HYPERTHYROIDISM HELP - need advice with my sugar levels

[davidrichardwales]

Hi
I have recently had surgery for 2 malignant melanoma growths and left arm lymph node removal. I am on a 1 yr Nivolumab immunotherapy treatment. Sugar levels all over the place and high.(16 (300) Have tried increasing insulin to get it stable.

After 2 treatment sessions my blood tests showed hyperthyroidism and the immunotherapy has stopped. I have now been put on thyroid treatment drugs prednisolone and Nexium to sort this out. But my sugar levels are even higher (22 (400).

I am now becoming worried. Any help would be appreciated.

 

[Pumper_Sue]

Hi David, so sorry to hear of all your problems. Prednisolone is a steroid and world famous for increasing blood sugars so you need to increase your insulin quite a lot this means bolus and basal if you are on this treatment.

 

[Radders]

Hi David
It sounds like you’ve a lot on your plate. Sue is right about the steroids. Have you checked for ketones? If you have them then I would contact your diabetes team for advice and in the meantime follow the sick day rules if you are on a basal bolus regime.
Can anyone post a link to these?
If you’re on a mixed insulin then I’m not sure how you adjust that but perhaps someone else will be able to help?

 

[trophywench]

Nexium is a proton pump inhibitor to treat eg heartburn and acid reflux - neither have any effect on too high (or indeed, too low, if you really meant 'Hypo' thyroid) thyroid hormones - according to their Patient Information Leaflets - so as far as that's concerned, I'm puzzled.

Very good advice re your insulin requirements whilst on steroids - it's pretty gobsmacking sometimes just how much extra insulin our bodies need, when 'something else' is also going on.

 

[Amigo]

Hi David,

Sorry to hear you’ve required immunotherapy for your melanoma but thankfully Nivolumab was available. It’s a drug that’s known to sometimes raise blood glucose levels so you may need additional help to get them back on track;

https://www.macmillan.org.uk/cancer...therapies/monoclonalantibodies/nivolumab.aspx

Additionally Nivolumab can sometimes have an impact on the pituitary gland resulting in secondary thyroid problems and I’m wondered if this has happened in your case. These monoclonal antibodies are lifesaving drugs but can exact a price particularly accompanied by steroids! Hope you can get the right advice to stabilise your levels.

 

[mikeyB]

It all depends on the insulin regime. If you are on basal and MDI, it’s slightly easier. On high dose steroids, I usually have to increase the long acting insulin by 50%, and boluses the same. Don’t try this if you are on mixed insulin. Your team should be able to advise you. Best of luck.

 

[Wirrallass]

Hi David I'm sorry I can't advise you ~ just wanted to welcome you to the forum. Take care
WL

 

[trophywench]

David has not yet revisited to see any replies.

 

[Wirrallass]

Hi David
It sounds like you’ve a lot on your plate. Sue is right about the steroids. Have you checked for ketones? If you have them then I would contact your diabetes team for advice and in the meantime follow the sick day rules if you are on a basal bolus regime.
Can anyone post a link to these?
If you’re on a mixed insulin then I’m not sure how you adjust that but perhaps someone else will be able to help?

I think this is the link:-
http://www.mydiabetesmyway.scot.nhs.uk/resources/leaflets/SickDayRulesForType1.asp