Prednisone and Blood Sugar

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.

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