Prednisolone

P

PaulG

Well-Known Member
Relationship to Diabetes
Type 2
I've been put on this since 31st Aug, 30mg per day for 2 weeks, reducing to 25mg for a week, to 20 then 15 then 10 etc.
This is for my lung problems.

My finger pricks have been sky high lately, mostly high teens and even low twenties; 24 first thing this morning.

Its taken me a while to connect the two but at 04.30 this morning I looked it up. ( Insomnia is a side effect but I'm not loosing sleep over it. )
I found this amongst other info:-
Paul G
Screen Shot 2024-09-27 at 05.42.04.png
 
I was aware there was a link but was only diagnosed as diabetic at the end of July. I have an intermittent eye condition. Anterioruveitis and self refer if I have a flare up. Last time was May 2023. However in 2011 I referred late and was diagnosed with macula oedema and was given a tapering 6 week course of steroids. Apart from that if I have a flare iuse prednisone for 6 to 8 weeks as eyedrops.

I'm due to have a cataract op and when I saw the doctor in August she said they were likely to put me on drops before the op. I had told her I was diagnosed diabetic the previous month and she showed me how to put drops in so they stayed in the eye rather than went in the blood stream. I assume your steroids are vital and you will need to contact the doctor or diabetes nurse as to how to manage the type 2 in tandem.

Hope you get good advice.
 
Hello @PaulG,
Could you just confirm that you recently started week 5 of taking prednisone at 5mg per day. Is it anticipated this will be a long term medication at that level, or by the end of week 5 or 6 you should be down to nil?

My question arises, because your GP ought to be aware that steroids routinely elevate Blood Glucose (BG) and if this is a 5-6 week phase that degree of BG elevation could be considered acceptable in the long term but unacceptable if the steroids are going to be permanent.

There is a category of Diabetes, akin to T3c, but accurately is T3e; this is not widely known and steroids induced diabetes is often mistakenly called T3c. Either way, the important thing is a T3e or c diagnosis can (should) lead to an external referral to an Endocrinologist and that might lead to much more specialised medications being prescribed, including insulin and the possibility of having a Continuous Glucose Monitor (CGM). In general such specialised treatments are outside the experience of General Practice. So GPs aren't appropriately trained for managing T2 with "extras" that make them T3e.

That said, presumably, there is an element of trial and learning from your prescription of Prednisone which could need a slight "wait and see" result and meanwhile you need to manage your T2. How long have you been T2 and what meds, if any, are you taking for T2?
 
Proud to be erratic said:
Hello @PaulG,
Could you just confirm that you recently started week 5 of taking prednisone at 5mg per day. Is it anticipated this will be a long term medication at that level, or by the end of week 5 or 6 you should be down to nil?

My question arises, because your GP ought to be aware that steroids routinely elevate Blood Glucose (BG) and if this is a 5-6 week phase that degree of BG elevation could be considered acceptable in the long term but unacceptable if the steroids are going to be permanent.

There is a category of Diabetes, akin to T3c, but accurately is T3e; this is not widely known and steroids induced diabetes is often mistakenly called T3c. Either way, the important thing is a T3e or c diagnosis can (should) lead to an external referral to an Endocrinologist and that might lead to much more specialised medications being prescribed, including insulin and the possibility of having a Continuous Glucose Monitor (CGM). In general such specialised treatments are outside the experience of General Practice. So GPs aren't appropriately trained for managing T2 with "extras" that make them T3e.

That said, presumably, there is an element of trial and learning from your prescription of Prednisone which could need a slight "wait and see" result and meanwhile you need to manage your T2. How long have you been T2 and what meds, if any, are you taking for T2?
Click to expand...

All the tablets are 5mg. boxes and boxes of them. I took 6 per day for 2 weeks starting 31st Aug. 5 per day for a week starting 14th Sept. 4 per day for a week starting 21st Sept and today would be the last day. I should start on 3 per day starting tomorrow. But I'm not going to.

My lung problems began a year ago with an infection of black mould. Tabs prescribed by the dr in charge of the respiratory ward, local hospital.

Diabetes meds are 1000mg metformin in the morning and again evening. 36 injected units of insulin morning and eve.
 
Sorry to hear you’ve been having a tough time with your course of steroids @PaulG

It sounds like your diabetes meds could have done with some adjustment to keep your glucose levels in balance while on the steroids.

It should be possible to adjust your insulin doses to reduce the impact of the steroids. Adjusting your metformin might also be an option to reduce your insulin resistance.

Sounds like you would be advised to have a chat with your GP or nurse to help you finish the course? Are you due follow-up from the respiratory ward?
 
PaulG said:
I called 111 and I am awaiting a visit from the out of hours doctor who wants to test for ketones.
Click to expand...
Thanks for your earlier reply. How long have you been T2 and at what stage did you progress from oral meds to insulin?

Do you get periodic reviews of your insulin dosage at your GP's Surgery?

Do let us know how the out of hour Dr's visit went, particularly the ketone's result.

In the final analysis it does seem strange that no attempt was made to match your recently prescribed steroids with extra insulin. Like @everydayupsanddowns I do think it would be best to complete your full course of steroids, or get the prescribing Consultant to urgently review what is happening. This could be triggered if the visiting out hours Doctor included a copy of his report to that Consultant. This ought to occur since you are still technically not discharged from that Consultant's care and, as that Consultant's patient, that Consultant really should be fully informed about this event.
 
The ketone blood reading was 0.2 to which the doc said this was good.
She phoned through to the West Suffolk Hospital from the computer in her car (which records all the details) and my insulin has now been increased from 36 to 40 units. Details of her visit have gone onto my records so visible to both hospital and my GP's surgery.
.
.
I see the situation like this:- The respiratory doctors don't look at anything to do with my diabetes and vice-versa,
thus no warning was given about a conflict between Prednisolone and Insulin. This may have saved a few minutes at the time .... but how much did an OofH doctors visit cost the NHS at 10pm ?
.
Thanks for the replies everyone, Paul G
 
Glad you had a safe outcome; and yes, the sense of each HCP working in their own silo oblivious to anyone else or the Patient's wider need is hard to understand.

I have been under 6 Specialists for a lot of my 4 yrs since my Whipple; slowly reducing, despite adding the Stroke team after this year's TIA. I've learnt to ask each about the connectivity with my other challenges - it's in my self interest! I'm always disappointed that I have to do this. Each Consultant report regurgitates the stuff about me from my medical records, a lot of which is in itself inaccurate. I've tried to get the worst of those things corrected, but hit the brick wall of "not incorrectly written by that Specialist, so it's too difficult to correct".

Hope your insulin increases help you from here onwards.
 
Great to hear your levels have been coming down @PaulG

So unfortunate that there wasn’t joined-up thinking when you were started on the steroid - it’s a pretty well-known reaction, and at the very least you should have been made aware of the likely impact, and directed to talk to your diabetes Dr about dose adjustment.

Glad you ave it sorted at last though!
 
You must log in or register to reply here.
Back
Top