Sugar 2; This time its personal

So do we all Mark! It isn't for want of asking either!

if the glocose level is proportional to dose ( endo of the first paragraph), then maybe splitting dose would make the sugar peaks smaller and more equally distributed over time? Just speculation on my part, but it might be worth a try.

I don't read that as saying that - the bigger the dose the bigger the bump yes, but not necessarily proportional. The rest suggests that it is a variable effect, not consistent. In which case it possibly doesn't make much difference when it is taken. I suppose there is only one way to find out.

Eileen, When I took pred in the AM I fasted and charted blood sugar levels to my empirical satisfaction and found a pretty consistent bell curve starting several hours after I take it until early eveining very much as you describe in your earlier post.  I've also found it very predictable.  Essentially, when I take pred in the AM it is though I've eaten a huge meal lasting more than 8 hours. The levels during the day when fasting never rise (for me) above normal postprandial numbers...less than 120mg/dl.  However, eating ANYTHING during that bell curve was like a red rag to a bull.  My sugar would should way up.  What is more, because of the way pred impedes uptake into muscles and other organs, you can exercise as hard as you like and have LITTLE impact on your number during that bell curve.  The effect lasts 24 hours a day, but on either side of that bell curve the effect is muted and I can exercise on the treadmill and reduce my blood sugar very quickly.  Even a 5 minute brisk walk after a meal will knock off 25 points for me.

Today however, I had lunch, and instead of exercising 15 minutes later as is my want, I ended up starting 45 minutes after lunch.  I tested my sugar and it was a wopping 190 (it should never be over 120).  I hopped on the treadmill and did 40 brisk minutes and tested immediately afterwards:  77.  That's right, I'd knocked it down 113 points!  I promise you if I was still taking pred in the AM, it wouldn't have knocked it down 10 points, and the original number would have been higher.

As for splitting the dose, I think all that would accomplish is create an environment where there was no good time to eat or exercise, since all you'd have managed to do is create multiple pred bell curves.  I could be wrong since the dose is halved, however when I had to get off of pred quickly because of another infection what I found is that my blood sugar never was easy to control until after I was completely off for several weeks.

When I'm off of pred completely (and I will be) I will have lost more than 60 pounds (i've already lost 31) and I'll have built muscle mass and I anticipate no longer being pre diabetic, let along medically induced diabetic.  But that's in the future....years maybe.

Perhaps I haven't emphasized until now how important exercise has been in controllling my blood sugar regardless of when I take pred.  My treadmill is my best friend.  It is amazing what exercise can do to reduce sugar;  you just have to stay out of pred's sweet spot to do it.

My night time strategy as I stated at the beginning has one achilles heel;  my liver and pred seem to be singing much too happy a tune in the middle of the night.  my hope is that metformin will stem the tide and make my strategy permanent.

Nick, when I was getting off of pred to get rid of another infection,  I went from 20mg down to zero and saw NO improvement in my blood sugar until well after I was off the drug completely.  I was very disappointed as I reduced my dosage, felt the pain returning and realized I wasn't even getting benefit in my blood sugar results.  I can't say it will be true for you, but that was my experience.

In a separate issue, when I got under 4 mg per day I did begin to see a strong return in my capacity to produce nitric oxide.  I've heard nobody talk about it here, but one of the reasons pred narrows arteries is because it appears to completely paralyze the endotheliums' ability to produce nitric oxide, and also the secondary pathway through the gut.  That is a BIG deal.  People talk about how hard it is to walk up stairs, well apart from atrophy, your arteries may well be unable to dilate and get more blood!

I'm looking forward to reporting your experiences to some of the PMR research people who are doing steroid monitoring at present. But I think it is fair to say - EVERYONE is different and I doubt it is any different for diabetics/pre-diabetics. And no, I don't think splitting the dose is a guaranteed answer either

But it is definitely something that needs looking at far more closely.

Mark, how did you find this out?

Pain, any metobolism imbalance, fatugue, or infections, will drive BS levels up.   

THe only reason I suggested splitting dose is because of the posibility to spread the peaks ( and possibly lower them).  I am glad that at least evening dose helps to avoid peaks during the day, and hope that you can find solution for overnight sugar issue.  Good Luck.

One note on your comments above: pred does many not so good things, but I am pretty sure it does not narrow the arteries. In fact it does the oposite, it opens them up and that is why we take it.  I am not familiar what impact it has on nitric oxide and can't comment on that.

Exercise has the same effect - increases blood flow to muscles and beside improving sugar levels, it also provides muscle with nutrients and washes away waste products.

Nitric Oxide (NO) is released by the endothelium, a single layer of cells in your arteries when needed.  NO is the primary vaso-dilater for arteries.  Higher levels of pred completely impede ithe release of NO...or production, take your pick.  So if you prefer, it doesn't narrow arteries so much as prevent them from dilating.  There are a number of papers on the subject you can look up.  Prednisone does not open arteries at all, its simply a powerful anti-inflamatory.  There is a secondary pathway to creating NO, and that is through the gut;  if you eat a lot of dark leafy green vegetables like kale, the facultative anerobic bacteria in the cracks of the tongue will take the nitrates and convert them to nitrites, which then go down to your stomach where they're converted as needed into your nitric oxide pool.  However, pred destroys that pathway too at higher doses.  You can test out your NO levels with test strips you can get online.

Corticosteroids DO cause vasoconstriction - but they are also antiinflammatories and in vasculitis you need to reduce the inflammation that is thickening the blood vessel walls and narrowing the lumen which restricts blood flow. GCA is a large vessel vasculitis, PMR is probably a vasculitis that is found in the microcirculation, the very small blood vessels. 

 

OK, let me think on this  aloud.

If "Corticosteroids DO cause vasoconstriction" and at the same time "reduce the inflammation that is thickening the blood vessel walls and narrowing the lumen which restricts blood flow" I would assume that the second part (reduction of inflammation) is more significant which ultimately increases blood flow. If  the net effect is increase of the blood flow, would one be wrong to say that the reason we use pred is to open the small blood vessels? So my point was that prednisone does not narrow blood vessels. I used the word  arteries ( my bad), should have said Capillaries ( smallest blood vessels) for PMR.  I would assume that in a GCA and large arteries inflammation similar process happens.

The clue is in Mark's sentence:

"So if you prefer, it doesn't narrow arteries so much as prevent them from dilating"

It varies with dose too - the entire thing is awfully complex!!!!! I'd be interested to find out what it is that causes the hot flushes with pred - because that is almost always a case of sudden vasodilation and is worse at the higher doses that you would think would actually cause vascoconstriction. But my biochemistry isn't up to it...

Yes it does vary in dose.  The reason I know about NO and its effects, and on myself in particulr is that before PMR I used to eat 6 bowls of kale per day to amplify my pathetic level of NO.  I have atherosclerosis to the point where my endothelium doesn't put out squat.  However, when I eat max dark leafy greens I have the NO level of a teenager by using the secondary pathway I discussed above.  Weeeee!!!!  I can walk up stairs with ease...and other things!   ...Except that I can't now.  My 10 MG a day has destroyed both pathways :-(  When I had to get off pred in one big hurry I kept re-trying with kale, swiss chard etc.  Nothing worked until I got under 4 mg per day.  Then suddenly my NO test strips showed that I was producing again!...big time! 

For Nick, here's an interesting aside on NO:  People with angina, and heart trouble have been taking nitro for about...what...100 years?  Everyone understood that it quickly relieved heart pain, but nobody knew why.  Back in the 80's some doctor discovered that there was some, "relaxation factor" causing ateries to get bigger suddenly.  Even then, nobody knew what it was.  Finally, 3 doctors got themselves a Nobel prize by discovering that it was NO, and that the endothelium produces it.  However, by the time you're 50 even if you're perfectly healthy, you've lost about half of your ability to produce it through your endothelium, BUT if you eat lots of leafy greens and get the nitrates, you can use the secondary pathway thru the gut to augment what the endothelium produces (or doesn't) and have very high levels indeed.  Very helpful in staving off atherosclerosis, and walking up those stairs.,  That is what Nitro does when you place it under your tongue.  It uses a different pathway to give you a HUGE quidk dose of NO.  Viagra and its similars use yet another chemical pathway to give you a boost of NO.  Why?  Because when you have atherosclerosis (and if you eat a western diet you DO to some extent) then the arteries to the penis  which are smaller than the ones going to the heart tend to block up first...consider it a warning sign.  Then you take viagra and suddenly even arteries covered in plaque are dilating like crazy, and you find you can, "raise the flag".  Take away those foods that vaso-constrict AND eat lots of dark leafy greens, and eventually you may find you don't need the little blue pill.  All of that is off the table with pred at higher doses though.  Now, I'm betting your doctor has never mentioned NO, and likely doesn't even know anything about it.  Over here at least, they're just pill pushers.  As ai said, there are scholarly articles about pred's interference with NO that I can barely understand, but the basics I get.

Interesting... I had a quick read on NO, but it is way too complex chemistry to understand, especially while sipping on my evening drink ( which by the way also causes vasodilation, just like NO ).

At the begining of the PMR treatment I remember being out of breath for seemingly very light activity, but that problem disapeared after several weeks and never came back.  I atributed the improvement to my walking/streatching routine, but I really dont know for sure.  After training for 9 months or so, I am in decent shape, relatively speaking. I have no issue with 20Km bike ride in the hills or 2Km swim ( my typical workouts).

Oh, and never had to take blue pill thus far.. I guess I am eating enough greens and my NO supply is fine.

I feel much better too, and can go upstairs better, because I'm stronger and more aerobically fit, but I know full well from my tests that my NO isn't just low, its dead and gone.  Have you tested yours so that you know your NO is fine???  You can't know without one.  All you can tell without a test is that your arteries may have much less plaque in them than mine and therefore may be carrying blood more efficiently simply because your pipes are clearer than mine...that would be a partly educated guess on my part knowing my own pipes for what they are...lol.

PS - how do you test for NO?

I buy off of amazon.  Several companies have test strips.  I buy Berkely.  They work well.

Hi Mark

Question:  after you have knocked down your sugar 113 points right after 40 minutes of treadmill -   does that reading stay the same throughout the day or does it sneak right back up again? 

Oh it sneaks up, but not to where it was. Even off hours for pred my bs seems to want to settle in the high i0s low 90s. Preds hold never lets go entirely. Also, if i eat soething like whole grain pasta, it ca take r hours to digest and ill see my 2 hr post prandial rise even after getting iit down right after eating. Thst said, its cunulative...it all helps. Im still having trouble at night tho. Im hoping metformin will kick in and keep it manageable, or i may have to rethink