Blood Sugars with Diabetes 2 & PMR

[GHDirect]

Hi All.

I need to ask whether other members with Diabetes type 2 and Polymyalgia Rheumatica have seen similar issues with blood sugar control. I have had type 2 diabetes along with High Cholesterol for some 12 years and traditionally take the following tablets daily which kept me inline.

2 x 1000mg Metformin 1 x 40mg Simvastatin 1 x Alogliptin.

Then along comes Polymyalgia Rheumatica (PMR) in November 24 and once diagnosed I take 20mg Prednisolone + 20mg Omeprazole daily. (I have since dropped to 13.5mg of Prednisolone) which I take at 4:00 am with tea & toast ready for a 9:00 am wake up.

Working the above my lowest blood sugar reading taken at 4:00 am before any food or new steroid tablets is 12. However, by 9:00 its usually over 20 and continues to be high during the day. Daily I eat sensible foods, mainly freshly prepared and not fast foods etc

My Diabetes Nurse has tried to offset this by introducing Gliclazide which despite increasing the daily dose to maximum passed weeks (320mg) hasn’t really had much effect on my lowest nor highest Blood Sugar readings.

I understand Prednisolone can have an effect of blood sugars but have other members seen similar issues and have they been offered any different medication thats helped to control such.

[DorsetLady PMRGCAuk volunteer]

Now you have asked, you can see related posts.. and others will be along with their experiences.

[PMRpro Ambassador]

I'm sure you will get lots of replies - it is a common complaint. One of the first things we tell people is to cut their carbs - drastically sometimes. For many, that is enough to prevent them developing steroid induced diabetes but people who already have Type 2 diabetes have a much harder time although Koalajane cut her carbs and managed to reverse her Type 2 diabetes and lose a lot of weight - definitely our pin-up girl!

Just a healthy diet isn't enough, you do need to also restrict carbs because of the effect pred has on carb metabolism. Koalajane and a few others did a lot of testing, some with the blood strips and some with CGMs (continuous glucose monitors) and found that they had a period of time about 4-8 hours after taking their pred where their blood sugars really spiked. When they avoid eating, especially eating carbs at that time, their BS levels improved.

You are on a good start with freshly prepared food, not junk food, but maybe there is still too much carboydrate - root veg and fruit can be a problem too - at the wrong times. If you aren't alreadym I think you probably need to be under the hospital clinic rather than the GP because you are a complex patient.

[Diver249]

I have GCA not PMR but same issue with pred. . Insulin. Obviously you need to get them to prescribe it, and you would need the long acting and the short acting . Long acting once per day. Short acting before meals and correction doses as needed. The needles are 5mm long, very thin, and no problem, no pain., simply screw on to insulin pen, inject into abdomen area,. You have to find the right dosage and learn how insulin affects you ( ie how many units you need for a given reduction, which differs person to person) which is a bit trial and error but diabetic nurses will help you. Combine with continuous glucose monitor which again needs to be prescribed. Generally this is Freesyle Libre which is prescribed and give you real time glucose levels. The app sits on your phone and the monitor sends glucose levels every minute. Diabetic nurses can receive all this as a continuous data stream remotely by linking to your account to assist titration and learning. Also has alarms though I find them a nuisance. Once up a running very easy to use and can be used in any situation - restaurants, car, out and about, top of mountains, down in the valley, out on the wide blue ocean. A lot better than hoping pills will sort you out and you have much more control. of what’s happening.

[Diver249 in reply to Diver249]

Addition: I’m assuming you are Type 2. The prescribing criteria for CGM is as follows:

some people with type 2 diabetes who use insulin intensive therapy (2 or more injections a day) should have access to Flash, for example if they experience recurrent or severe hypos, if they have a disability that means they cannot finger-prick test or if they would otherwise be advised to test 8 or more times a day. (NICE).

I was given cCGM because being on pred glucose levels go haywire and necessitate finger pricking multiple times a day. Thats the argument you need to use if there’s any resistance, and obviously insulin is a much more reliable method of reacting to hypers / hypos in real times than any tablets.

[GHDirect in reply to Diver249]

Thanks for the detailed info. I admit I am needle phobic and dread the day of injecting but if pushed I'd get spouse to do it. Currently I dont prick finger multiple times daily but use Freestyle sensors at my expense (£100 per month) because my Dorset Area GP dont want to prescribe them.

[PMRpro Ambassador in reply to GHDirect]

They may not WANT to prescribe them - but it is probably worth a protest and complaint.

[Tiggy70]

Hi, I’m type 2 Diabetic (for 9 years). Pre PMR I controlled my diabetes with diet and oral medication but now after 4.5 years with PMR have to take a combination of oral meds. and insulin. My HbA1c in December 23 was 77! Like you my numbers were very high particularly before bedtime but I now have better control using insulin. I was very apprehensive at first but you do get used to injecting. Good luck 🌸

[GHDirect in reply to Tiggy70]

Thanks for update

[Viveka]

Just adding to what others have said, Pred can have a really big impact on blood sugar. This is greatest at high doses and then decreases. At levels 20 and above it's likely to be huge; twenty to ten still a lot but going down; ten to five still noticeable; five and under negligible. This is anecdotal information and very approximate rather than scientific but it's probably in the right ball park. So it will improve over time but obviously given your situation you need medical help in the meantime.

Perhaps something can be done with marginal gains. I guess you follow the Mosley/Zoe/Glucose Goddess advice on diet, exercise and hacks already?

[Pol53]

hi GHDirect , I have both PMR and diabetes type 2 and pred sent my blood sugar into orbit - I went back to my gp for this and was prescribed an extra tiny pill called gliclacide sorry spelling) it is a pill fir steroid induced diabetes which I take at lunchtime it works faster than metformin - I still take my metformin x2 after my evening meal but this has kept me stable throughout the day for the last 6 months they do have to monitor with your dosage of pred so they may ask you to test more frequently x

[GHDirect in reply to Pol53]

Thanks for the info, I wish Gliclacide on me.

[Pol53]

yes maybe u can ask for it - I was flashing ketones in my machine permanently until I took it and hbac1 of 71 I hope you can get it and stabilise