Insulin dosing with prednisone

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Insulin dosing with prednisone

Postby dm1hypopit » Wed Mar 01, 2006 7:35 pm

Hello everyone. I'm hoping for some advice. I got great information on insulin dosing with hydrocortisone here before, but I have had some changes in my medication and I'm having to get the basal rates on my insulin pump readjusted since my sugars are now higher throughout the day. I have secondary adrenal insufficiency due to a damaged pituitary gland. I was taking hydrocortisone 5 mg with breakfast, lunch and at 5 pm. This dose worked fine for cortisol replacement, but every time I missed a lunch time dose I ended up with a low sugar at 2 to 3 pm. Pituitary problems give you bad memory problems, so needless to say missing that dose was not an uncommon occurrence. Well, this finally landed me in the ER when it happened while I was driving. Thankfully I did not crash my car or anything but I pulled into a parking lot straight into a parking space, got out of my car and the people there said I fell flat on my face and had a seizure. When the ambulance arrived they couldn't register my blood sugar on the meter. They also had a very hard time getting any glucose into me becuase I was quite combative and it took four big firefighters and the ambulance personnel to get any glucose into me. I didn't really come all the way back until they gave me 200 mg of IV hydrocortisone in the ER. I remember the feeling and it was like the fog just cleared immediately after getting the dose. I absolutely know now that you need a stress dose steroid with any severe low blood sugar. It didn't take me 3 days to get over the low this time like it did the last time I ended up in the ER with a hypo. Also, a medical ID bracelet or necklace is absolutely necessary. I had no confusion or acting strange that would have clued any witness in to a low sugar but a nurse saw me and knew to look at my bracelet and saw that I was diabetic. Everyone knew exactly what the problem was and the ER doc knew to give me steroid from calling the inofmation number on my bracelet.

Anyway, on to my question. My Endo switched my steroid from hydrocortisone to prednisone to eliminate the risk for hypoglycemia during the day. Now my blood sugars run up in the mid afternoon. I'm just wondering if anyone else takes prednisone and how you adjust your basal rate for this.

Candy
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Postby SueM » Thu Mar 02, 2006 5:26 am

Hi Candy sorry to hear what happened to you :(

I take pred and HC in the morning and found that I had a higher bs in the mid afternoon so I use 2 extra units of insulin then would normally be needed for thecarb intake for that meal.
I don't have a pump so can't help in that department.
How much pred do you take now?

Sue
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Postby gkardel » Thu Mar 02, 2006 12:08 pm

Hi Candy,

Glad to hear you got through what must have been a scary episode. Definitely shows how important the medic alert emblem is.

You should test your sugars a bunch over a several day period to see how the prednsione is impacting your sugars. Another option is to get on the Minimed CGMS - it's a device that measures average sugar every 5 mintes for around a three day period. You also keep a log of carb intake, boluses, exercise, meds and anything else impacting sugars. You and your doc can go over results and see where to adjust basals.

I just got off the CGMS yesterday. How long the sensor lasts varies but I lucked out and got 6 days out of it. Should get to see the results later today.

Glenn
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Postby dm1hypopit » Thu Mar 02, 2006 4:42 pm

Sue,

I am taking 5 mg of prednisone at 7 am. I just can't function until about 10 am. This is not working because I have to get my 4 year old ready for preschool and the bus comes about 7:30. I am almost unable to do this and fall back into bed until about 9 or 9:30. What is your dose? I am thinking I should lower the prednisone a tad and take a small hydrocortisone dose with my prednisone in the morning to step things up a bit earlier.

Glen,

Good idea about the CGMS system. When I get my steroid regimen worked out I think I will ask if we can do one of these. I have done one before but it has been years ago.

Candy
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Postby SueM » Fri Mar 03, 2006 4:48 am

Hi Candy
I take 5mg pred and 5 mg HC I find this is fine for me on that dose I muck out 6 horses feed them walk the dog etc.

Sue
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Postby gkardel » Fri Mar 03, 2006 11:34 pm

Candy,

Morning fatigue can be a problem with Addisons. If you look at the normal production cycle of cortisol and how cortisol is replaced you can see why this happens: http://www.johnlynn.com/adrenals/adrenals1-4-1.html. Cortisol levels should be peaking when we wake up. When taking hydrocortisone after waking up, this peak happens later than it should. There's even more of a delay in this peak with prednisone as it has a slower onset.

You should talk to your doc about taking some prednisone at bedtime. Another option is to wake up a few hours early and take hydrocortisone and go back to sleep.

I currently take 1mg prednisone at bedtime, 10mg cortef mornings, and 2.5mg cortef at lunch and 4:00 pm. Before this I was on the same routine except 2.5 mg prednisone at bedtime. Had problems with higher sugars on this routine. Amazing how much difference a 1.5mg decrease in prednisone made on my sugars. There seems to be a fine line between having cortisol properly replaced and being over replaced and sugars going out-of-wack. Prior to this, I was on 5mg prednisone at bedtime. Did well on this regimen with good energy in the mornings but I was concerned with higher than normal cortisol levels in the early morning hours and no cyclical peaks during the day. My initial regimen was the 15mg cortef mornings and 10 mg cortef afternoon but had big problems with morning fatigue on this one.

Glenn
Last edited by gkardel on Sun Mar 05, 2006 9:30 am, edited 1 time in total.
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Postby dm1hypopit » Sat Mar 04, 2006 11:30 am

Glenn,

I had also been thinking about taking a second dose of prednisone later in the day because I seem to run completely out of steam about 7 to 8 pm. I am good for nothing but sitting around after that. No washing up supper dishes or folding laundry leftover from earlier in the day. Since the switch from hydrocortisone I feel significantly better from 10am to about 7 pm and have no danger of a surprise low blood sugar. But the rest of the time I just can't physically function. This is just so frustrating. I also started Growth Hormone replacement 3 nights ago and that increases your blood sugar. I have increased my basal rate all 24 hours, but it's not high enough yet. I'm still working on that. Too many things changing at once in terms of blood sugar, but I'll get it fixed soon and I know I will feel better then.

Candy
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Postby rwk » Sun Mar 05, 2006 7:59 am

Definitely, take your prednisone twice a day. Play around with the timing, and take the larger dose (2/3 or so) in the AM. Yes, it's a pain since you'll have to play catch-up on your basals, but it'll be worth it.

GH replacement will also affect your steroid needs. All this stuff interacts.

I'm glad you've made the switch to prednisone, given your situation. Of course, with taking two doses, you can still forget your second dose, but the consequences of that will be much slower and forgiving. And the first dose would be still helping (and 2/3 of the total). Since the timing is less critical on prednisone, you can pick a time for the second dose that makes it easy to remember.

Can you set a reminder alarm on your pump to remind you to take your meds? That's what I do -- unfortunately, the alarms are all the same and all too easy to miss if I'm busy, so I also have a watch with 5 alarms. Between them, I'm pretty good at getting my meds approximately on time.
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Postby dm1hypopit » Mon Mar 06, 2006 11:53 pm

RWK,

Thanks so much for your info. I thought I had done all my research on growth hormone and I knew about it's interactions with insulin sensitivity and with estrogen, but I did not realize that it induced steroid metabolism. This completely explains some problems I have had since starting the GH injections. Growth hormone is supposed to improve strength and is also supposed to cause salt and fluid retension. Well, I have become unable to get out of bed in the morning, I feel worn completely out all day to the point of not being able to even load the dishwasher, I get dizzy and have felt like the orthostatic hypotension was returning, I completely lost my appetite and weirdest of all the constant nausea and vomiting that I had before my diagnosis came back accompanied by diarrhea. I have been trying to pass it all off as a stomach bug and stress but a drug interaction makes much more sense. Before switching to prenisone, I was taking 15 mg of hydrocortisone per day. I had to take the smallest amount I could get by with without getting fatigued, nevertheless I experienced thin skin, weight gain, problems with wound healing and was getting the buffalo hump on my back. When I switched to prenisone I initially felt much better with reduced swelling, more consistent energy and I was not constantly hungry. However, over time and after starting on the growth hormone I have gotten dizzy and developed all the problems above that absolutly sound like adrenal deficiency. One of the studies I saw mentioned that if you were on a suboptimal dose of cortisol replacement starting growth hormone could cause symptomatic deficiency. I think that may be what has happened. I'm taking 5 mg of prednisone every morning and this morning I took 5 mg of hydrocortisone along with it. This increased dose seemed to improve my GI symptoms. I'm going to try increasing my prednisone dose and take 3/4 of the dose at 7 am and the other 1/4 at 7 pm. My glucose seems to drop about 7 to 8 pm so I think that is when I lose the prednisone activity. I will have to call my endo to see if I can get an increased prescription. I have been increasing my basal rate every day and I was still fighting with 400's range sugars today. That's enough to wear you out. I'm hoping for better days this week.

Candy
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Prednisone with Diabetes

Postby clansing1 » Sat Apr 08, 2006 12:35 pm

Candy,

I was diagnosed with Type I Diabetes and Addison's in December of 2005.
I take .5 MG of Prednisone at 8 AM and .1 MG of Fludrocort at 9 PM.

For breakfast I usually have 30-35 Carbs with 1 unit of Humolog.

15 carbs for mid morning snack at 10 AM.

Lunch - 70-80 Carbs with 5 units of Humolog.

Mid afternoon snack - 15 carbs.

Supper - 70-80 Carbs with 5 units of Humolog.

9 PM - 10 units of Lantus - 15 carbs.

The prednisone definately raises your blood sugars, per my endocrinologist. In the morning my insulin unit/ carb ratio is 1/30 and that raises to 1/15 for lunch and supper. In the morning, when my prednisone levels are low, I need less insulin.

Hope this helps.

Chad
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Postby Kassiane » Sat Apr 08, 2006 4:33 pm

I've found that Prednisone raises sugar too-but for me this is feature-not-bug since I've got chronic hypoglycemia (largest measure EVER=91. No diabetes mellitus here, that's for sure).

I'm lucky in that I can take my whole Pred. dose at once, because I have slow drug metabolism. For a while I was taking part of it at 5 AM, falling back asleep, and getting up for my day a few hours later...then taking the other half in the early afternoon. This gave me horrendous insomnia, so scratch that.

I don't know squat about insulin, or how to use the pumps, but maybe even changing the dosing would help.

Kassiane[/i]
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Re: Insulin dosing with prednisone

Postby anupamax » Tue Nov 22, 2011 10:21 pm

What volume of insulin is required for this order? Patient weighs 60kg. How many units of insulin would you expect to draw up for a 10 hour infusion if order is 0.2 units of insulin/kg of body weight/hour?
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