Steroids and type 1 diabetes.and type 2.

[mickt]

Hi all just to say to anyone with type 2 diabetes that you will need to watch your levels whilst on prednisolone.I am a type 1 insulin dependant ,and my control has gone all over the place in the 17 weeks ive been on high doses of pred ..Apparently these things can cause, and worsen type 2 patients.I find my bm is high in the morning in 20,s sometimes then inject and normally decreases,but pred increases them ,danger is overdoing it with insulin and exposing yourself to Hypoglacimic attack ..low blood sugars under 4 ..This has happened to me on numerous occs. My diabetic clinic have suggested if sugars are above 10 in morning then to take some long er lasting insulin aswell as my short acting one.To be honest still hard to gain as tight control.I cant speak for type 2 diet and tablet folk, but be interesting to hear how folk in my or anyone else situation is managing.

[JontyW]

Hi Mick,

What level of Predisolone (steroid) were you on when it was 'high' and difficult to control blood sugar (BS)? Now that you are on a lower dose, I assume you can now get better control ... correct?

I'm a Type 1 diabetic for last 44 years, and always had good control and so no complications. Four month's ago, I was diagnosed with Churg Strauss Syndrome, and I started on 30 mg/day steroid, which is reasonably 'low'. My blood sugar did indeed increase quite a lot and so I restarted on slow acting background Lantus insulin (previously had found that I did not need Lantus because it caused me night time hypos). Then over next 3 months, as steroid was reduced, I also reduced Lantus and stopped completely when steroid dose got to 10 mg.

Now my steroid dose is 12 mg (had to increase slightly due to increased CSS activity), and I have returned to excellent BS control just using carb counting, many regular tests and just quick acting insulin Humalog. My BS increase due to 10 mg is very small e.g this morning BS on waking was 5.8, took steroid 10 mg, BS two hours later before breakfast was 6.2, so not a big increase.

If the steroid dose is kept constant I would not expect BS due to that to change. BUT what will change is the BS increase caused by increased vasculitis inflammation, unless you are in well established full remission state. I have not yet reached remission state, so the activity is still varying, and I can see when that happens since the BS increases as do the symptoms I experience. BS level is very variable day-to-day, just like vasculitis symptoms do, but I manage pretty good control by accurate carb counting and adjust insulin dose based on Insulin-to-Carb Ratio (insulin units needed per 10g of carbs) plus correction factor dose if BS is high before next meal.

What method do you use for BS control? Do you carb count and use the ratio or just use same carbs each meal?

[mickt in reply to JontyW]

Hi Jonty .You sound like a man well in control of things.I was admitted into hospital after a loss of vision in left eye ,amd pmr symptoms ,put straigthon iv for 3 days to save sight.The symptons cleared was in 5 days .When discharged was on 70mg daily ,reduced to 20 over 7weeks ,started to get double vision 20 times a day ,put back onto 80 ,down to 35 now,im getting chemo cyclophosphomide and methy pred iv ,on third one on friday,im also an addison s disease sufferer to boot.,so take 20 mg of hydro cortisone also daily.My control has up and down i dont carb count i just do balus boli go off my readindgs on mahine basically.Im normally in good control but pred definatly does not help.Maybe i should carb count not sure how to do it .Iv e had type 1 for 15 years now and work shifts so it was best way for me .I wont be doing anymore nights now tho with all this.Good that you are managing good control ,mi was at diabetic clinic they said it wasnt too bad considering amounts of pred.He reccomended i start long acting 15 in morning if bs over 10 i take humilin i for log acting and humilin s for fast acting.I think its a balancing act Jonty ,and were doing our best.

[JontyW in reply to mickt]

Hi Mick,

Well you certainly have had a bad time recently, and I'm so glad that you seem to be progressing. Your diabetes clinic are correct that you are doing well with all the nasty steroids you have taken. I think going to long acting if BS is high in am is a good idea and should help, but you may need to back off some of the other insulin in case of hypos. BTW: for hypo recovery I now use Barretts Jelly Babies and find them really good .. fast and no over shoot .. each one is 6g carbs and takes my BS up by 1 mmol/L, so 3 babies is ideal after a hypo at 3.5

As you say, it is a balancing act, both for diabetes and vasculitis control, and it sounds as if you are doing OK. Regarding using carb counting, for that you have to be on only quick acting insulin such as Humalog or Novorapid, plus slow acting background insulin like Lantus or Levimir. But shift workers often don't find this suitable for them.

Nice to talk to you Mick, and I wish you well in your multiple health challenges ... Jonty

[mickt in reply to JontyW]

Thanks Jonty for that ill tryb the jelly bbes I love them the yellow ones ..All the best to yourself.I was 2.8 this morning more jelly babies needed ...CHEERS MICK.

[Tony-LakeDistrict]

you can also have STEROID INDUCED DIABETES`, which I had, it was controlled by insulin.But within a couple of weeks of coming off steroids my sugar readings where normal , no more diabetes

tony

[SandieB]

Hi i was on a high dose of pred and developed type 2 Diabetes and didnt seem to be able to control it but after getting down to 5mg pred which iam on now the diabetes has gone or at least nothing shows up on my blood tests now, so there is HOPE. Take care and good luck x