Just curious how much others have to raise basal rates (and I guess I:C ratio and correction bolus too) after a cortisone/steroid injection?
I knew increased BG's were likely but I was up all night & couldn't get it below 300 no matter how much insulin (after a cortisone shot in my hand for trigger finger). Now I think maybe a problem with my set/site and going to change it right now, but wanted to put this question out there.
Thanks for your response.
I would correct with a syringe, just to play it safe. My brother has trigger finger and gets the cortisone shot in hand. It spikes his BG for 2-3 days tapering back to normal...what ever normal is? It can take massive amounts of extra insulin...YMMV
I was on Prednisone for 6 months and I don't think getting my pump set and back to my normal BG was in the cards I just did allot of corrections and checked for ketone ...;-)
Thanks John. Changing my set did get it under 300 but still not great. I raised the basal 40% but am going to change it to 60%, and I raised the I:C ratio and correction bolus around 30%.
I just had a cortisone injection for frozen shoulder. I have doubled my basal, my corrections AND my carb boluses. Once the BGs go down, I will decrease basal in 10% increments. This was the plan I came up with my endo....good luck!
I've had this problem. I decided to program a temporary basal--I would set it for 6 hours, see how it worked, raise it, etc. I finally discovered that, for me, a 1 unit per hour temp basal worked like a charm.
And I never really understood correcting with a syringe. I have low insulin basals and blouses, so a 3 unit correction is really impossible, even with small syringes.
Kimberly,
Thanks for your response. I wish I had doubled mine to start with.
I've had frozen shoulder too but didn't do an injection for it, I did physical therapy. Hope the cortisone gets rid of it for you and may you never have to put your bra on over your head again :)
Thanks Spock. I did try correcting with a syringe as a test to see whether there was a problem with my set/site, I have the syringes that have 1-unit increments.
I sure wish insulin worked as fast as it's supposed to, then it wouldn't be quite as hard on us to deal with all the trial and error.
I wonder if it depends on the actual steriod they use? I have suffered through a couple rounds of prednisone, during which if I could get my BG under 300 it was a good day!
I was prepared for all h311 to break loose when I opted for steriod shots in both thumbs last May for cases of trigger finger (tigger thumb?) and NOTHING went wrong. I waited on edge for days, and while it wasn't a comfortable experience, or something I would do again without good reason, it didn't affect my BG in the slightest AND it fixed my thumbs!
I guess this is a good example of YMMV for sure!
Sympathies though, both for the trigger finger and the BG-related mess!
I upped my basal by 200% when I had steroids c. 2008. It seemed to work fine.
For the past many years, I've been able to prevent cortisone highs by increasing my basal to 135% immediately on getting the shot...that's all it took (she said, sighing)
Then last week I had two cortisone shots, one in each knee. I immediately increased my basal rate to 135%, and unfortunately, it wasn't nearly enough. I've been struggling with highs ever since. I can get the numbers down when I do a correction before bedtime (last two mornings were fine), but I still can't eat ANY carbs without going extremely high...and I'm afraid to overcorrect. I hope this resolves itself within another day or so. This is the second time in two months I've gone through this...first time was a week on oral prednisone. So much for my last A1c, which was 5.7, and was taken the day before I started the week of prednisone. Can't imagine what the next A1c is going to be like.
Really bugs me because I've never had this happen since I've been on the pump. On the other hand, I can't remember a more stressful summer since I've been on the pump. Two dear friends are very sick, one of them is dying...and my condo was flooded thanks to a neighbor's negligence in not repairing a leaking pipe. All the stress may have something to do with the numbers, but I think it was mostly the steroids.
Ruth
LOL. That's an image - bra over the head! Can so relate.
Skye,
Good point. I guess the dosage would make a difference too. They didn't provide that specific info to me; I will definitely ask if I have to do this again.
Thanks.
It's wild how much insulin we need for this, isn't it. I got up to 170% and now am trying to decrease it but hard to tell when and how much.
Ruth, Is that the first time you had two around the same time? I wonder if twice the amount means twice the increase needed in the insulin.
I know everyone is different, but seems like there should be a protocol that will at least give us a starting point with changing our insulin (considering amount and type of steroid as well as things like weight, activity level and age of patient).
Stress can make it worse for sure, I'm sorry you are having such a horrible time. (This brings up another question I've had - how to find the right person to help with depression/anxiety - a lot more difficult than finding a regular doctor).
But I agree with you that the steroids are probably the biggest part of the increased BG's. The next A1C may not be what you hoped, but the one after that will be (seems like I heard the steroid doesn't stay in your system more than a couple months).
I hope you are getting closer to normal today.
I met with my endo before the injection and we came up with a pump plan. I had the injection in thumb earlier this year. Right before shot I checked my blood sugar and set temp at 130%, within 2 hours I was at 150% and by that evening 180%, Tested a lot! And did see blood sugars up to 400. Was a rough few days, like the worse flu. Day 3/4 was able to drop to 130% and # spikes (big) continues with everything I ate. About 10 days after things were normal. The plus was I can move my thumb and pain is gone.
That's the smart thing to do, ask the endo. Don't know why it didn't occur to me.
I'm about 8 days out from the shot and still seeing spikes but not all the time, really erratic, so I stopped increasing my basal.