Prednisone

Been having to take prednisone off and on for the last few years for
problems with my legs. Although the prednisone helps my leg problems, it
really plays hell with my levels, even when I try to eat less. Normally my
levels will stay below 130 and I feel fairly good, but with the prednisone
the levels go over 200 and I don't feel like doing anything.
If I do some work/exercise the level comes down, but it can be very fast
and reach the 70 and lower levels. Of course I then have to eat something to
get it up and it will shoot up high again.
Anyone have any ideas for keeping the sugars down to a reasonble level?

"MB" <olddragon@earthlink.net> wrote in message
news:INu8h.1422$sf5.759@newsread4.news.pas.earthli nk.net...
: Been having to take prednisone off and on for the last few years for
: problems with my legs. Although the prednisone helps my leg problems, it
: really plays hell with my levels, even when I try to eat less. Normally my
: levels will stay below 130 and I feel fairly good, but with the prednisone
: the levels go over 200 and I don't feel like doing anything.
: If I do some work/exercise the level comes down, but it can be very fast
: and reach the 70 and lower levels. Of course I then have to eat something
to
: get it up and it will shoot up high again.
: Anyone have any ideas for keeping the sugars down to a reasonble level?
:
:
You don't state if you're a T1 or T2... You also don't state if you're on
any DM
medications...

I have a couple of suggestions. You could benefit from a low dosage
probably
of Lantus at night or first thing in the morning to help keep your glucose
leveled
out through the daytime. With the extra insulin in you, when your body
starts to
process the Pred the background insulin *should* take care of the rise,
coupled
with your daily exercise... you would have to be careful with the exercise
because
it could cause you to drop very quickly and hit below 70 at any point. So
testing
frequently would be key.

Another suggestion would be to ask your doctor for say, Regular Insulin.
Reason
I mention this older type Insulin is because it takes up to 30mins to start
to work
and it's peak is around 2-3hrs and is usually gone within 6-8hrs, iirc. I'm
assuming
you're taking the Pred before 9am, (as recommended on how our bodies work)
so
it would just be a matter of timing of when the Pred hits your system to
cause you
to start to go high and counter it with the Regular Insulin.. This is faster
acting and
has a bit more punch then the Lantus. BTW, Regular Insulin can be bought OTC
without a prescription, depending on your state if you need a script for
syringes is
another story. Most pharmacys I've found if you're buying insulin and
syringes at
the same time don't bother to ask for a script for the syringes.

Another suggestion would be to ask your doctor for an oral medication such
as Starlix
or Precose? IIRC.. I'm not sure if those would work with a medication
induced high..
they are oral meds usually taken when a T2 eats to help fight off the carbs.
Maybe
ask your doctor if they're resistant against giving you insulin.. Another
one might be
to go on Metformin if you aren't on it yet. Studies have proven that T2's
can benefit
greatly with using Metformin even if they have lower IR. It has shown to be
a good
Heart protection medication.

Last suggestion is to ask your doctor about using Byetta. There are studies
currently
going on in Lousiana with using Byetta and women who have PCOS which is
mainly
high IR, which is what Pred is inducing as well. So, I would think it would
have the same
assistance. This is a newer medication and clinical trials are still being
conducted so
your doctor might not be too hip on this suggestion.

If it were me... I would first opt for the Byetta because of how well it
works with reducing
the IR, my second would be to ask for the Regular and if my doctor refused
I'd go get it
myself.. But thats just me and what I've learned after several years of
reading and learning
about MY disease.

Best of luck and let us know how you make out...

Reisa, T1 Pumper Animas IR1250
TDD: 34-38u

T2 - Currently taking avandia 8mg and glyburid 6mg daily. Been taking the
prednisone in the evening just before bed time - I don't eat when I'm
asleep. I have been using an extra dose of glyburid when the levels are
high but it takes awhile for it to come down.

"MB" <olddragon@earthlink.net> wrote in message
news:qov8h.1606$ql2.407@newsread3.news.pas.earthli nk.net...
: T2 - Currently taking avandia 8mg and glyburid 6mg daily. Been taking the
: prednisone in the evening just before bed time - I don't eat when I'm
: asleep. I have been using an extra dose of glyburid when the levels are
: high but it takes awhile for it to come down.
:
:

Ouch! the glyburide is hard on your pancreas as it forces it to produce
more insulin then it normally would.. Some would say, it's a good way
to burn out your beta cells faster then it normally would. The avandia
is a good sub to metformin so you're taking a IR med.

Did your doctor tell you to take the Pred before bed? When I was taking
mine, I was told by my doctor, the pharmacist as well as the insert slip
that said to take it before 9am. I guess our bodies naturally put out the
Cortisol (the steriod) before 9am for our all day supply. I also read up
on it and thats what it said as well. Granted your condition might be
different and require it to be taken at night.. again.. YMMV.

Best of Luck.


--
Reisa, T1, Animas IR1250 Pumper
DX-5/00 ASD-7/00
A1C: 6.2% (8/24/06)
Daily CHO: 150-200gm
TDD: 34-38u

The included prednisone instructions say to take before 9am, but no reason
why. And I have found that my sugars rocket after taking it and after each
meal. Asked my doc if the time was really important and he said not really,
mainly to take it within the same time frame each day. From what I could
find out, the early morning was suggested because it should be taken with
food to keep from having stomach problems and it affects sleep.
It doen't affect my stomach, but the sleep problem does affect me, but not
too badly.

"MB" <olddragon@earthlink.net> wrote in message
news:mPv8h.1514$tM1.538@newsread1.news.pas.earthli nk.net...
: The included prednisone instructions say to take before 9am, but no reason
: why. And I have found that my sugars rocket after taking it and after each
: meal. Asked my doc if the time was really important and he said not
really,
: mainly to take it within the same time frame each day. From what I could
: find out, the early morning was suggested because it should be taken with
: food to keep from having stomach problems and it affects sleep.
: It doen't affect my stomach, but the sleep problem does affect me, but not
: too badly.
:

Actually not exactly correct with why one should take Pred prior to 9am. The
reason being is that the body puts out it's daily dosage of Cortisol before
9am
and when you take Prednisone it stops the bodys output, therefore you need
to replace it. Which is why it's recommended you take it in the morning.
Yes,
I'm sure it does raise your glucose quite high.. I was hitting 450+ on some
days.
And yes, it's recommended to take with food because it's very hard on the
lining
of the stomach. I was warned to watch for blood in my stools because it can
eat the stomach quickly if one isn't careful.

Again, best of luck


--
Reisa, T1, Animas IR1250 Pumper
DX-5/00 ASD-7/00
A1C: 6.2% (8/24/06)
Daily CHO: 150-200gm
TDD: 34-38u

MB wrote in message ...
>Been having to take prednisone off and on for the last few years for
>problems with my legs. Although the prednisone helps my leg problems, it
>really plays hell with my levels, even when I try to eat less. Normally my
>levels will stay below 130 and I feel fairly good, but with the prednisone
>the levels go over 200 and I don't feel like doing anything.
>If I do some work/exercise the level comes down, but it can be very fast
>and reach the 70 and lower levels. Of course I then have to eat something
to
>get it up and it will shoot up high again.
>Anyone have any ideas for keeping the sugars down to a reasonble level?
>
>

The standard problem with Prednisone is that it "orders" your liver to
release glucose into your blood.

Two common attacks on this problem are:

a. Metformin, which "orders" your liver to not-release glucose into
your blood.

b. Insulin injections which provide the extra insulin needed to
process the extra glucose.

In general, Prednisone doses are large enough so that the metformin can't
totally stop the release but the metformin helps.
One problem with metformin, though, is that it takes days and sometimes
weeks to build up activity so you just can't pop a metformin pill this
morning to handle the Prednisone you plan to take tonight.

OTOH, metformin + Avandia is a fine therapy for T2 diabetics. If you plan
to take Prednisone now and then but for the indefinite future, then adding
metformin to your present therapy is a fine idea.

Insulin always works but is inconvenient.

One major advantage of insulin: you take a shot, it does its work, and
it wears off. That's not what's happening to you with that extra
glyburide you're taking. The glyburide takes all day to wear off and is
whipping your beta cells to force them to make extra insulin for much of the
time. That means extra wear and tear (extra death) to your beta cells,
and the chance for low blood sugars.

I suggest (but don't really know) that those 70's and lower blood sugars are
coming from the extra glyburide.

I suggest (but don't really know) that a shot of Lantus at bedtime will
help. I know that a shot of Humalog when you see a high sugar; or even a
shot of the cheaper Insulin R an hour or so before you expect to see a high
sugar will help.

You might (. . .gasp!. .) live like I do. . . see a high sugar, take a
shot. . .see a high sugar. . .take a shot. That kind of stuff leads to
regarding 150 as a high sugar and an HbA1c of 6.0 as a high HbA1c.

I suggest that any of those insulins might be better for your overall health
than the glyburide. You might want to discuss this possibility with your
doc.

Regards
Old Al

MB <olddragon@earthlink.net> wrote:
> Been having to take prednisone off and on for the last few years for
> problems with my legs. Although the prednisone helps my leg problems, it
> really plays hell with my levels, even when I try to eat less. Normally my
> levels will stay below 130 and I feel fairly good, but with the prednisone
> the levels go over 200 and I don't feel like doing anything.
> If I do some work/exercise the level comes down, but it can be very fast
> and reach the 70 and lower levels. Of course I then have to eat something to
> get it up and it will shoot up high again.
> Anyone have any ideas for keeping the sugars down to a reasonble level?

How much pred are you taking? How often? How often and for how long do
you stop? There's a very important difference between levels which are
high enough to shut down your adrenals, and levels which are
lower. That's very roughly around 8mg/day, but it depends on body
weight, timing, and other factors. I note you take it in the
evening. One of the reasons for recommending morning dosage is that
what matters for adrenal shutdown is how much is still around in the
morning. In other words evening dosage shuts down the adrenals at a
lower dosage than a morning dosage. That's the kind of detail an
endocrinologist is more likely to remember than an ordinary family
doctor.

If you shut down your adrenals enough they first of all become
reluctant to start working, and then they atrophy. The result of that
is that you end up with no natural production and having to take the
pred as a constant supplement for the rest of your life. Because it's
an artificial dose unregulated by the body's needs you become liable
to a number of long term unpleasant complications, such as
osteoporosis and diabetes.

It's a very good idea not to get into that state, if possible, and if
you have got into that state, to try to recover from it. If you can
get off the pred, or reduce its dosage to well under replacement
levels (adrenal shut down levels), then you'll have much less trouble
with high BGs and much less long term risk of nasty side effects.

If you can't get off the pred, and are having diabetic BG problems,
you need to consult an endocrinologist, because this is a very tricky
situation.

--
Chris Malcolm cam@infirmatics.ed.ac.uk DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]