Prednisone and Blood Sugar
Posted , 10 users are following.
I thought I'd share some of my experiences with blood sugar because when I first started taking prednisone at 20mg my diet was terrible, and I never got any guidance from my Rheumatologist. Net result? I've lost considerable feeling in my feet. lesson learned: doctors here are NOT looking out for me. I have to do that, and so I am.
I went to my GP, and he put me on Metformin to lower my sugar a bit. Then I set out to learn how to be a good little diabetic, and so I did, reducing my sugar levels from catastrophic to merely dangerous in the long term. Not being satisfied with that I continued to research diabetes, and I am still learning because eating with a blood sugar problem is part science, and part art. However, after I got my sugar under some control, I decided to investigate what if anything I could do about prednisone's affect on my blood sugar. I should point out that I was pre diabetic before taking prednisone, but then with the horrible diet I had, I wasn't shocked when I discovered that I now had medically induced diabetes.
So, after learning to eat better...and I do, I also learned that I can exercise and take up good amounts of excess blood sugar in the muscles, and organs. It works, but its more complicated than that. First, at high levels prednisone interferes with the ability of muscles to take in sugar. I also discovered that when you take prednisone, and I take it at 7:30 AM that it starts to enter your system, and seems to form a bell curve starting to rise very rapidly by noon, and then starting to come down after 6 PM. If I have any meal at all between noon and six I can be certain of a serious spike in my blood sugar, one that may or may not respond to exercise.
So I had an epiphany: I wasn't eating 3 meals a day anymore, I was eating 4: break, lunch, Pred, and dinner. And prednisone is a loooong meal lasting about 6 hours. I could eat something as inconspicuous as a banana at 3:30 in the afternoon and it would raise my blood sugar nearly 40 points, whereas if I ate the same banana at 8 PM I'd get a more modest 12-15 point rise.
That led me to a strategy where I've shifted breakfast to an early hour right when I take the pred. I then get out and walk 30 mins, then 2 hours later I have a light lunch, almost a brunch, because I eat it at 10:30 AM, then follow that with 30 mins of exercise. That takes me to the no mans land of prednisone which owns me for 6 hours. What can I eat? Not much. I tried sugar free popsicles to satisfy not only my hunger but my sweet tooth. I struck a disappointment there, because while they are sugar free, they do have sugar alcohols, and testing showed that If I had more than one I was on the sugar eexpress, although roughly half the problem of a banana. I have discovered that I can have a raw carrot, or celerly, or even some raw broccoli. If I cook it however, it becomes, "bioavailable" ...translation, it turns into sugar fairly fast. So I nibble my way through the prednosone no mans land until about 6 ish, when I can go ahead and start dinner. Dinner allows me more options because the sugar effect of prednisone is really fading fast by then, and not only do I spke less, but it responds to exercise much better. Bottom line, I can keep my a1c below 6, and possibly under 5.5 and all without the aforementioned Metformin which I've been off of for awhile. Getting my a1c below 5 (and I'm taking mg/dl here) is probably not possible on pred, or at least not until the dose is quite low. When I had to wean off of pred I kept expecting my sugar to come right, but even on lower doses the effect was pronounced. I hope this rant is useful. The bottom line now is that I can keep spikes to a bare minimum, and I no longer test as diabetic, even though I have to work quite hard to stay out of that range. One final note. As a medically induced type 2 diabetic, some of what I'm suggesting would be of no value to a type 1 since they're dealing with an intrinsic inibility to manufacture enough insulin, as opposed to insulin resistance. That at least is my best understanding to date.
0 likes, 18 replies
EileenH mark9992
Posted
It is fairly simple for that 6 hour window: cut the carbs to as low as possible. Banans have a massive amount of carbs - of course they will spike a blood sugar. Bacon and egg however have no carbs - no sugar spike.
If you are using prednisone then it will take longer to rise than if you are taking prednisolone - prednisone must be processed by the liver so the peak is delayed. Prednisolone peaks in less than 2 hours. Prednisone is rarely used in the UK but is used a fair bit in the USA. Lodotra/Rayos is prednisone - but releases after 4 hours so the peak is more like 7 to 8 hours (you take it at 10pm.)
Have you seen the blog Diabetic mediterranean diet by Steve Parker? Really worth a look. There have been many lies about how we MUST have carbs - rubbish! Our bodies do very well without - though it takes a few days for them to adjust and it's more comfortable to reduce slowly - just like with pred!
mark9992 EileenH
Posted
The trouble...the connundrum actually with bacon and eggs is that they're atherogenic, and so they would simply be a different path to heart trouble, and I already have enough plaque in my arteries to supply a small city. I'm vegetarian, although I'm making a few exceptions right now in the mornings with very low fat meats like turkey breast in order to reduce carbs while taking the least amount of damage.
The exercise regimen I'm doing is keeping blood sugar in check, and I'm getting better and better at it, and getting fitter into the bargain.
EileenH mark9992
Posted
That particular theory has been disproven. The sugar industry paid for "research" 40-odd years ago that made fat the baddy - so they could double the amount of sugar used in the food industry. In making "low fat foods" you have to replace fat with something to make it palatable - and sugar and HFCS were the perfect answer. HFCS also extends use-by dates because the food remains soft - win win for the manufacturers as making it was cheaper and there was less wastage. As carbs in the diet have increased so has obesity and all its attendant evils, particularly diabetes.
I appreciate your objection on veggie grounds, that's different, But atherosclerosis? Not as much as you'd think!
lodgerUK_NE mark9992
Posted
got to the PMR & GCA North East website, read the last Newsletter.
All about Diabetes both Type 1 and 2 by a Lead Dietician located near us and cam to talk to our Support Group.
The most telling comment was from a person who had had Type 2 for well over 10 years. The comment was 'why have I not been told all of us by my Diabetic Clinic'. Three months down the line, that Lady has emailed me to tell me, it has changed her life.
mark9992 lodgerUK_NE
Posted
I'll have a look!
lodgerUK_NE mark9992
Posted
It so helps me to get input from other people.
Thank You.
jeannae68307 mark9992
Posted
Thanks for the info. Every bit helps. I'm still trying to figure this out. I take liquid prednisolone at 8:30 am and it starts to kick in by 7:30-8 pm. It's better than the prednisone which took 26.5 hours to work. I am trying to stay away from high glycemic index foods therefore eat NO JUNK. Boy is this hard. No more cake, cookies, pie for me but I will allow myself piece of homemade apple pie if I can conjure up the energy to make it. How lucky no have u been on pred?
Anhaga jeannae68307
Posted
Jeannae, please tell me more about this liquid pred and why it takes so long to work? Why did ordinary pred take even longer for you, and how did you figure this out?
I have to say after giving up refined carbs for more than a year (not entirely, but I eat very few and not every day) I feel quite happy to do without. But I'm lucky I guess not to have much of a sweet tooth. I like high quality dark chocolate for a treat, and usually prefer slightly salty to sweet things.
jeannae68307 mark9992
Posted
mark9992 jeannae68307
Posted
I was first on Prednisone back in March. Sugar went wild, lost feeling in my feet permanently. Nobody was worrying about my sugar you see, and I didn't know I needed to either. Then I went to my GP, had a chat, left with a report...that I didn't read. Went to another doctor for Epstein Barr, and he said, "did you know you're diabetic?" I said no. I went back to my GP and he said, "it was in the report." I said, "That's fine, but when you come down with a serious illness, isn't that the sort of thing you ought to mention out loud?" He replied, you should have read the report. What can you do with such caring medical service? End of rant. Bottom line, I took control of my sugar. Technically I'm no longer diabetic because my numbers are normal, but I have to watch my diet and sugar like a hawk, so really whats the diff? To me not being diabetic is picking up a box of powdered donuts guilt free. Not to be.
Anyway, I had to get off of pred because of the epstien bar and endure several months of agony in bed. I restarted Sept 6 on 10 mg. So far so good.
jeannae68307 mark9992
Posted
Ok, Mark I hope it keeps going well for you. How long is the latest nest stretch of pred u were on and u didn't have any problems with your adrenals when u went off? You said u spent a lot of time in bed. Was that pain and stiffness or dizziness and feeling faint? Thanks
mark9992 jeannae68307
Posted
I had to get off of pred fast so that my impaired imunne system could deal with the flair of Epstein Barr that I had. My Rheumatologist had me on a very aggressive reduction to do that which gave me real fits, so I took my GP's advice and just went down 1mg every two weeks. I went through a month of severe fatigue and a month of severe pain. The slightly slower still left me with obvious withdrawals as my poor adrenal glands tried to remember they had a job to do. There was an awful middle period where I had most of the pain and still had fatigue. For the last 3 weeks all the fatigue seemed to fade but I was left with so much pain that I could hardly move from bed to bathroom, and sitting in a chair was tough because it would take me half a dozen tries and a LOT of pain to get up. No dizziness or faintness at all.
When it seemed the epstein barr had run its course I took on sept 6 my first 10 mg dose as recommended to me by the Rheum. Three hours later I startedd feeling better and I got on the treadmill...just for 5 minutes because it was all I could do. Now, not even 3 weeks later I walk more than an hour and a half a day split up mostly after meals to lower blood sugar. I'm taking it up to two hours and then adding in other exercises to retain muscle, because I'm losing weight to improve my health. I'm down 29 lbs as of today. I have 33 lbs to go. In two weeks...maybe less, I'm going to start DSNS as posted here.
nick67069 mark9992
Posted
Thank you very much for your analysis. It is very true that ultimately we are responsible for our health and it is imperative to understand details and implications of what prednisone, food and exercise does to our body.
After reading, one thing that I would suggest, if you have not tried is to consider taking pred very late at night (after midnight) instead in the morning. The effect would be similar on PMR ( targeting morning peak in cytokines at 4AM)) except prednisone will be ready for it. What would this potentially accomplish? Prednisone peak and 6 hour fasting would happen at night, so you can have more regular day.
I split my dose in 2 half's; take half at 1AM and the rest about 8AM... that creates less of a peak, but may not work for you due to sugar sensitivity ( I am one of the lucky ones that can consume large amount of carbs and sweets with no lasting impact on blood sugar or weight, but I exercise a lot too.)
mark9992 nick67069
Posted
What an interesting idea, Nick; sleeping through the prednisone sugar dead zone. I'm going to give that long thought.
arnold83548 nick67069
Posted
Thanks,
Arnie
nick67069 arnold83548
Posted
While I don't have any insulin issues, I do have PMR and I used to take split dose of prednisone late at night ( 1AM) and morning 8-9AM when the dose was higher. After almost 2 years of PMR my dose is 4mg and I take all of it at night. Keep in mind that everyone is different and what worked for me, may not apply to you.
I found my "perfect" schedule by experimenting and had understanding rheumatologists who supported it. My reason for late night dose were the fact that I work late at night and was up anyway, and also was trying to best target release of cytokines, which happens at 4-4:30AM. From what I read, un-coated pills take 2-3 hours for max concentration in the blood, so taking them late at night creates the peak just before cytokines release. Doctors recommend to take prednisone as early as possible in the morning for the same reason - to target cytokines release.
EileenH arnold83548
Posted