Splitting the Prednisolone dose to help blood glucose spikes - help please?

[AmberGamble]

I am delighted to report after just short of a year, I reduced my insulin dosage in correlation with my tapering down on Prednisolone, and I successfully came off it at Christmas! I am also on 25mg weekly of Methotrexate.

I did this with the approval of my diabetic nurse. I also changed from Metformin to Dapaflaglozin as I have some kidney issues and I’d researched to find that this might more helpful than Metformin.

So far so good 🤞

I have stayed on a low carb diet which started when I got steroid induced hyperglycaemia due to high doses of Pred which I am prepared to stay on for life - I lost 2 stone which I needed to lose and my overall health has benefited from that.

Despite this I cannot stop the lunchtime hikes in my BS which sends my levels way up, even if I don’t eat! I am now down to 7mg and will start tapering to 6 next week, which I take with breakfast.

Could it possibly help to split the dose into morning and evening, and how’s the best way to do that please? Will it be OK to just start it?

Best wishes to all!

[DorsetLady PMRGCAuk volunteer]

Splitting dose might help… usually advice is 2/3rd am, 1/3rd later in day/evening.

But don’t try and do that and taper at the same time ~get one thing sorted first, before you embark on second , PMR doesn't like too many changes at once.

You might also want to consider tapering only 0.5mg a time in the not too distant future - many find it helps as they get lower.

[PMRpro Ambassador]

How long do the spikes last? And how high?

Some others have found they have a window when their BS spikes which seems to be about 4-8 hours after taking pred. They have also found some foods cause spikes in the day but not at night.

I'm not convinced splitting the dose would make that much difference - and might spread the spiking period. But I suppose you need to try to find out. Others have used a CGM to identify what seems to trigger spikes and when they occur.

[AmberGamble in reply to PMRpro]

Thank you, I did try it for a couple of days but it did indeed shift the spikes and gave me 2 rather than one!

I do have a GCM which I carefully monitor, but still I get surprises! Sometimes I expect to spike and I don’t🙄 I know that carb content varies from brand to brand and I take that into consideration.

I am continuing with the Dapafaglozin and it seems to be helping stabilise things the longer I’m on it. I need help with my kidney function which this drug seems to do, or at least that’s my hope.

[Diver249 in reply to PMRpro]

Yes, I concur with spikes happening, in my case, about four hours after pred. no matter what I eat, which is low carb. I use insulin, and give myself a correction dose. Usually quite a hefty one which sorts things out then in the afternoon I am in target territory or thereabouts.In the evening the opposite quite often happens and I go into hypo territory, even though I have learnt to reduce the insulin dose from what would normally be needed for the type and contents of evening meal , and by bedtime ( midnight usually) I quite often have to have toast to keep glucose levels up through the night. Sometimes that’s quite problematic, and then it’s jelly babies in the middle of the night. Overall my Hba1c is in very low forties, but the amount of work keeping an eye on things is wearing.

[PMRpro Ambassador in reply to Diver249]

I can imagine!

[CocoaChanel]

Despite this I cannot stop the lunchtime hikes in my BS which sends my levels way up, even if I don’t eat!

You could try the ‘glucose goddess’ remedy of a tablespoon of vinegar - she particularly recommends apple cider vinegar - at lunchtime to see if that makes a difference. Interesting experiment!?

[Zebedee44 in reply to CocoaChanel]

Sadly it’s not a habit you will enjoy for as long as you have PMR or blood sugar spikes! and probably not good for your teeth. Maybe apple cider vinegar tablets rather than liquid work just as well.

[CocoaChanel in reply to Zebedee44]

I drink 2 tablespoons of apple cider vinegar in half a glass of water every day and I quite enjoy it. Don’t know about the teeth - haven’t noticed any issues do far

[AmberGamble in reply to Zebedee44]

I have some capsules which I haven’t tried. I will check that out, thank you!

[Viveka]

Do you use a CGM or finger pricking? You don't need to use a CGM all the time - just intermittently to identify the food culprits and any lifestyle helpers. At the lower levels of pred the spiking period (which starts approx 2 hours after taking tablets) gets less noticeable. I don't know if splitting the dose would help - it would be interesting to find out. How high are your spikes?

Exercise/moving after meals is very important. After eating carby meals or meals in the spike zone it is important not to sit down. Do some housework that involves moving around. Or go for a walk. As fast as you can for twenty minutes is good. I have found that walking for an hour doesn't bring extra benefits. The other amazing thing I just found is that high intensity exercise after a carby meal keeps the bs down. I had a bowl of pasta and went up and down the stairs as fast as I could (not very fast) until I couldn't do another step. Six times was all I could manage and I did it three times - every ten minutes. The bloods were about 3 mmols less at the peak than they would have been and stayed stable!!! Could not believe it. The downside is that I can't use that trick too often cause it hurts my knee. Many won't be able to try this at all, unfortunately. I now have trainers and dance-fit tracks lined up for after carby meals - a bit kinder on the knees. X

[PMRpro Ambassador in reply to Viveka]

That is really interesting!! I knew that exercise after meals reduced the BS levels - a guy on another forum did a study on himself and used his exercise bike. Not that dodgy knees like them either! He found some very strange times for the spikes too.

[Viveka in reply to PMRpro]

I'll repeat it next time I do the CGM. It reminded me of when Michael Mosley did that intensive exercise experiment. It was the shortness of the exercise which was so great. I was back on the sofa before my partner had made a cup of tea. Here's some links. X

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

diabetes.co.uk/high-intensi...

diatribe.org/exercise/high-...

[PMRpro Ambassador in reply to Viveka]

It's the definition of high intensity exerice that is always so difficult isn't it. High intensity here where I live seems to be rather more than I could manage!!! I leave the house feeling as if I am walking normally and in a hundred yards I am nearly beat - and that at a speed most other people walking here leave me way behind, It is a bit better since the cardiologist adjusted the pacemaker and my heart rate gets above 60 - no idea what she did, No possibility of what I would call a brisk walk as they keep telling us we should do!

[Viveka in reply to PMRpro]

Oh dear, it's never just one thing.

Very short bursts seem to be what's needed, but that is beyond most of us on this forum so probably not for PMR/GCA cohort. But it could have benefits for a younger prediabetes group. I guess it's about metabolism. But people still need to address weight issues so it gets very complex.

[PMRpro Ambassador in reply to Viveka]

Exactly - in acquafit the instructor we have now does do interval stuff with "do it as fast as you can" alternating with more reasonable levels. Hellish trying to move faster in 4 ft of water ...

[AmberGamble in reply to Viveka]

I have a GCM which I watch very carefully. I try in every way to keep within the parameters it’s set at by the diabetic nurse which is 3.9 - 10.0 mol/L and the spikes saw me around the 15 mark which I was concerned about.

I am aware re exercise and totally agree how much it helps reduce any spikes, but sometimes it’s not doable, especially when out in a social situation.

Controlling my previous well controlled Type 2 Diabetes has actually been the worst trial of this past 14 months since I got these rotten diseases 😣

Thank you for you for your suggestions!

[Viveka]

Sorry to go over stuff that you are experienced in. It must be a real pain to have pred disrupt things. Let us know how things go as you taper. X