Steroid induced T2 diabetes

[Mandyq]

Sorry this is a long story !

Started on Pred (15mg) nearly 3 years ago. Gradually reduced and now at 6mg. Planning to Reduce 1/2 mg every 6-8 weeks 🤞🤞

18 months ago prescribed metformin for T2 diabetes - probably associated with steroids. HBa1c was still too high so metformin dosage increased and Dapagliflozin added in July 2024.

Since then I’ve felt increasingly unwell ( tired, light headed, occasional palpitations etc) and to add to my woes in September 2024 was diagnosed with anaemia and ferrous sulphate was added to my various potions.

I now look back to the days when I felt “OK” my only medication then was low dosage tablet for high BP and prednisolone for PMR.

I’m now wondering if the reason I feel so rough is because all my additional medications are “fighting “ each other. I’m inclined to suggest to GP that I start to reduce the diabetes meds as I really feel that my general malaise started soon after these were thrown into the mix.

Has anyone had steroid induced diabetes that required medication - did the need for medication fall as Pred was reduced

As ever thanks to everyone on this site, GP is good but I feel personal experience is often more useful

[SnazzyD]

Are you checking your blood sugar and blood pressure when you feel unwell? Did you have to start medication in spite of radically reducing carbohydrates back when? Steroids make your liver breakdown reserves to make glucose which one can’t influence. If one then eats carbohydrates it adds to the blood glucose and you can end up coasting on a consistently high blood sugar. This bit you can influence. Some here have reversed their T2D diagnosis and others, like me, kept their HbA1c at a good level.

Was the Metformin supplemented with the new drug because it wasn’t working?

The side effect list includes feeling dizzy and low blood sugar and blood pressure. I think you need to speak to your doctor as you feel so unwell.

[Mandyq in reply to SnazzyD]

Thanks Snazzy - it wasn’t ever suggested that I check my blood sugar but I do check my BP regularly anyway and it’s always OK.

I wouldn’t say I radically reduced carbs tho I did cut down on the obvious and easy!

I’m due a blood test next week to check if anaemia is responding and also HBa1c and I’ll organise a F2F with GP then. I find them quite approachable and understanding so I’m hoping I can agree a way forward.

[PMRpro Ambassador]

I was going to ask exactly the same as SnazzyD - steroid induced diabetes isn't the same as Type 2 diabetes and for a lot of us, radically cutting carbs, above all processed carbs and carbs like potatoes, rice, pasta etc, and limiting fruit, can keep Hba1c in the pre-diabetes zone and avoids adding medications. Some people find that adjusting their eating patterns relative to pred dose timing also makes a massive difference.

What WERE your Hba1c numbers?

And the lightheadedness and palpitations - is the lightheadedness constant or is it now and again? Does it relate to the palpitations?

[Mandyq in reply to PMRpro]

Thanks for the reply -

re HBa1c, for years I hovered in the pre diabetes zone (between 40-44) and was told to watch what I ate, that was all before PMR struck!

For the first year or so of taking Pred I remained at that level (testing only done every 12 months as part of annual MOT) then went up to 48 and I was put on metformin (1000per day) despite that just under a year ago it went up to 55 and metformin was increased and then Dapagliflozin thrown into the mix.

As a result of this and some reduction in carbs I’ve lost weight and last test in October indicated HBa1c was down to 48.

Next test due next week and if HBa1c has continued to fall I’ll be suggesting I reduce metformin etc.

Why are health issues so complex, I remember being young footloose and fancy free and taking the odd vitamin supplement seemed to be all that was needed to keep living life to the full 🤣🤣

[PMRpro Ambassador in reply to Mandyq]

Ah yes - but with age comes not only wisdom (maybe) but also wear and tear!!

Relying on medication is a false friend really - better to try to tackle the evil at source, however hard it may feel, so the medication is there if the basic approach fails.

[Excelsior80 in reply to PMRpro]

I have steroid induced prediabetes and my GP seemed pretty unconcerned, she said its the steroids it'll go when you are off them ... I am cutting carbs, at least the easy ones .... is she right not to worry? currently at 5 1/2mg pred.

[PMRpro Ambassador in reply to Excelsior80]

If it is ony pre-diabetes it is probably acceptable but high BS is high BS whatever is underlying it and the high sugar levels cause damage to cells. She should be encouraging you to try harder with diet if there is room to play there. Timing of eating carbs relative to taking pred can also make a difference - there has been a lot of discussion about that in the last 6 months or so.

[SnazzyD in reply to Excelsior80]

Goodness. I always say don’t wait for the revolution. What if you have flares and don’t reduce at a steady lick or that your PMR doesn’t allow a smart descent? Or that your adrenal function doesn’t return at the pace you want it to? You run the risk of getting insulin resistance if your pancreas is having to keep putting out in response to the spike in glucose. It depends how sensitive to Pred’s glucose raising powers you are. Personally, I found I had to keep to a fairly strict low carb diet even after getting to zero for some time; my metabolism didn’t snap back to normal. As PMRPro says, a raised blood sugar is a raised sugar. Your body doesn’t care about intention or label given to it, the effect is the same.

[Mandyq in reply to SnazzyD]

Thanks snazzyD - I think I’ll invest in a BSM, it would be useful to know how my blood sugars react to what I eat and when and particularly the impact of the various medications.

[Mgt1234]

Hi Mandyq, like you I have type 2 steroid induced diabetes 500mg slow release. I was told when diagnosed I didn’t need to monitor it but I like to have my finger on the pulse so to speak and do monitor it, initially once a day and now just as when I feel it necessary. I take 2 metformin a day and my last HBA1C measured at 44. I do try to keep my carbs low but am not always successful. I wish you much success. Love Margaret

[CJDLSR]

Hi Mandyq

I've been on Metformin since November last year. My HBa1c was 60.

I have just had my first 3 monthly HBa1c check and it's down to 44. I'm thrilled and want to ask if I can at least reduce the Metformin as it makes me feel sick and I haven't felt well since Christmas although I haven't been totally blaming the Metformin for that. In fact I don't know what's causing it!

I had understood that the need for Metformin should reduce as I reduce the preds, but the diabetes nurse said that isn't always the case.

However I have recently discovered that the fact that our surgery has a dispensary is what is keeping it financially viable so that's another thing to have to keep an eye on. They actually NEED to have their patients on medication!!!!

We live in a sad world right now!!!!

[Mandyq in reply to CJDLSR]

Morning CJDLSR - thanks for your response.

Like you I’ve felt generally unwell (including feeling slightly nauseous all the time) for the last couple of months. Somehow I don’t feel it’s the “unwell “ I associate with PMR. I think as you get older you become more knowledgeable about the quirks of your own body and mine is just not quite right! I’m convinced this is down to the pot pourri of medications I’m on.

Pre PMR I teetered on the pre diabetes brink (HBa1c low 40s) but managed to dodge metformin. I understand that once my levels increased to the 50s I needed to medicate to address them. GP agreed the increase was probably steroid related.

As I’m on a v slow Pred reduction my simplistic thinking is that I could now also do a v slow metformin reduction. I’m currently waiting the results of various routine blood tests and if my HBa1c has fallen to a reasonable level I’m going to suggest that’s what I do. Hopefully my GP will agree because generally we work well together but ……even if they don’t I may start a slow reduction anyway and see what happens ( I’m on maximum dose of metformin + Dapagliflozin)

My husband is in a similar position re metformin - HBa1c down to 44- but he was told not to reduce his dosage. He’s been quite bullish and decided to gradually reduce anyway and will review at next 3 month test.

I know the wonderful array of medications on offer can help us stay fitter for longer, but I do wonder if GPs dish them out as an easy option, as long as they’re cheap! As PMR pro says “ sometimes they can be a false friend”

Hope you feel better soon

Mandyq

[PMRpro Ambassador in reply to Mandyq]

Have you tried cutting your carbs as well as the metformin? Some have managed to avoid the metformin by doing so - Koalajane even reversed her Type 2 diabetes!

[Mandyq in reply to PMRpro]

I’ve cut out / reduced the really obvious high carb foods but haven’t gone down the road of “rigorous” low/no carbs. TBH at the moment I don’t have the mental energy / enthusiasm to embrace a totally new way of eating. You know you SHOULD do something to improve your health but can’t quite make the effort. I have lost weight and cut drinking massively - to just the odd glass on special occasions - and I’m hoping those things will have made enough difference 🤞🤞

As ever thanks for all your help and support