Hello
@Kathleen68,
Welcome to the forum. We are a friendly bunch and amongst us we have a huge breadth of knowledge and experience about the diabetic condition.
Diagnosed with steroid induced diabetes 2 yrs ago. I have severe asthma which requires a maintenance dose of prednisolone and several courses of high dose prednisolone each year which unfortunately raise my blood sugar. I was put on Metformin, couldn’t tolerate it, then Gliclazide also couldn’t tolerate, then Sitagliptin which I’ve been on for 12mths and find ok. My Hba1c readings were initially 66, by altering my diet I managed to get down to 49, however my last reading this month was 56
You have already provided 2 really useful bits of medical information: your current HbA1c and your diagnosis as Steroid induced diabetes. I wonder if anyone has explained the significance of that particular diagnosis.
I am diagnosed as Type 3c. My diabetes came from damage to my pancreas after surgery. [In my case the damage is a bit extreme because they removed all of my pancreas]. There are various Type 3s, ranging from T3a to T3k and one of those T3s is for pancreatic damage from steroids. Another is for alcohol and various other types of damage to make up the "set" of a-k. Alas I can't remember which letter applies to steroid damage - but in the wider scheme of things that specific letter is not so important. The significant thing is that you have a form of Diabetes, an inability to manage your blood glucose levels because of insufficient insulin production (caused by the pancreatic damage). This sets you and other T3s apart from the majority of the UK and Western world, who are either T1s (c.10% of us) or T2s (c.90%). We T3s are already in a relatively tiny minority of all the UK diabetic community, less than 1%. T1s (the c. 10%) have an autoimmune condition which destroys their insulin production capability [and in that sense we T3s are as if T1, yet very different from T1]. T2s (the 90%) are just the opposite, they produce ample insulin but their bodies resist that insulin and their surplus BG is because of that inability to complete the transfer of excess glucose from their blood into their cells, muscles and organs.
Understanding some of this matters because many (I personally think most) Health Care Practicioners (HCPs) are not aware of this major difference. We are in a rare and specialist category and our bodies are not behaving the same as T1s or T2s. Going a little further, the treatment for diabetes needs ro be appropriate to the cause, NOT the diagnosis Type. Most (virtually all) T1s need extraneous insulin from very early on after their diagnosis; a tiny, tiny few get the T1 diagnosis and can initially manage their D with oral meds. I have a 22 yr old great niece now into her 2nd yr like this, but as a medically confirmed T1; this is an exception. The majority of T2s manage their D by diet (low carb) and oral meds such as the metformin, gliclazide or sitagliptin, that you are familiar with. I understand there are other oral meds. A few T2s reach a point where the oral meds don't help and they start on insulin injections.
You are in a minority Type 3 and even more unusual getting by with oral meds and diet control, but no insulin injections. So at first glance you are as if T2 BUT actually not T2 since you have pancreatic damage hindering insulin production rather than significant insulin resistance in your body. You could also have additional insulin resistance .... we all have a certain amount of insulin resistance which varies over the 24 hr day and can be markedly different from one day to the next. That varying insulin resistance is much more apparent to those of us fortunate enough to have Continuous Glucose Monitors (CGMs), allowing us some insight on our BG minute by minute and giving us the opportunity to take extra corrective action if appropriate.
So how does this all background knowledge help you.
I’ve been on a lot of high dose prednisolone and feeling very down about my asthma which has led to me “falling off the wagon” and scoffing chocolate, bread and potatoes. My diabetic nurse wasn’t happy with me and has made an appointment to see me in November, says I need to get back to 49 Hba1c and lose the 4lb that I’ve put on. My BMI isn’t too bad, about 26 I think - I’m 5ft 9in and weigh 12st 4lb, should be 12st or under.
Well weight control is a great help and with your BMI of 26 seems OK to my non medical view, yes those extra 4 lbs won't help but I think aren't at all serious. Losing a few more lbs can only help, as well; but as you say not too bad.
So that leaves the obvious interpretation, for me as a non-medical bod, that you need further medical help to compensate against your steroids. The question for me is who is best placed to provide that medical adjustment. If your 'diabetic nurse' is actually the GP Surgery Nurse who routinely looks after the T2s in that Practice then, with absolutely no disrespect to that diabetes nurse it will be unlikely that he / she has the knowledge and experience for the management of a T3(x). Your D does not originate from excessive insulin resistance and there may be other less obvious medications that could work for you.
Sorry to drone on but finding it so hard to get motivated again and steer clear of comfort food. Any suggestions are most welcome
Meanwhile you could do worse than review your current daily menus and see if there are foods (alas perhaps including those comfort foods!) which could lighten the strain on your hard working damaged pancreas. This would be akin to treating your food consumption as if T2. I'm not particularly knowledgeable in this zone, but plenty of others on the forum are.
The main thing is by writing within this forum you have taken a big step to getting remotivated and continued dialogue within this forum does seem to provide many others with that helping nudge to make some longer term "sustainable" changes. Until there is a big break through for your asthma treatment you look likely to be constantly dealing with these 2 quite different conditions of asthma and diabetes. I hope this is of some help to you. A problem shared is invariably a problem being reduced if not fully resolved and while you may not encounter many others with steroid induced diabetes you will almost certainly get help from reading how others manage their D. Sorry this is so long! Good luck.
