I have had PMR since March 2019, stress-induced. I quickly became diabetic after starting prednisone. I'm currently on Metformin and have an Hb1Ac of 43, so it's not too bad. I'm on 2.25mg prednisone, on a dead slow taper. I also take Leuflonamide as a steroid-sparing agent after several flares and a bout of RA in my hands.
I saw my wonderful rheumatologist this week for my 6-monthly review, and I asked about my diabetes, ie will I ever be non-diabetic? I'm of normal weight, fit, and active. She said she'd seen some evidence that Intermittent Fasting can help the pancreas increase insulin production and therefore stabilise blood sugar levels. Now, she wasn't suggesting this was an NHS guideline, but she said I could investigate it.
Does anyone have a view on this?
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HelenDaisy
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Unless you have been diagnosed with Type 2 diabetes rather than steroid induced diabetes I think she may have her facts wrong.
Steroid-induced diabetes usually has nothing to do with the pancreas being unable to produce adequate insulin, it is due to pred triggering the liver to produce random spikes of glucose from body stores in liver and muscle. Over a long period if the blood sugar level isn't managed well it MAY turn into Type 2 as the body cells become insulin resistant but it is possible to reduce that risk either by using antihyperglycaemics as you are or entirely without medication by drastically reducing the amount of carbohydrate in your diet so that the random spikes of glucose being released aren't superimposed on an already highish level due to diet.
Both Koalajane and tangocharlie have also found that the highest peaks of blood glucose can be related to when you eat relative to when you take your pred dose. Koalajane identified it as from a couple of hours after taking her pred and avoids eating during this period. Tangocharlie used a CGM (continuous glucose monitor) to identify similar information but also found how eating a particular food in the morning resulted in high BS but when eaten in the evening it didn't. There has been a lot of discussion about it - if you have a look at tangocharlie's profile page and past posts you can find at least some of these very interesting threads.
Personally, my Hba1c has always stayed in the normal range, albeit towards the top, ever since I cut my carb intake a lot - very little bread, pasta, rice and so on, they really are treats for me, after all, I live in pizza and pasta Italy so do eat them occasionally!! I also usually only eat from lunchtime at the earliest, usually later, about 2pm, until dinner at 8pm. In the early part of the day I'm not entirely fasting as I drink lots of British tea with a small amount of milk!
Thank you, I appreciate your reply. I'll look at the other threads. And I'll ask my diabetes nurse too, although she has never shown much interest in steroid diabetes.
There aren't really any symptoms - your GP needs to do a test called "Hba1c" every 6 months to monitor it. Which they should be doing - if they aren't, ask about it.
If you don’t eat in the morning how do you take your Pred. Can’t take it on an empty stomach I thought and later in the day could interfere more with sleep?? Often feel I would like to skip breakfast
I take my prednisone and other meds with water at 9. I take omeprazole to protect my stomach and haven’t had a problem. I know you are meant to take it with food but I’ve been ok. It’s a good question though; I should have asked my rheumatologist when she suggested intermittent fasting .
Oh wow. That is interesting. I went off the omeprazole once under 10mgs. Have you been advised to stay on it? As a super worrier I went off for fear of the bone density. Am dreaming of the day I can get down to 2-3 mgs 😃. Patience !! Might just try the 5mgs with less breakfast anyway. 🙏
As I’m on blood thinners I don’t really have a choice, although I’d rather not take them. I’m on Alendronic acid as I have osteopaenia. So many wretched drugs!
Mmm - but what LEVEL of osteopenia? Pretty much everyone on the form will have some degree - it is a term covering a range from normal to osteoporosis and it is wide. All it means is that your bone density is lower than it was on average when you were 30! If your osteopenia is close to normal - why take a drug when you may well achieve the same with dietary adjustments and exercise? As this member did:
Yes. Agreed. And then I also take a whole pile of supplements. !! Who knows if they help but then don’t want to risk going off them. Get the feeling they do help 😃
My pred is a form you take at night within 3 hours of food. Like HelenDaisy, before that I just took it with a pot of tea ... Many people just take their pred with a spoonful of yoghurt - by no means everyone has stomach problems with pred and while a spoon of natural unsweetened yog might spoil your keto diet it isn't likely to do much damage to interval fasting effects.
My GP insisted I stay on the omeprazole until I was under 10mgs. I understand there is divided opinion on the causing of stomach ulcers. Hard to know what to do Ultimately I guess there are so many individual factors.
Good luck on your journey. Hope you can get as low as possible. 😊🙏
You have now got a measurement that is counted as pre-diabetic which is good. I try to follow Dr Michael Moseley’s intermittent fasting and do not eat for around fourteen hours per day. I have HbA1c in the 30s. I am not sure if it is the diet or I would have had that reading anyway of course.
My diabetes arrived 2 months after prednisone so I know it’s steroids. I’m aiming for 14 hours to start, 16 if I can. I’m prepared to be an experiment of one!
There was some trial that Prof Tim Spector set up on fasting which I did. They were recommending not eating for a period of at least nine hours a day if I remember. It was actually quite interesting. I suppose I cheat as I have never really had breakfast just more of a brunch.
I thought nine hours was pretty low, but I suppose it may be not for some people. If you have breakfast at 7am the commute and get home at 7pm for supper.
I always thought breakfast was the most important meal of the day, although I never feel like eating then. I would stick with breakfast if it is right for you. As they say “ Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” I must admit at school I used to faint if we had a lot of exercise in the morning, so I probably should have had breakfast!
My husband and I do 16:8 IF - it is a way of life for us now. Sometimes we do have breakfast and then just close our eating window earlier that day. If we are going out for dinner we open our eating window later that day and the day after. That is the thing about IF - it is so adaptable.
6 hour window. Dinner/main meal at midday (ish, it was 1pm today). Last food (sandwich or toast) at 6pm (will be 7 today). Snack in between if I feel hungry.
I hope it is a big dinner midday!! Apparently the monks did not eat at all after lunchtime in the good old days. I am not sure how much they ate before lunch though.
interested, as my result was 41…what was your result when they diagnosed you as type 2 diabetes, please? As my pre diabetes is steroid induced, my results come with a caveat that my results are expected to be above normal, I assume it’s so a Dr doesn't just automatically put me on Metformin & ‘label’ me diabetic…for which I’m very grateful! Two years ago,morso, my result was higher, so I went onto the keto diet & reversed my diabetes within3 months. Other people have done this, too. You should be able to see related posts now, or search for steroid induced diabetes…the subject arises regularly, & you will find stories of how others, including myself, have successfully managed to get back to the pre diabetes range, and lower, in some cases!!
I have been on a completely keto diet for 2 years for that reason purely and it has been the best thing I ever did... I feel amazing and will stay on it for life ...I thoughly recommend it
Of course I am and have stayed fully in Ketosis being on steroids has no bearing on it ...but dabbling would ...you cannot dabble at all as it takes your body a while to get into ketosis properly....its great and I've never felt better ...
Bloomin well done! When I say dabbled I mean I managed to do keto for about a month I think when I was on very low steroids but got bored or waylaid, I can't remember now. I hav e maintained low carb but not quite keto. I'd like to try again but as I'm on 11mg Pred I wonder if I will be able to stay there. My natural fasting bs level is about 5.4 but steroids take it to about 7 which might kick me out of ketosis. It's worth a try, i'm going to get another CGM in January and give it a go and see what happens.
Yes I'm on a 4 mg maintance dose and have been a few years now...I had my meals delivered for about the first couple of years from a place called Keto kitchen Lytham which is where I live but they deliver nationwide now ...Kate's meals are gorgeous and you can buy snacks etc too...go on line and take a look ...I manage my own keto now and find it easy ....
Incidently my dad lives near Lytham, a nice part of the world to be. Around 5mg steroids or lower would definately make it easier to stay in ketosis as that's almost the same level of cortisol your body produces naturally. Above that and you'd more likely get glucose spikes caused by the steroids which would probably push you in and out of ketosis often. I shall try again in late January
Yes I'm brilliant on 4mg but never been able to go lower so on it for life now...You find your own bodies level...I hope it works for you as well as it does for me...I don't miss anything now as you can buy keto everything ...xx
"being on steroids has no bearing on it " - yes it does. If you are a person who develops severe spikes of BS due to the random release of glucose from the stores in liver and muscle than that is more than enough to take you out of ketosis however "good" you were in dietary terms.
Research suggests ketosis, which is technically a kind of fasting, is good for lowering inflammation and all sorts of other things. Have you also lost weight as a result?
I’m on 2.25mg after nearly 6 years. I haven’t lost weight yet but that’s not my goal. I’m 62kg. Just trying g to nudge my body into not being diabetic.
Low carb worked for me, I went from HbA1c of 50+ which is diabetes range to 40 which is normal, below pre-diabetes. I've also lost a lot of weight on the way, or maybe it's a case of chicken and egg, losing weight helped ontrol blood sugars, but I could do with the last stone off which will make 5 stone total and take me to about 75kg in new money. You're lucky that you don't have to lose weight, I'm envious! I have a skinny friend who has to eat more nuts, avocados etc to keep her weight UP as she has totally cut sugars out of her diet.
That seems sensible to me, 5mg or less is a low dose and probably won't do you any harm. I'll be happy and so would my rheumatolgist if I can get to 10 or less which is still a relatively low dose. Maybe taking low carbs or keto properly will help. I'm my own worst enemy for going off plan though, I admire your willpower and you have inspired me!
It was easy as I felt so bad and decided it wasn't a good quality of life before I changed over . .there are plenty of nibbles cakes crisps etc in the keto range that are lovely to stop you straying ever ...
My late hubby had type 2 diabetes. We found Michael Mosely's books very helpful. He was able to keep his blood sugar levels better by doing 2 fast days a week. He would only eat 500 cals in those days. He was on Metformin and another drug that I cannot recall. My hubby loved sweets things so on the day after his fast days he allowed himself something sweet. His daily blood sugar levels stayed between 6-12 depending on when he tested.
My Hb1ac fluctuates and last time I had a call from my new surgery. They had read my results without taking into account my previous levels and that I am taking Prednisolone! I had blood tests on Thursday so waiting to see what my current results look like.
Let's not bother looking for context - think of the time they could have saved if they looked!! But no doubt they thought that would take them too long ...
Think they were trying to get me on a pre-diabetes course! I think they are financially rewarded if they get people on these health awareness courses. It's a numbers=cash situation. You should see the state of my arm where they "tried" to take blood. The phlebotomist just wouldn't listen to me and went for a vein that just collapsed. Finally she had to give up and go for the one that works and that has the track marks to mark the exact spot. Surprise! It worked and left no bruising! Why are people so unwilling to listen, it's so annoying!
I will grant that to the phlebotomists here - even without my tale of trying to be a white cell blood donor, I failed on the need for a second vein that was easy to find!!!! One day that single wonder vein will say no ...
Depends on the course contents and course provider. If it's one that teaches you which foods spike your blood sugars and which don't then it'd be useful, whether you you T2D or steroid-induced diabetes or a combo of causations. If it's one that tells you to eat loads of fruit and bread and pasta (as some do) it'll leave you worse off
I follow a nutritionist called Dominique Ludwig who also has a website if you Google. She suggests working up to a 14 hour fast. I manage 13 hours as take my pred around 9. Also to have 3 meals a day with no snacks (I find between lunch & dinner challenging) and only drink milky / caffeine drinks with your meal. That way your body is not continually processing food
The order if eating food is supposed to help your blood sugar. Veg / protein/ carbs - creating an obstacle course in your gut.
Maybe focus on what you are eating - low carb. Avoid processed foods. Plus walk for at least 10 mins after a meal - could just be movement clearing up the kitchen.
Different foods spike different people - oats apparently really cause different results. It might be worth trying to get a glucose monitor to get an idea.
Tbh - I'm finding that stopping milky drinks between helps me feel less hungry. If you need to snack - have a protein rich snack - I find a couple of spoons of cottage cheese with a few almonds helps.
I agree with PMRpro it sounds like the Dr is confusing T2D with steroid-induced diabetes but IM can help both it seems. I do do a kind of intermittant fasting but it's not to do with making my pancreas more responsive it's about keeping blood sugar levels stable and avoiding spikes. I tend to skip breakfast, have something low-carb for lunch as a snack to keep me going if necessary and then eat a main meal any time after about 5pm up to about 7pm. Most days I just have one meal a day early eveing so that is IF. The main meal is still low-carbs but I do allow myself some good carbs sometimes like maybe the odd slice of granary bread or a few ounces of brown rice or tiny jacket potato.
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