Not sure how to handle new blood sugar spikes. I am on 47.5mg prednisone now and have GCA/PMR. I will start Actemra in coming days. Lately my blood glucose spikes everyday to around 140 mg/dl, but yesterday it shot up to 180mg/dl. (I think conversion is about 10mmol/L). I have a continuous glucose monitor so I can see what is happening. At these numbers I get shakes, irritable to say the least, and heart pounding. Its all very hard for me and my family to deal with. Then, I will crash and just have to sleep for a while. I have a good diet- mostly vegetables and protein, very little processed foods or snacks or sugar. Giving up sugar- is very very hard. I am thinking of trying to just eat in morning before prednisone and then waiting till prednisone begins to wear off around 7pm or so and then eating again. Its like I have no control over the glucose levels during the day. If I walk for 30 minutes or so the glucose goes down but when I stop the numbers go right back up. Any thoughts are appreciated. 1988JTB
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1988jtb
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Are you actually diabetic or have you bought a CGM to be able to see what is going on? If it is causing symptoms, you need to speak to your PCP about this as something like metformin may help. However, a BS of 140 is a normal peak post prandially and 180 is not out of the way when you are on pred if it is causing a spike coinciding with a food spike or even if you have eaten a lot of carbs in the meal. It is normal to have spikes after a meal - it is the fasting levels that are of more concern.
We recommend keeping a food diary to go with the CGM readings and identify what sends the spikes up particularly high. Several have found that the spikes are worst in a time window a few hours after taking the pred and so they avoid eating in that time - TRE (time restricted eating) has been shown to improve BS control so can be employed here too. Different people react differently and it has been found that even some of the carbs previously considered "good" like oatmeal can cause spikes for some people but not others.
That diary needs to be honest and preferably really accurate about the amount of carbs by identifying and calculating the carbs eaten which you do by weighing the carb food and looking up nutritional values. When you are on pred the liver releases random spikes of sugar from the body stores - you can only control the contribution made by diet. It doesn't mean giving up carbs altogether, it means moderating simple carbs at certain times and adding complex carbs that release more slowly as well as eating them together with protein or a small amount of fat. But sometimes it can be a shock to discover how much carbohydrate you are eating in the normal western/US diet.
It may be hard to give up sugar - but it isn't JUST sugar you need to moderate but all simple carbs which quickly turn to sugar once eaten - white bread and baked goods even if not sweet, pasta, rice, root vegetables, most fruit, and all the obvious things like cakes and sweets. And while it may be difficult, if it avoids or at least reduces your sugar rush episodes, not only will life be more pleasant but you are also reducing the risk of developing full diabetes and all the damage it can do to your body.
Thank you PMRpro. All good info. I am not diabetic. I bought CGM after diagnosis to monitor what was happening. As far as spikes happening after eating, I have not been keeping a thorough diary but it seems -in general and in my case anyhow- that the glucose rises about 10 points about 2-3 hours after breakfast (meat/vegetables) and after taking morning prednisone. Lately however - no matter what I eat it just continues to rise. This general rise in glucose is a new occurence. I was thinking that maybe it is connected to length of time on prednisone and the high doses. I have been on prednisone- 60mg-47.5mg- since August 2024. I guess I will have to keep a better food diary to see if there are any more connections- food, exercise, stress. Ah- sometimes this is all just too much.
You are still on a very high dose of pred - and the pred effect will reduce over time as the pred dose falls. However - as I explained, it is absolutely normal to see your blood sugar rise to the levels you mentioned after eating. Bear in mind that you are SEEING what your blood sugar is doing and that is worrying you and that alone will add to how you feel as you see it rising.
Like you, I'm on a high dose, 60mg, and hope to drop to 50 at a doctor's visit this Monday. Both my father and brother were diabetics, but I've escaped so far. ? I hope I'm not sorry I said that.? I, too, am mindful, but I stay away from sugar or carbs that turn to sugar. I'm glad you saw a positive result in walking...that must have felt good, just having some control. You can do it, I know you can. Be well.💞
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