New prednisone induced post-prandial hyperglycemia

[plaidshorts]

Hello, thank you for such a great forum! I am here to help and support my university aged daughter, who is too busy studying and writing papers to write herself. She has prednisone induced post-prandial hyperglycemia, after taking prednisone for 2 years, anywhere from 15 mg daily to 60 mg daily. I will bullet point some possibly helpful info below, although this is the basic short list!

• Juvenile Psoriatic Arthritis/Ankylosing Spondylitis since age 8 (taking biologic Cimzia)
• Autonomic neuropathy, small fiber neuropathy, and erythromelalgia starting in early teens (presently treated with Prednisone and Myfortic).
• Wears Freestyle Libre 2. AM FBG 4.2-6.5 before treatment. Afternoons go into high 9's 10's and sometimes 11's for 4-5 hours. Follows the typical steroid pattern with high afternoons and early evenings. Pretty good numbers overnight.
• Disastrous 9 day trial of 500 mg Metformin in the morning that caused episodic severe fatigue and chills, heavy legs and difficulty climbing stairs, poor concentration. Felt back to normal 2 days after stopping.
• Then started on 6 units Novomix (NPH and Aspart 70:30) in the morning, which did not work because the rapid acting insulin needed to be separate from the intermediate acting. Also had overnight lows most nights, which we did not expect.
• Then put on basal Lantus 4 units in the morning and Apidra 2-4 units as bolus with meals. Works great in the daytime but several lows throughout each night.
• Eats an enormous amount of food to maintain weight, which is not her normal; weight=114 pounds; 5' 7"; lost 16 pounds in the past year even while taking prednisone; can't regain weight; modest cardio 45-60 min daily, one to two 30 min walks daily; does not smoke or drink; back living at home with parents during the pandemic.
• Vegetarian since age 12 for ethical and environmental reasons, so very high carb diet.

I do have a few questions which I will post later. But thank you for so much great info on this forum, I have been reading and learning here, along with reading Think Like a Pancreas.

 

[Inka]

Welcome @plaidshorts 🙂 If the Lantus is fine during the day but causing lows at night, she might be better off with a twice daily basal like Levemir as she’ll then be able to have less in the evening thus reducing her risk of going low overnight.

A vegetarian diet doesn’t have to be “very high carb”. There are lots of lower carb options if that’s what she’s looking for.

 

[rebrascora]

Hi and welcome.

Sorry to hear yopur daughter is battling such health issues at such a young age.
Does she even need to use a basal insulin? If her levels are good overnight and she uses the Apidra during the day for meals and/or any corrections then she could probably save herself an additional injection by dropping the Lantus and perhaps just use a bit more Apidra as necessary during the day. Might be worth a try. Good diabetes management is all about finding the best fit for you as an individual, so doing a bit of experimenting on yourself is usually the best way to find what works for you.

 

[plaidshorts]

Thank you for your suggestion regarding Levemir. I looked it up and that is a very interesting idea that could work. My daughter could discuss with her Endocrinologist. I agree that a vegetarian diet does not need to be high carb. The problem is that the volume of food she is required to eat to maintain her weight is quite astonishing. So the amount of carbs goes up! We will need to do further research! Thank you kindly for responding!

 

[Inka]

If it was appropriate for her, could she add some good fats? I’m slim and when I need to put on weight or even just maintain it, I add extra fats and that helps. Also, I use MyFitnessPal to put on weight. It has a personal daily calorie target so I make sure I get the calories in each day. Things like avocado and nut butters are good. I also snack to add extra food/calories.

 

[plaidshorts]

Hi and welcome.

Sorry to hear yopur daughter is battling such health issues at such a young age.
Does she even need to use a basal insulin? If her levels are good overnight and she uses the Apidra during the day for meals and/or any corrections then she could probably save herself an additional injection by dropping the Lantus and perhaps just use a bit more Apidra as necessary during the day. Might be worth a try. Good diabetes management is all about finding the best fit for you as an individual, so doing a bit of experimenting on yourself is usually the best way to find what works for you.

Thank you for your suggestion rebrascora! We have wondered the same thing, and in fact tried no bolus insulin today, while increasing the Apidra a bit. So far this has resulted in many uneven peaks and valleys, although it just may mean that we have not tweaked the Apidra dose and timing very well. She is rather desperate to avoid night time lows, as she is becoming very tired and this makes studying more difficult!

 

[plaidshorts]

If it was appropriate for her, could she add some good fats? I’m slim and when I need to put on weight or even just maintain it, I add extra fats and that helps. Also, I use MyFitnessPal to put on weight. It has a personal daily calorie target so I make sure I get the calories in each day. Things like avocado and nut butters are good. I also snack to add extra food/calories.

Thank you for your great ideas! I think you are right, she could consider increasing her healthy fats. At one point she tried the high carb low fat diet for 2 weeks, as per Mastering Diabetes, and so perhaps we have not added back all the fats from before. She eats large meals, along with 3 substantial morning snacks, 3 substantial afternoon snacks, and recently an evening snack. I think she will enjoy adding more avocado and nuts.

 

[Leadinglights]

Thank you for your great ideas! I think you are right, she could consider increasing her healthy fats. At one point she tried the high carb low fat diet for 2 weeks, as per Mastering Diabetes, and so perhaps we have not added back all the fats from before. She eats large meals, along with 3 substantial morning snacks, 3 substantial afternoon snacks, and recently an evening snack. I think she will enjoy adding more avocado and nuts.

Also go for full fat Greek yoghurt and add your own berries, there are also low carb pastas based on edamame beans or black beans with a creamy sauce and vegetables with grated cheese.
Snacks can be cheese , peanut butter or protein bars like Nature Valley, Kind or shop own. I just bought some from Aldi at 5.5g carb per bar
Also eggs

 

[plaidshorts]

Also go for full fat Greek yoghurt and add your own berries, there are also low carb pastas based on edamame beans or black beans with a creamy sauce and vegetables with grated cheese.
Snacks can be cheese , peanut butter or protein bars like Nature Valley, Kind or shop own. I just bought some from Aldi at 5.5g carb per bar
Also eggs

Fantastic ideas!! I will definitely add those things in. Such helpful ideas, I am grateful for the time you took to respond.

 

[rebrascora]

Will be interested to hear how she gets on tonight. It might be worth persevering for a few days or if it is too erratic then perhaps try just 2 Lantus.

 

[plaidshorts]

Will be interested to hear how she gets on tonight. It might be worth persevering for a few days or if it is too erratic then perhaps try just 2 Lantus.

Thank you...your suggestion to persevere for a few days may be a good one. It is also good to be reminded to be patient and wait and see! 🙂 2 units Lantus would be a reasonable place to start if/when she tries again. I will try to post tomorrow and let you know if there are any low alarms tonight!

 

[everydayupsanddowns]

Welcome to the forum @plaidshorts

Glad you are finding the shared experiences of the forum to contain interesting and helpful ideas. It is worth remembering that no-one on the forum can offer specific suggestions or advice - you must always assume that no one here has any medical training, and it is best to check any strategies or options you are considering with your daughter’s physician or endo.

But do ask away with your questions, and folks on the forum with share their experience, and things they have been advised over the years 🙂

 

[rebrascora]

I will try to post tomorrow and let you know if there are any low alarms tonight!

Not sure if you are aware but Libre sensors can suffer from what is known as compression lows if you lie on the sensor during the night in a way that puts too much pressure on it for too long. It is always recommended to double check any low or high readings given by Libre using a finger prick before treating.

 

[plaidshorts]

Welcome to the forum @plaidshorts

Glad you are finding the shared experiences of the forum to be interesting ideas. Always remember that no-one on the forum can offer specific suggestions or advice - you must always assume that no one here has any medical training, and it is best to check any strategies or options you are considering with your daughter’s physician or endo.

But do ask away with your questions, and folks on the forum with share their experience, and things they have been advised over the years 🙂

Thank you @everydayupsanddowns! I do understand no one here can provide medical advice. 🙂 The shared experiences from others have provided great jumping off points to continue my research, and possibly relevant topics for my daughter to discuss with her Endocrinologist.

Thank you for your warm welcome, and I will surely have many questions in the near future!

 

[plaidshorts]

Not sure if you are aware but Libre sensors can suffer from what is known as compression lows if you lie on the sensor during the night in a way that puts too much pressure on it for too long. It is always recommended to double check any low or high readings given by Libre using a finger prick before treating.

Yes thank you! We have read about the problems of Libre sensors quite extensively, and work hard to try to sort out a "real" low from a compression low. The interplay between the sensor reading, what shows up on the graph, and the bg meter reading seem difficult to tease out at times. It remains a learning process and I think I may have a few specific question about this in the near future!

 

[rebrascora]

I'm on the original Libre 1 and it is much more straight forward for me as regards readings being consistent and the graph following the readings. I rarely need to do a finger prick these days and I am confident to bolus and correct off the readings it gives. Of course it doesn't have the alarms but I manage fine without them as I have good hypo awareness. I was offered an upgrade to the Libre 2 but have decided to stick with what works well for me after reading of some of the problems people have had with Libre 2.

 

[plaidshorts]

I'm on the original Libre 1 and it is much more straight forward for me as regards readings being consistent and the graph following the readings. I rarely need to do a finger prick these days and I am confident to bolus and correct off the readings it gives. Of course it doesn't have the alarms but I manage fine without them as I have good hypo awareness. I was offered an upgrade to the Libre 2 but have decided to stick with what works well for me after reading of some of the problems people have had with Libre 2.

Thank you for replying! My daughter now has a 3 month supply of the Libre 2, so that is her sensor for now, but it is interesting to hear the perspective of someone using the Libre. It strikes me as somewhat confusing that she can tap a low, say 3.6, and then tap 3 more lows over 15 minutes, and it may or may not show up on the graph. So much to learn!