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Medical Forum / Diseases and Disorders / Diabetes / March 2006Prednisone, Type 2 and Insulin
Hi All Looking for some suggestions from insulin and/or prednisone users please. I have a friend doing chemo, including prednisone. He is type 2 and also has CLL. And before you reply - he is well aware we aren't doctors, but he is interested in learning from your experience. Here is his first request to me: "I would be interested in any tips you had to keep my diabetes more under control during treatment week. I am thinking that perhaps I am not getting enough insulin during those weeks, although last week was better and I tried to watch what I was eating even more closely. It only got over 200 three times and once over 250, but didn't hit the 300 mark. My very first week, the very first day it hit over 300. I am guessing you aren't doing insulin yet, but here is the scale they gave me: I am using the Humalog 100 units/1 ml Disposable Pen system: Blood < 150 take none, 151-200 take 3 units, 201-250 take 6 units, 251-300 take 9 units, over 300 take 12 units. Once I go off the 80 mg of Prednisone, I go right back to getting everything under control. I do find it odd that my numbers are even lower in the morning now after my third round. Before treatment they were usually around 95 to 105 in the morning. During normal times, my doctor wants them under 110 in the morning and under 120 two hours after eating. The morning I was at 65, I didn't feel any different than usual. Of course that was right before breakfast and so I had food in my system within a few minutes. If you do a Google search on Vincristine, you will see that neuropathy is a fairly common side effect. I am glad my oncologist was on top of that one!" (Vincristine was part of an earlier discussion). I offered some tips on carbs and test timing, including Jennifer's advice, but said that I could not advise on insulin and asked if I could ask the insulin users here. He replied, some time later: "I have not tested at the one hour point but I will do that this week as I am on Prednisone again. Today, before breakfast I was at 113, higher than normal for me at breakfast, but not high enough for insulin, of course. Before lunch, my numbers were only 99 so I didn't have to do the insulin again. We went out for my grandson's birthday party tonight and unfortunately I left all my supplies at home so I didn't test before dinner. Sheesh. Memory again! I only had the low number one time and yes, they did tell me what to do if it is too low and I keep orange juice in the refrigerator and carry some hi carb candy in my pocket, just in case. I certainly don't mind if you ask on usenet for any suggestions. I am open to anything and always trying to learn." Thanks in advance. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg  SignatureEverything in Moderation - Except Laughter. Well, Alan, I guess that fits me, huh??? :o) LOTS of similar experience as that of your friend. My email address is below if he wants to talk to me. It *might* be easier to do it privately; I don't know. Uggggggggggh.......... 80 mg per day!! Bless his heart!! Billie in AR MM 715 with Humalog Symlin 20u Prednisone now down to 20 mg per day bh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : Hi All : [quoted text clipped - 67 lines] : Cheers, Alan, T2, Australia. : d&e, metformin 2x500mg > Well, Alan, I guess that fits me, huh??? :o) LOTS of similar experience as that of your > friend. My email address is below if he wants to talk to me. It *might* be easier to do it [quoted text clipped - 17 lines] > : from your experience. > <snip> Billie and Alan: I missed the exact amount of prednisone involved. Is it a one time dose of 80 mg. at the start of a week of treatments, or a step-down dose over the week? High doses of prednisone causes very debilitating withdrawal symptoms if it is taken for a few days and then stopped "cold turkey". I saw that happen to a friend taking chemo for Hodgkin's' Lymphoma when the doctor screwed up her prescription. There are other side effects to watch for, including temporary mood swings that can come out of nowhere. My BG's used to swing from 6.0 to 15.0 mmol/l (108 - 270 mg/dl) when I took my maintenance dose of 15 mg of prednisone every other day. Now I take half as much every day, and the spikes are more manageable. Thankfully it has been years since I had to even take 20 mg per day. Dennis (Type 2, Kidney Transplant 1995) Maintenance dose 7.5 mg Prednisone daily Dennis, here is what he wrote to Alan: Blood < 150 take none, 151-200 take 3 units, 201-250 take 6 units, 251-300 take 9 units, over 300 take 12 units. Once I go off the 80 mg of Prednisone, I go right back to getting everything under control. No way to tell how he is taking it, and not even fair to venture a guess. I am sooooo impressed with your Prednisone level! So far, I've not been able to go beneath 20, and even 20 is pushing my luck, but that is what the doc would like for me to try to maintain; 25 works best for me, feeling-wise, but side-effect-wise the lower the better. Not sure what my asthma would be like if I were to go down another 2.5. Billie bh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : > Well, Alan, I guess that fits me, huh??? :o) LOTS of similar experience as that of your : > friend. My email address is below if he wants to talk to me. It *might* be easier to do it [quoted text clipped - 35 lines] : Dennis (Type 2, Kidney Transplant 1995) : Maintenance dose 7.5 mg Prednisone daily > Dennis, here is what he wrote to Alan: > Blood < 150 take none, 151-200 take 3 units, 201-250 take 6 units, 251-300 take 9 units, [quoted text clipped - 9 lines] > > Billie Billie, what are you now taking the daily 20 mg of prednisone for? I couldn't tell from your sig or letters, other than you had a thyroid problem and had had chemo at one time. The bugger of it after my transplant is that I went for almost five years on 15 mg of prednisone every other morning, with the spikes coming by lunch time and lasting until dinner time on those days. After I finally got an endo, he asked after our third appointment (almost 9 months) if the transplant centre couldn't change it to a daily dose. Three months later when I had my next transplant appointment, they just nonchalantly said, "sure, why not?". Bart Simpson moment - "Doh!" There is a an old cliche in transplant circles that applies to any medical specialty. The autopsy revealed that the patient had glaucoma, diabetes and heart disease, but the graft (transplanted organ) was still working at the time of death, so the transplant was considered successful. Dennis (Type 2) Dennis, I first started taking it for asthma. Back in the mid 90's I was on a breathing machine four times a day, with frequent complications of bronchitis and pneumonia. In Feb '65, I was diagnosed with Rheumatoid arthritis following the birth of my first baby six weeks previously. Throughout the years that one autoimmune disease has progressed, plus others have been added to the fold. :( I now have a diagnosis of Multiple Connective Tissue Disease which includes several, separately diagnosed autoimmune diseases, including Systemic Lupus. You must have gleaned from the Methotrexate that I have had chemo previously. :) No, it is also used with - not sure if it is off-label or not - autoimmune diseases. Though I had blood sugar problems before, the extended, and higher doses of Prednisone sent me into frank diabetes a few years ago. It also was instrumental in giving me osteoporosis with a large amount of bone loss. Consequently, when I took a bad fall last Labor Day, I ended up with a vertebral fracture, my T-9. Whenever I have tried to go lower than 20 mg, my allergies and asthma begin to act up in addition to the increased symptoms of the connective tissue diseases, the pain more than the other things like the fatigue and general system problems. Additionally, I have Cushing's Syndrome, and Sjogren's Syndrome, both from the excess cortisol. You can see why he wants my daily dosage to come down. *Maybe* one of these days, but not right now, though I never give up that goal; some other things will have to come in line before being able to do that. Having alternating doses like you had been doing will probably be the first step we will take if/when I go any lower. I am like a junkie with my Prednisone....... would LOVE to be able to be back at my 40 mg dose! That *really* makes me feel half normal. Every now and then, maybe once/twice a year, I do have to go on a large, 70 - 80 mg, titrating downward, but those times have been becoming fewer and further between. I *am* finding that I can control my bg better on the 20 mg dose. Hope you can know of a successful transplant without having to wait for the autopsy! :o) Billie bh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : Billie, what are you now taking the daily 20 mg of prednisone for? I : couldn't tell from your sig or letters, other than you had a thyroid [quoted text clipped - 14 lines] : : Dennis (Type 2) > Dennis, I first started taking it for asthma. Back in the mid 90's I was on a breathing machine > four times a day, with frequent complications of bronchitis and pneumonia. [quoted text clipped - 27 lines] > > Billie I know relatives with Lupus and thyroid problems, and methotrexate is also used for severe psoriasis. It is an immunosuppressant, like the new class of treatments for psoriasis that have been approved in the last couple of years. They affect BG's as well. Loretta took it I believe. Methotrexate is an older and harsher drug than the new ones for psoriasis, like Remicade (Infliximab). Similarly, Imuran (azathioprine) was one of the first immunosuppressants used in transplants, and is still used today. I take cyclosporine, which in the mid 1980's largely replaced it and opened the door to the explosive growth in successful organ transplants. In the late 1990's, newer drugs like CellCept and Tacrolimus came along, and then five years later Rapamune, and so it continues. Hopefully, the same thing is happening with other autoimmune diseases. Research in monoclonal antibodies seem to be at the forefront of many such diseases. In the meantime, I can see that you are stuck with the prednisone. Just remember my little anecdote about the narrow-mindness of specialists. If you have several specialists only worrying about their own little piece of your health problems, something could slip between the cracks. That leaves your GP or yourself to keep everybody in line. Good luck. For example, I am a little concerned about the progression of your osteoporosis. Were you sent for regular bone mineral density (b.m.d.) tests? Were medications for your osteoporosis tried? Some transplant centres in the USA do baseline b.m.d. tests at the time of transplant if the patient will be taking prednisone, and then follow up every few years from there. Mine didn't, but my b.m.d. at six years showed only a small weakening in the spine, with no apparent degradation in the pelvis or ankle. A follow up three years later in 2004 showed no change. I am due for another one next year. Since over 90 - 95 per cent of b.m.d. tests are for women, I got the "and why are you here?" look and question. Once I uttered the magic phrase "sustained dose of prednisone", they just nodded their heads in understanding. If the time comes, I will just add another pill or two to my daily schedule. ;-) Dennis (Type 2, Kidney Transplant 1995) Hi Dennis. No doubt Methotrexate is a harsh drug. I took it a while back, but due to liver problems, I had to stop it. Oh, what a bummer!! Once my levels were back to normal, we reintroduced it... aaaah.... :-) I am having problems keeping up with other immunosuppressant, and new ones on the block since I've been having so much problem with memory, concentration, etc. that has come along with this brain atrophy. :( I struggle just to find common-to-me words that I've used so fluently throughout the years, and having a worse time introducing new words and concepts, especially that having to do with my computer usage. I have forgotten how to use some of my software that I've been using since the early 90's, have forgotten even what software I have either on here or in my stock waiting to be added. I've had to pay for my computer tech work for the first time, and it has been hard to turn my computers over to someone else. I digress, though. Talking about this has just reminded me that I forgot to take my mtx injection yesterday. Osteoporosis. I *do* take Actonel. Have had two bone density tests, with the last one showing about 35% loss. My pain doctor first noted it several years ago during a block for my sciatica. I took a bad fall at Hampton Inn last Labor Day resulting in a fractured vertebra which required kyphoplasty surgery which was a great success. I was very lucky that I did not end up with a hip fracture, though it *did* leave me with a lot of bruising in the hip area which is still bothering me today. I am glad that your Prednisone did not have a bigger impact on your bones than what it did. My heavy use of it started back in the mid 90's which is pushing on up to about ten years now, and *I* am lucky that mine is no worse than it is. I have a good rheumatologist who is very straightforward, and lays it all on the line which I really need sometimes because I get so tired of managing all of this and get lax. My GP is my internist, who does an excellent job of being the overseer. He was recommended to me by our family psychiatrist, and I have been so thankful that I found him. He doesn't hold on to me whenever I need to see a specialist, but also is not too quick to jump in there, putting too many in there stirring the pot. He also knows how I hate adding other doctors, too. Been traveling down this road for too many years, 42 of them now since my initial onset of rheumatoid arthritis. Even at that time I had already had more than the normal childhood problems, some requiring a two week stay at Oschner Foundation Hospital in New Orleans seeing a pediatric heart specialist. Spent my 16th birthday there. LOL My trig teacher in high school told me in, I think it was my senior year, that I needed to donate my body to medical science. Oh, how I'd like to see him today, and let him know how much worse it got after I finished school. At 18 y/o I had already experienced more than most people see in a lifetime. Oh, well, it could surely have been worse; I could have been left with much worse heart problems from the rheumatic fever than what I was. I also am thankful for my mom who could have held me close to home, but allowed me to go ahead and be a normal kid/teen, which laid a great foundation for what was to come when I married into the Air Force. Jim was on his second enlistment, and had decided on a career in it. Whew! What an interesting life we had ahead of us!!! 'Nough said now probably. Will be talking to you, along with John. Fell asleep last night, and did not get back to him, but am headed there very quickly now. Thanks for your concern. I have a great team that works wonderfully well together, each keeping the other informed, but with my Internist at the helm. Billie bh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : I know relatives with Lupus and thyroid problems, and methotrexate is : also used for severe psoriasis. It is an immunosuppressant, like the new [quoted text clipped - 32 lines] : : Dennis (Type 2, Kidney Transplant 1995) >Well, Alan, I guess that fits me, huh??? :o) LOTS of similar experience as that of your >friend. My email address is below if he wants to talk to me. It *might* be easier to do it >privately; I don't know. Uggggggggggh.......... 80 mg per day!! Bless his heart!! Thanks Billie, I'll pass the address on. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. Sounds good. I'm glad I can be giving back for all that I've gained from being here these past few years. My endo gave the group a thumbs up several years ago when I dropped my a1c after learning about testing and all. I have been blessed with finding good groups of people with lots of good support and information, but most important of all is the excellent endo I found. Billie bh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : Thanks Billie, I'll pass the address on. : : Cheers, Alan, T2, Australia. : d&e, metformin 2x500mg >Sounds good. I'm glad I can be giving back for all that I've gained from being here these past >few years. My endo gave the group a thumbs up several years ago when I dropped my a1c after >learning about testing and all. I have been blessed with finding good groups of people with >lots of good support and information, but most important of all is the excellent endo I found. > >Billie Thx Billie. Can't promise he'll get in touch - but I've sent it. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. |
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