Living with a chronic health condition means there is part of your body that needs a little assistance to function at its best. In diabetes you know only too well all the ways in which it can impact on your body and your life. After a while it is easy to get into a space where diabetes is just part of your life – that is what we all want. We want to be able to sit with diabetes and get on with life. You will still have plenty of points where diabetes is right up against your face, it is the primary thing you are dealing with right now, but in the main you are reasonably comfortable with it – until something upsets the apple cart….another health problem for example. Keeping the ship steady is not easy when it comes to diabetes. My recent experience with my usually well controlled asthma and dealing with Prednisolone and Diabetes is a great example.
I got asthma well before type 1 diabetes, when I was 5 years old. It got better in my young adult years and returned again later. It usually stays well controlled with a preventer puffer, except if I have a major virus – such as about 9 years ago when I got Whooping Cough and ended up in hospital with asthma and pneumonia, and about 5 years ago when I got Influenza A despite having the immunisation – not happy Jan!
My most recent experience was about 3 months ago when I started coughing following a virus. It was not the worst virus ever, enough to put me in bed for a couple of days – but not like these other 2 experiences. However the cough did not go away. It got worse and worse. I went to the doctor and got antibiotics. It got worse. I tried natural remedies. It got worse. I tried taking a heap of regular ventolin which helped temporarily, but overall it got worse.
I ended back at the doctor who said I needed to take prednisolone – an oral steroid which does the job well but also causes huge surges in blood glucose levels and creates havoc with diabetes,among a whole other host of side effects.
So, as you do, I put it off for another week. It got worse. And then it was Christmas and we were going away and I didn’t want to have a crappy high blood glucose holiday and Christmas, so I put it off another 2 weeks. It got worse.
While we were away my cough was out of control and then the wheezing started. It was awful and my diabetes was not happy about all this stress on my body. By this stage I had been coughing for 3 months so the rest of the family were not impressed either!
Tips for dealing with diabetes and Prednisolone
So I came back home and took more antibiotics and the steroids….
Here is how I managed my diabetes (please consult you doctor if you are going on steroids as we are all different)
- It takes a few hours for the steroids to start to impact levels which then tend to rise over the day and peter out in the early hours of the morning. I watched my levels every 30 minutes or so until I saw them rise in the middle of the day on day one, and started taking more small bolus doses.
- Once they were up consistently around 12-13 mmol and it was tricky to get them down with usual boluses, I cranked my basal rate in my pump up by 30% to 130% and kept checking regularly during the day and taking boluses where needed
- I set my alarm for every 2 hours overnight to see what was happening and take small boluses
- The next 5 days I increased the basal rate by 30% still and took about double the usual bolus rates
- Minimised carbohydrates – really only having my 2 small pieces of toast at breakfast when the steroids were at their lowest impact
- Day 7 I was better and so I stopped the meds and went back to usual management
Sadly 48 hours later the cough and wheeze came back with a vengeance……
So I am now back on a higher dose of steroids for a longer period, and am using a 150% basal which I will taper down by 10%, as I taper the dose of steroids down over the next 2 weeks. I am still doing a lot more checks in the day and overnight and regular additional boluses at higher rates, about double. On the 50 mg of prednisolone I am on for 3 days, followed by 37.5 mg for 3 days, I will need the 150% and will then creep down the basal to work with the reduced steroids every 3 days.
***Please bear in mind this is my personal approach – you need a clear plan from your doctor. This is also my plan on a pump – on multiple daily injections or if you have type 2 diabetes the approach will be different – always seek advice, this is to show how insulin resistant the steroids can make you. In general once they kick in mid morning I am finding they sit between 12 mmol and 15 mmol and can drop to 8 – 10 mmol by breakfast. I have not experienced the 20 mmol+ I expected due to not eating many carbs and the fine tuning I am doing – it is hard work so you need to be prepared to do some TLC. I have tried to stay active despite needing a lot of ventolin to complete exercise which I am sure is helping me. You may find you get agitated, moody and find it hard to sleep. These are some heavy duty drugs.
I am hoping this time it will be the end of the never ending cough.
Do you have an experience with taking steroids or do you have other conditions that complicate your diabetes?