Had one 18 years ago for “frozen shoulder” and swore I’d never have another. Neither the orthopedist nor I knew the effect of a cortisone injectinon on a T1’s BG levels. I was still on R/N back then, which didn’t help. Couldn’t figure out wtf was going on until I called my PCP, who had a sub-specialty in diabetes, and he said “Of course, it’s the effect of the cortisone.” Took a couple of weeks to wear off, and I swore Never Again!
And then this agonizing case of tendonitis in my right thumb came on with exquisite timing back in mid-March, just on the cusp of Covid lockdown. Called my current hand surgeon: no appointments until June, she said. Ibuprofen, icing, Futuro hand brace, weeks going by, only slight improvement. I swore I’d take the shot–anything to make the pain stop. It turns out we have opposable thumbs for a reason, and not being able to use the one on your dominant hand without breathtaking agony makes you keenly aware of that fact. After weeks with it not getting better I was all about the shot, BG be damned.
Fun fact: my surgeon’s husband is a T1, so she knows this stuff. Her husband’s on Lantus + Afrezza, but we talked about how having a pump & CGM makes this a whole different proposition from what it was for me back in 2002. Plus the amount of cortisone for a thumb joint is a lot less than you get for a frozen shoulder, so there’s that. I’ve set a temp basal to 120% for the next 24 hrs, maybe a bit aggressive but I will be relying on Dexcom to keep an eye on it and stay safe. I’m definitely seeing some upward pressure eight hours after the shot, but it’s not too bad even given my BG OCD.
It would suck to be cut off from the optimal treatment for this kind of orthopedic pain, so I thought I’d post this as an experiment in getting over a deep-seated resistance to it based on an outmoded insulin regimen. I’ll check back in and let y’all know how it’s going. If anyone else has recent experience with the dread cortisone shot feel free to weigh in.
Not recent, but had cortisone injections over 35 years ago. No warning of affect on BGs, and I was still on NPH + Reg. Was doing BG testing only, so kept blaming high bgs on food choices. Years later had another, and thankfully different doctor that warned me of the connection.
What I learned was always ask, and research new meds ! My endo generally knew the common ones.
Sounds like it is going well! I think an injection in a thumb is a small amount vs a shoulder or knee etc. like you said. I had a shoulder shot pre diabetes or pre knowing about it anyway and it was amazing. I could not lift my arm and 2-3 minutes after I could. It was still painful and I did 4 months pt. I hope it is helping your pain.
I had a steroid injection in my right shoulder in May 2018. The doctor said it was frozen shoulder. I felt immediate pain relief and my shoulder, with sustained physical therapy, fully recovered. The healing was so complete that I just now had to check my records to verify which shoulder it was. I was very hesitant to get that shot due to the my fear of BG chaos. In my case, my fear was not justified.
Sounds like the early days have been good for you. I wish you success in the long run.
Do you think the tendonitis is related to diabetes?
Well, I wouldn’t assume so. But I do seem to have a lot of inflammation issues, which I gather can be related.
Right now it seems like I’m not seeing any elevation effect on my BG at all, so that’s good. The injection itself caused quite a bit of pain the first 24 hours but now that that’s faded the joint pain is much improved, though not 100%.
I get cortisone injections in the seasamoid bones in my feet. Well, I try my darndest to NOT get them. The injections are more painful than the chronic fractures.
They don’t provide a whole lot of craziness in the blood sugar department, though. Unless I just don’t notice it because of pump automation.
Finally had both knees replaced last year, but for years I was getting steroid injections. Once I went on a pump, no problem at all. For me, +30% (130%) on the basal immediately and for the next two days, then eased it back. Also, while I didn’t exactly change my insulin to carb ratio, I did give myself about 1/2 unit extra each time I ate. Never went above 150, and woke up every morning in the 80’s or 90’s.
Yet another reason to have a pump! You did great, Dr. BB…glad you also were able to get relief without upping the bg’s.
I firmly believe that tendonitis in my fingers (otherwise know as trigger finger) is definitely related to my diabetes. I had three successful minor surgeries to release tendons in my right hand after cortisone began to be less effective. Having been free and mobile for the last 5 years, I now have tendonitis in my left hand. Wearing a finger brace at night but I will probably look for a surgery in the next 6 months. My father was T1 too. He never had tendonitis in his hands but suffered from both a frozen shoulder and a tennis elbow. I too have suffered both. My orthopedist has also confirmed that diabetes is very common amongst his patients with these conditions.
My orthopedic doctor is recommending an injection for knee pain, but warned that cortisone may have a big effect on blood sugar control, typically for the first week. Endocrinologist said same, but that it was manageable as long as I watched the CGM carefully.
Orthopedic MD recommended a different injection called Synvisc-One, a synthetic joint compound meant to imitate fluid in natural joints & supposed to be non-consequential for diabetics. Made by Genzyme Biosurgery. There is no reference in the literature for side effects on insulin-dependent diabetes.
I’d expect a knee injection to have a larger effect because of the larger amount of cortisone required. They basically try to fill the joint capsule with the stuff.
My first experience was back when I was still on the old R/NPH regimen, no CGM, no pump obviously. Having those things makes a huge difference.
My ortho this time didn’t mention Synvisc. I’m surprised since her husband is a T1 and she’s very cognizant of the disease, but I might have gone for it if she had. As it is, I haven’t had much trouble BG wise. Still having some pain though.
Two points…one, while synvisc didn’t work for me, it didn’t raise my bgs.
Two…in order to prevent the highs from a cortison injection, especially in the knee, which is quite a lot of cortisone, you must raise your basal rate IMMEDIATELY after getting the injection. Once your bg’s start going up from cortisone, it’s nearly impossible to get them down.
