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Steroid induced hyperglycimia/diabetes? so confused, lots of questions about my sugar levels.

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Posted 8/16/2014 6:35 AM (GMT 0)
In advance I do apologize, I"m very afraid of this being a permanent/month+ thing and am so stressed out. I know nobody here is a doctor or anything, but I won't see a doc for probably about a week and I need some kind of assistance in getting this at least a little more under control. I'm having a very hard time eating any kind of carbs at the moment, let alone being able to have anything to nibble on as any kind of treat... and I"m already restricted on fats and salt too, so it's getting more and more difficult figuring out what I can even eat... getting more tempted to try to just eat protein and avoid carbs all together... though i know it isn't possible.

This is my second day being fully out of the hospital and I'm so confused about my blood sugar levels, i need to get them under control and don't understand why my levels change the way they do, hoping to get some help. :(

Body info: 5 foot 5 inches, about 115 pounds. Male, 24 years old.

Sugar controling meds: "Lantus 10 units one daily" and "HumuLIN R, sliding scale before meal and bedtime"

Story:

I was prescribed 30mg prednisone to try to help reduce the inflammation in my liver... sadly the doctor didn't give me much information about the side effects and what to look out for. The first month I... acquired thirst (never had it before so it was good) but then I got all the hyperglycemia symptoms... major thirst, blurry vision, metallic taste, tiredness, the works. After about three weeks of this (about 7 weeks on prednisone) I went to the hospital because of a major cough and worry about my mouth, thinking i had an infection. My sugar levels were at 700, they tested me for some acidosis stuff in my arteries and didn't find it, so they said I don't have diabetes. Now I'm getting weened off the steroids and hoping this gets resolved quickly.

While in the hospital my sugar levels were around 250 before meals and what not, and 70-110 in the morning, so things seem to be going good... BUT now that I'm home I am having HUGE trouble controlling things. The dietitian gave me pamphlet to try to help me eat right, so 4 carb choices in the morning, 3 lunch and dinner, 2 before bed... but it doesn't seem right for me at all!

I wake up my first morning after eating 30ish grams of carbs the night before and I'm at 160, ok for my first morning... 430 at lunch, was sucking on halls I bought before and didn't know about sugar alcohol, 256 at dinner yay?! 406 before bed, "sugar free" candy having sugar alcohol that I didn't notice till it was too late uhg... Learning day... so I guess it wasn't too bad...

This morning I'm at 115 ish, great! Looking forward to getting on the right track and having a happy day... but then I try to eat the way this pamphlet says with 4 carb choices and i'm up to 360! so I eat lunch aiming at 3 carb choices and I'm at 370! ... I decided to forget the pamphlet and aim at 2 carb choices for dinner and i'm at 250... I don't know what's going on! :'(

Questions, ideas, stuff:

What are "good" levels for someone like me to have before I eat? I was told to measure my sugar levels half an hour before I eat if that means anything at all...

So... I"m thinking about taking the suggestion the dietitian gave me and eating 2/3ds what she suggested for carbs for my meals to try to keep my numbers low... maybe lower idk. Is this a good idea or there something better that I should do? I am so confused.

Last night I ate 2 granola bars for 30-40 grams of carbs and my system brings me down to 117! Why is my body so happy when I sleep, is it my kidneys cleaning up my blood? I did have to get up once at like 6am to go to the bathroom. What can I do to make my levels more like this?

Has anyone had any experience like this? When I was in the hospital the nurse that was watching over my sugar levels seems VERY happy about my morning numbers and how they liked to be around 70-110. Is it really that good for steroid induced hyper?

Edit: I miss gummy bears already D=

Post Edited (EPhantom) : 8/16/2014 12:38:05 AM (GMT-6)

Posted 8/16/2014 12:29 PM (GMT 0)
Hello and welcome EPhantom. I'm sorry you're going through the mill with this. There are other members who also have dealt with steroid-induced diabetes and blood sugar problems and I hope they can also help you.

I honestly don't know why the body will sometimes respond like that (unpredictably) on prednisone withdrawal. I can help you with food though.

As you know carbs are what will make the blood sugar rise and normally when a patient is on prednisone, the doctor will warn the patient to cut back on carbs and sometimes prescribe insulin until the blood sugar comes down. Now that that's done, the blood sugar should be slowly come back down to normal.

If I were you, I would eat for the blood sugar which means cut out the carbs and don't try to eat the "recommended" carb choices because they will keep your blood sugar high. Please know that I am not a doctor. I do know what food will raise your blood sugar though and if you stick to the carbs recommended (2 or 3 etc. for a meal or X amount during a day) your blood sugar will not come down.

Eat a normal portion of meat/chicken/fish and a variety of vegetables (but not potatoes, root vegetables, or corn) and leafy greens. Salads. A small portion of bean, maybe. Nuts. Some dairy if you like yogurt and cheese.

A non-diabetic's blood sugar is usually under 100 all day except after he eats a meal with carbs like pasta or rice or potatoes and then it might go up to around 120 but come down to under 100 after an hour or so.

Normal fasting is in the 80's. If you continue to have trouble with the blood sugar fluctuating and not coming down, you should consult an endocrinologist who is a specialist.

I would hope that if you go very low carb, your numbers would come down better. Most food has carbs with the exception of oil. If you were to eat an entire head of lettuce you'd have carbs that could affect blood sugar, but eating a few leaves in a normal salad should not bother you.

Good luck and keep posting.
Posted 8/17/2014 5:54 AM (GMT 0)
I added a "estimated carbs" section to my spreadsheet... At night, i guess you would call this my fasting period, my blood sugar drops like a rock unless I go a little insane and eat 50+ grams of carbs... 40-50 grams during the day brings me around 215... and with one test so far, if I eat around 20 grams I'm at 130, which is where the doctors are telling me is the border where I start to need insulin. I hit 138 and the scale says 131 to 150 i should take two "units" of insulin, but because I'm not going to eating tons of carbs before bed like the nights before while trying to figure this all out... I decided it's low enough to not inject anything to make sure I don't go hypo while I sleep.

So... should I be aiming to eat just 15 to 20 grams of carbs so I don't have to take any "regular" insulin throughout the day? Anyone have any idea if this would be best to help with the whole insulin resistance?
Posted 8/17/2014 12:33 PM (GMT 0)
Well, as I answered in my first post, I think you should eat for your blood sugar. I don't eat more than 30 gr. of carbs a day. If you follow the ADA plan for recommended grams of carb a day, your blood sugar will remain high.
Posted 8/17/2014 11:56 PM (GMT 0)
Giving an update to help people see what can happen with prednisone like steroids.

So... I"m trying to track my carbs and sugar levels... now tracking how much insulin I inject pre meal... today was an odd day.

Related meds at breakfast:
15mg prednisone (20mg yesterday)
10 "unit" injected Lantus
0 "unit" injected "regular"/HumuLIN R insulin

blood sugar level before eating first meal = 123mg/dl

Meal: 4 egg whites, 3 slices of deli ham, some low fat chedar cheese, about a cup of cantaloupe
My estimation on carbohydrates before next measure: around 20g
My estimation of carbohydrates of dinner the night before: 22g
Blood sugar level around 4 hours after last nights dinner: 138 mg/dl
My expectation blood sugar level 4 hours after breakfast: less than 130 mg/dl
ACTUAL blood sugar level 4 hours after breakfast: 200 mg/dl

Yeah... doesn't look like it makes much sense at all... I'm pretty sure what's going on is my liver can't see the sugar in my blood cause of the insulin resistance caused by the prednisone. Liver can't see sugar in the blood, so it thinks there is a problem and tosses some in the blood stream till it's happy...

Note: I've been trying to spread my meals out the say the hospital did during my ER stay. So each meal is about 4 hours apart, blood sugar levels are taken around 30 minutes before eating as suggested by my ER.
Posted 8/18/2014 12:42 AM (GMT 0)
Meal update
Estimated carbs from lunch: 30 g from 1 large peeled cucumber, 1 large tomato and 16g from yogurt (3 slices of deli ham with estimated 0ish carbs)
Expected blood sugar level based on breakfast: probably around 230-250 mg/dl (expected 40mg/dl per 10g of carbs consumed)
Actual blood sugar level: 181 mg/dl

it's lower even though I ate 10g MORE carbs...

Prednisone is metabolized by a normal liver at a rate of half per hour... my liver isn't that good so its a bit longer. But because there is less of this steroid in my body, my insulin resistance has decreased therefor making my liver produce less sugar and making it so it takes more carbs to affect my levels.

Tomorrow morning I will try to remember to eat just some egg whites and ham making my carbs less than 2 grams (tiny amount of carbs in egg whites and in the deli ham I have should still be considered). We should see my blood sugar still spike up even though I don't really add any carbohydrates to my system.
Posted 8/18/2014 1:39 AM (GMT 0)
Keeping track like this will certainly help you understand what's going on. I hope that you will eventually get back down to normal though. Fingers crossed for your fasting blood sugar tomorrow and post prandial after breakfast!
Posted 8/18/2014 7:38 PM (GMT 0)
Update

Related meds in the morning:
15mg prednisone
10 "units" Lantus
0 "units" regular insulin

Morning blood sugar level: 103 mg/dl
Morning carbs ingested estimation: 1-2g from 3 egg whites and 2 slices of deli ham
Walked 3-4 miles
Blood sugar level 4 hours after breakfast: 160 mg/dl

This is what these kinds of steroids do. My liver can't see the sugar in my blood so it throws tons into my blood stream. Even though I walked for about an hour and a half to lower my levels, they still shot up.
Posted 8/18/2014 8:53 PM (GMT 0)
It seemed like a better fasting. Although I may not fully understand the working of the liver in your case, I do know that blood sugar will rise for a time after exercise.

When will you be finished with the prednisone?
Posted 8/18/2014 10:38 PM (GMT 0)
I have one more day of 15mg, three days of 10mg, then I am off. I am not sure why they didn't give me three days of 5mg, but I will be talking to a large hospital here in michigan about it to understand more and make sure this is an ok taper.
Posted 8/19/2014 4:56 AM (GMT 0)
Had a kiwi and chicken for dinner, about 30 carbsish. Four hours later I'm at 97 mg/dl.

Post Edited (EPhantom) : 8/18/2014 11:32:22 PM (GMT-6)

Posted 8/19/2014 12:29 PM (GMT 0)
Another experiment... Stayed up to make sure I could call the doc to schedule my follow-up from the ER visit that the hospital told me to make... basically got a no from the doctor (no room till november, ***) and waiting for a call from a larger hospital to get info on what's going on... so let's have breakfast early!

Blood sugar level 113 mg/dl
No "regular" injected insulin
Lantis last injected 20 hours ago, 10 units
taking 15mg prednisone
breakfast: yoplait light 16g carbs, multigrain cheerios with low fat milk 40g. total 56g of carbs

Decided to measure an hour after, 256 mg/dl.
With information about a glucose tolerance test, link below, and just having taken prednisone, I'm alright with that number.

Will update this post in 4 hours

Glucose tolerance test (don't try this on your own, I"m not even insane enough to do such a thing while on insulin or this steroid)
no food or drinks for 8 hours, then a 75g carb drink. One hour after a non resistant/diabetic will be below 200 mg/dl. two hours after levels will be below 140 mg/dl
http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm

Post Edited (EPhantom) : 8/19/2014 7:43:35 AM (GMT-6)

Posted 8/19/2014 1:13 PM (GMT 0)
I'm glad you're documenting what you're eating, the blood sugar and the meds. I hope everything goes back to normal when you finally get off the pred!
Posted 8/19/2014 7:02 PM (GMT 0)
I tried to get some information from the hospital that prescribed the prednisone in the first place... I didn't get to talk to a doctor, so I"m still walking in the dark... they said they will "try to schedule an earlier appointment"...

Now I"m scared and freaking out... I don't know what I"m going to do if I become diabetic... my doc told me that I'm at a higher risk like two years ago... then they didn't give me any warnings when they put me on prednisone... had I known I would have said no... and didn't tell me what to look out for symptom wise. I won't be able to eat much at all if this sticks...
Posted 8/19/2014 7:19 PM (GMT 0)
an hour after my morning measurement I had some white chocolate coffee with no fat milk in it at a cafe... idk how many carbs, probably anywhere from 30 to 45... so "breakfast" had... idk 80 to 100 carbs before taking any insulin at all... measurement at 4 hours after the 56 carbs and 2 hours after the 30-45 my level was 235. Then took my lantis and 6 units of insulin and ate two slices of deli ham.

"lunch" 0 carbs. at noon
three hours later I'm at 173 mg/dl , taking 4 units of insulin.

Just... feeling really depressed right now... Feeling like I"m falling apart mentally right now :/
Posted 8/19/2014 7:51 PM (GMT 0)
First of all, get a grip. There's a fine line between being concerned and falling-apart here. In my opinion, you're pushing the envelope eating/drinking all the high-carb stuff. If you already know your blood sugar is high and will rise because of the prednisone therapy, then why are you ingesting all those carbs!

You need to eat more sensibly, low carb food and drink until you're off the steroid and you see your blood sugar hopefully going back down to normal.

Please, eat some regular meals with a piece of protein and some vegetables (no corn or potatoes). Eat lettuce wraps with some slices of luncheon meat and cheese. Yogurt with no sugar added or artificially sweetened yogurt. Snack on cheese and nuts.

You will see better blood sugar results if you do not eat Cheerios or drink those coffees with lots of sugar.

Please do this and report back here!
Posted 8/19/2014 8:06 PM (GMT 0)
I literally just ate some cereal and what not... I don't have a job to get good food or anything, I just have some support from my dad and the people I live with for food. And with the symptoms of the prednisone, I can't work for a while... Idk how long it's going to take to recover... tried to jog yesterday just to cross the street and I immediately collapsed in the middle of one of the busiest streets in town... I"m just lucky i waited for all the traffic to have stopped at the lights on both blocks away.

I just feel like breaking down because I'm not getting any help from the medical community. It's like they didn't care if I get diabetes, and now that my sugar is up I"m just... abandoned.

I was supposed to get a followup appointment for after the ER visit, but apparently they have no openings till november. The diabetes center of the hospital that prescribed the prednisone to me has me talk to a nurse who just takes my info and tells me she'll try to make a closer appointment... I wanted to get a few answers, some info, something... a clue on what to look out for, something...
Posted 8/19/2014 8:18 PM (GMT 0)
I'm sorry you're not getting the support you need but I'm glad you have your dad and some friends. May I ask how old you are and where you live?

I would be mad and confused if I were you, too. I'm trying to give you the best information I have so please bear with me. I'm not a doctor but I know about food.

You need to eat better and if you can possibly avoid those high-carb things, please do that. A package of chicken and some packages of frozen vegetables are cheaper than a lot of the fast food or other packaged food and drinks. If your dad can either buy some of this or give you the money, you would be eating much better and your blood sugar would be much lower. Frozen spinach, broccoli, cauliflower and green beans are all good choices. The reason I'm suggesting frozen vegetables is that you can take a little out of the packages and then put the rest back in the freezer. Fresh is better, of course, but fresh vegetables can wilt and go bad if you don't eat them fast. A package of chicken parts can be cooked and you can eat one piece at a time.

Does this help?
Posted 8/19/2014 8:30 PM (GMT 0)
I'm 24 and live in Michigan. I didn't work while I was in college cause I wanted to be able to focus on my studies, but I had a hard time... doctors say my thyroid should have made it so I didn't really want to get out of bed, let alone pass any classes that I did. Then my Ulcerative Colitis popped up, took to incompletes then couldn't focus at all in class or anything and I had to drop out, liver got worse and got eczema and I couldn't sleep at night, For about a year I got probably 1-3 hours of sleep a night. Felt horrible all the time and never looked for work because I never knew when I would even be able to fall asleep, let alone when I"d be awake.

I think I"ll have to get some frozen vegetables... I can't have fats or salt cause of my liver, so I already don't eat most packaged foods and I don't really eat out at all.
Posted 8/19/2014 8:49 PM (GMT 0)
Ok, you need to choose the food that will not aggravate the UC (and I don't know about this, so if I'm suggesting any food that's not appropriate for a UCer, you need to tell me and take it off that list.)

While you're on the prenisone, keep your carbs as low as possible. You will not pass out or feel weak if you're avoiding the carbs as long as you eat decent food. See if you can get some money together and shop for those frozen vegetables. Otherwise, some bell peppers, cucumbers and some tomatoes can be eaten with some lettuce and cheese. If you can eat chicken, then buy a package of chicken parts or a whole chicken if you want. If you buy a package of parts, then wrap the parts individually and put them in the freezer so you can take one out at a time. If you buy a whole chicken, you'll have to bake it. Then, you can take it apart and wrap up parts individually and freeze them. The point of this is to save money and eat decently. You can do the same with most any meat package. Look for sales.

Aim for a piece of protein at meals with some vegetables. Fruits have natural sugar and depending on how much you eat your blood sugar will rise but part of a banana would be fine. Again, you can actually buy frozen berries and just eat a few and put the rest back in the freezer. It's the same problem with vegetables as fruit. Sometimes, I'll buy a little container of strawberries and some will go bad before they're finished.

This will help you feel better in general. Maybe you can look into some counseling in your city. Most cities have free services for those who are unemployed.
Posted 8/19/2014 9:01 PM (GMT 0)
started doing a little bit more reading online... the fact that I didn't have any ketones (that I know of) and that I remember the doctor saying I had "very mild pancretitis" at the ER is making me feel a little better... I stayed up all night to try to get that follow up and talk with a diabetic doc at the big hospital... I may go to sleep in a bit

Last time I tried to get help from a free service place was when I just wanted to get back on my thyroid meds... they rejected me and told me to go to the large hospital that was treating my liver... the large hospital told me to find someone in my own town to take care of it (at that time)
Posted 8/19/2014 9:08 PM (GMT 0)
Ok, do what you need to do to pursue your other health issues. Maybe someone at the hospital can refer you to some healthcare or other free services where you are living. As you dad to help you do this if he can.

Get some sleep, eat better and get some mild exercise when you're feeling better.
Posted 8/19/2014 9:22 PM (GMT 0)
My father won't be much help... he's a schitzo... believes in demons and that everything will get better cause "god says so"...

How many carbs should I take per meal? I mean... if I take none then how will I know if my pancreas is producing insulin? will my blood glucose just drop and show that I need to take less insulin?
Posted 8/19/2014 10:09 PM (GMT 0)
I don't count carbs. I eat as I described above: a piece of protein and vegetables, salad food (lettuce, cucumbers, tomatoes) but maybe not all of this in one meal.

The fewer carbs you eat, the less insulin you need, so, yes, your blood sugar will be lower. If you have to inject insulin based on what your blood sugar levels are, then your need for insulin would be lower. The pancreas will know how much and when to produce insulin on its own, and hopefully it will go back to normal once the prenisone is out of your system. The only time the pancreas does not produce insulin is when you're a type 1.

If you're only on the insulin because of the steroid medication, then you should be using less and less and your blood sugar goes down.
Posted 8/19/2014 10:38 PM (GMT 0)
I'm feeling much better... went on a internet depression scavenger hunt and I stumbled across two articles. One talked about the pancreas and it's insulin production, and then remembered that one of the doctors said something about mild pancretitis (normal for me cause of my liver) and decided to call up the ER here to see if I could get any of my information about my pancreas labs and what not. I got ahold of one of the nurses in the ER, not a specialist or anything, and she told me what I need to do and how much I should eat and that this should all just blow over... which makes NO sense that she would know and the nurse at the diabetes center at the large hospital doesn't know anything about prednisone... the nurse at the diabetes clinic didn't understand how my blood sugar increased when I didn't eat any carbs, but the one at the ER here did completely! She seems to understand this and have experience, she had complete confidence in what she said, I have to at least trust her for a while. I mean absolutely no offense to you and appologize if you are offended :(

I think having hypo issues prior to this is a good thing... for all I know my kidneys and pancreas are actually super heros for being able to keep up with all the stuff thrown at them...

She was telling me that I should still be eating carbs every meal and once my blood glucose gets down below the taper level for my humulin R is when I"ll be able to start getting off the lantus.

She also informed me that taking my meds at the times I have been, waking up at noon and taking them then, is probably messing things up and making things worse... and the morning I didn't eat carbs was probably bad too, so eating low carb is a bad idea. So I"m going to have the people I live with wake me up earlier so I can eat breakfast at noon. And I was told that I need to make sure to eat in 4 hour intervals (been trying to do this already) for this treatment.

So we'll see what happens with about 30 carbs per meal as the dietitian suggested... I"m just glad that some medical professional of some kind has info and is able to talk to me about what's going on... Not feeling so abandoned anymore. who would have thought it would have been a nurse at the ER at the hospital I don't like that would be the one to give me ANY relevant information about steroid induced? Go figure.

when this is all over I'm going to have to hunt her down and thank her somehow.

Will take a measurement at 9 to see where I"m at... I"m going to go get some better carbs to work with than cereal starch...
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