I have found that the more I sit down the stiffer I get. Sometimes, I do just want to do nothing but I make myself get up and move.

Don't get anxious. I have been on steroids for a total of 7years and nine months...(first time 6 years, second time one year and now, nine months) mostly on 7mgs or less. I am now 71years old. I take calcium tablets and hair supplements, Iron supplements and Vitamins K.. and however I feel, I try to keep moving.

[PMRpro Ambassador in reply to reefswimmer]

I think this would be really useful as a post in its own right so lots more people see it - do consider putting it up. The trouble with a reply in the middle of an existing thread is that few people besides the originator of the thread, DL and me see it!!

[AtopicGuy]

The following link to Diabetes UK covers steroid-induced diabetes:

diabetes.co.uk/steroid-indu...

All the usual advice about food and lifestyle still applies. Don't worry about the risk, because stress only makes things worse.

[tangocharlie]

Do you mean a continuous glucose monitor (CGM)? I found it invaluable for learning how to control blood sugar levels by avoiding eating carbs and sugar when the level was already higher from the steroids.