HbA1c Figures and reducing/tapering Prednisolone

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I'm posting on behalf of husband (he's not good on computer or keyboard) and we also look for info on the Polymyalgia Rheumatica forum.

July 12th he was admitted to Rapid Assessment [u]U[/u]nit ater Gp appointmnet ans blood test results - diagnosis PMR + GCA. He was in for 3 days and saw "hordes" of Drs etc.

Prednisolone was prescribed while he was there and a blood test just prior to discharge showed raised blood glucose (don't know what level he didn't ask and wanted to get out!) and Gliclazide 40mg daily was prescribed. He was advised to have "random blood tests" but our GP says they have moved to HbA1c at 3 monthly intervals.

A sample was taken 4weeks after discharge and 40mg Prednisolone daily. So the 3 months covered by the test will be 2/3 prior to Pred and 1/3 after.

He's now been asked to go to the Health Centre for 1/2 hour appointment with nurse re diabetic check/management.

A PMR blood test result should be in shortly and he may well be told to start reducing the Pred (I gather this is the general procedure and likely to take several months at least). Hopefully this will result in gradually reducing blood glucose levels.

Does anyone on this forum have any experience in this fieeld or should we just follow the PMR forum?

apologies if post inappropriate)

 

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9 Replies

  • Posted

    Nothing too specific, but related to the PMR, make sure his vitamin D levels are at or above "normal" levels.

    Getting off prednisone/cortisones can be a struggle, make sure you do some research on that, doctors are often no help and will just leave you on it forever.

    But do get the actual A1C readings and BG readings, hard to say much without the actual numbers.

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    • Posted

      Thanks - but the Rheumatologists and GP have already warned him that it could take up to 2 years to taper off the Pred
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    • Posted

      Two years is better than never! 

      I don't have a lot of experience with this, and apparently some/most do manage to complete the process - but not all.  And it may be possible to move a little faster, with the proper support and guidance - and a good thing if that could be done.

      I'm just not a big fan of the way cortisones are used in a lot of ways, insofar as I have run across them.  So, just do your research, is all I'm saying here.

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  • Posted

    Dear jones10939,

    First of all, I would advise you to not pay too much heed to the response from jx41870.  S/he, obviously, know very little, to anything, about what s/he is talking about, though vitamin D supplementation should be considered if your husband has to stay on prednisolone for a long time ... and this MAY be the case with the treatment of PMR.  (Ideally, it should be a vitamin D3 and Calcium supplement.  This is because long-term use of prednisolone is associated with potential bone toxicity, causing osteoporosis.)

    Your husband's doctor(s) MAY consider bone mineral density testing, dependent on the sorts of doses, and length of time, that your husband remains on prednisolone.

    Unfortunately, as you've found out, prednisolone, which is a corticosteroid DOES affect blood glucose levels.  (I'm a type 1 diabetic and was admitted to hospital due to being unable to control my blood glucose levels ... even though I was taking anywhere between 7 and 10 injections of insulin per day.  During my hospital stay I was on a continuous insulin infusion 24/7 and remained in hospital for more than 2 months whilst I was gradually 'weaned off' prednisolone.)

    It's reassuring that your husband has been requested to attend  the Health Centre for 1/2 hour appointment with nurse re diabetic check/management.  This indicates that they are fully aware of just how much the taking of prednisolone can affect blood glucose levels.  Hopefully, you are already aware of just how much damage can occur to the body's organs, blood vessels, and nerves when blood glucose levels are above the 'normal' range.  Don't worry about this, as none of the diabetes-related complications come on suddenly.  They take time ... months, or even years, before anything would be noticed.  Your husband's doctor(s) would need to 'balance up' whether the risk of continuing with prednisolone for his PMR, and the subsequent rise in his blood glucose levels, can be successfully treated in a way that is beneficial to his long-term health.

    I'd be incredibly surprised if your husband was requested to start reducing his prednisolone so soon after diagnosis, ma'am.  It's hardly had chance to start working effectively if he was only diagnosed earlier this month.

    The HbA1c test offers on 'overall control' reading of blood glucose levels over the previous 3 months, with a slight emphasis on the latter 6 to 8 weeks of that time.  (It's based on the lifespan of red blood cells, which survive for anything from 90 to 120 days each.  Obviously, not all read blood cells are created, or die, at the same time, and the newer produced red blood cells are likely to 'pick up' more of the glucose that's circulating within the bloodstream.)

    Gliclazide is a type of anti-hyperglycaemic medication called a sulfonylurea.  This type of medication works by stimulating the beta cells (islets of Langerhans) of the pancreas to produce more insulin.

    I'm not sure whether I've interpreted what you've said correctly, ma'am, but my understanding is that the higher than 'normal' blood glucose levels have only come on since your husband was put on prednisolone.  If this is the case, AND the prednisolone dose(s) is/are going to be reduced, then the HbA1c test that his GP has stated they've "moved to" will be insufficient.  This is because careful control of the balance of prednisolone against the Gliclazide MUST take place, otherwise, if the prednisolone is reduced, the Gliclazide will still be stimulating the pancreas to produce more insulin.  This COULD result in your husband's blood glucose levels falling below the 'normal' range, resulting in a hypoglycaemic event/attack.  Dependent on just how low, AND how quickly blood glucose levels fall, this could give unneeded side-effects, such as confusion, sweating, blurred vision, tiredness/lethargy (wanting to go to sleep), and others.  (I, genuinely, have no intention of frightening you, ma'am, so I won't expand on hypoglycaemia further.)

    Prednisolone DOES have to be reduced gradually, ma'am.  With it being a steroid, sudden withdrawal can cause side-effects that neither your husband, nor yourself, would want to happen ... particularly whilst he's taking the Gliclazide as well.

    Hopefully, ma'am, both your husband and yourself will get a good outcome from the appointment he's been requested to attend at the Health Centre.

    Lots of Love and Light.

     Mick

    x x x x

     x x x

    P.S. Please don't be offended, or alarmed, at the 'x's'.  It's merely a logo, of sorts, that I've used for 40-odd years now.

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    • Posted

      @micksmixxx, not sure what you found mistaken about my post.  If it's my comment about doctors leaving you on for life, well, sorry, seen it.

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    • Posted

      Thanks for the detailed response. Husbands blood glucose levels prior to Pred are unknown - the GP has already said that they can provide him with monitoring equipment and he intends to ask for it when he attends for this check.

      Calichew 3D Forte has been prescribed, presumably as a precaution since there was no bonescan when he was being assessed in hospital (apparently not carried out for over 65s on steroids!!)

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    • Posted

      Actually that is not true. I have been on steroids since 2006 when I was 58, and have had 2 yearly bones scans since 2010. I am now 70 and my last one was when I was aged 69
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    • Posted

      Could be a difference between England  and Wales in rulings though 'cos of the Welsh Assembly.

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    • Posted

      Sorry, I had not realised that, or that you are in Wales! Actually you might be interested to know that I am on prednisolone because of an eye condittion called uveitis and I was on prednisolone for 8 years before I developed diabetes. However, when I did get it, it deteriorated very quickly so I was on insulin in less than 3 years later. Diabetes. And weight gain are the only side effects I have had from prednisolone 
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