I have rheumatoid arthritis as well as T1D, and while it's better now than it's ever been it's nonetheless still aggressive. Lately one elbow in particular has become bad, beyond what I can treat at home, and the neuropathy in that hand has gone from 'a bit tingly' to 'intermittent hot welding iron.'
In the best of all possible worlds this is when I'd ask for a cortisone shot, but as my T1D was triggered by corticosteroid use, I'm ... cautious. Or spooked, more like. But I gather the alternative is surgery, which I'd just as soon avoid.
So I'm asking ... those who've had cortisone shots, how have you managed?
Are you on a pump? It's easier to manage on a pump, but I guess you could figure it out for shots, too.
The way I manage cortisone shots is this (God bless my rheumy who figured this out): In the doctor's office, right before the shot, I set a temp basal for 125% of my regular basal. I then test every hour for the rest of the day, increasing the temp basal as necessary. Once my bg's stabilize (and they will if I get ahead of them), I keep the temp basal going for 2-3 days, then start tapering it off by the end of the third day. This usually works to keep my numbers reasonable.
I also give a bit extra for meal boluses, but I can't tell you any formula for that...it largely depends on what I'll be eating. With a high-carb meal, I usually just add 1 unit to what my pump recommends. With a low-carb meal, I'd probably just use what the pump suggests. And I do try to eat lower-carb for the three days after a shot.
If you're on MDI, I suppose you could figure out percentage-wise how much extra basal insulin to give yourself, and do the same thing I do with the meal boluses.
I've had numerous shots in the past several years, and I've been able to keep my numbers at least under 150, even after meals.
Although, some of this depends on how much steroid you're getting. My shots have usually been for bursitis or trigger finger, and as long as I get one shot at a time, this works. In September I got two shots simultaneously in both knees, and I didn't increase my basal enough...I was off the charts for days. I'll know better next time. But the main trick is to keep it from going that high in the first place because, as you probably know, once it goes up there from steroids, there's no getting it down until the steroids wear off.
I have arthritis of every kind in all the joints in my body, so in the past it was very likely I would have at least three cortison injections a year. However, I have decided after five years, that I can't do that and treat my diabetes rightly. The last time I had an injection in both knees, my blood sugars went to 500+; and I didn't know without taking a reading that they were that high.....I am on a sliding scale for high numbers, and wound up taking 20+ units of humalot to bring them down; five units each meal time to keep them down even with great eating habits and lots of exercise...this went on for a week. I would talk with my docs and see what other relief you can get. As you may or may not know over the course of time cortisone begins to be ineffective....the more you get the quicker your system becomes immune to it. There are many other treatments that won't or have less affect on your diabetes
I just got a cortisone shot in both thumb joints for osteoarthritis. Since Tuesday my blood sugars have been 16+ (288)with high ketones. I am trying so hard to deal with this but am almost at the end of my rope. I am a baker so need the cortisones to work but... I don't eat any more than 15g of carbs a day so it isn't what I'm eating. Every day I increase my basal percentage by 20%. I'm praying it will get better soon. :(
I received one this last Fall for frozen shoulder. I increased my basal rates to 150% and managed just fine. It took about 4 days for my bg's to return to normal range without the temp basal.
I had steroid shots in both my shoulder joints for frozen shoulders. I know the ortho specifically chose a steroid "cocktail" and dose to minimize effects for bg. There was an increase in insulin needs after each shot (shot lasted for about a month... insulin needs were elevated obviously for a week, less obviously for a few weeks) but was able to accomodate it by tweaking my doses, no problem.
The steroids worked wonders compared to other types of inflammation/pain relief. It was totally worth it.
This issue just adds to the debate over insulin therapy for T2 diabetics... We react to cortisone the same way, but if not on insulin therapy, well, you just sit there and stew in premium quality Vermont maple syrup running through your arteries.
It's nearly impossible to "get up to speed" on insulin temporarily to deal with steroids for a few weeks.
Just convinces me more that any diabetic should be given insulin therapy as a choice when diagnosed. We are getting closer to that practice, slowly…
Davem I have to laugh at your last comment, not because it's funny, but because I where I live. The rest of the world might be getting up to having all diabetics on insulin therapy, but I live in the boonies of South Dakota and that isn't the way it is happening here....the drug reps are our worst enemies as far as handing out pills to our medical providers --- while I hope and pray that we will someday moving to that also, I think I will have to move to get the best kind of care for me.
Tim, I think this must be another case of "it works for me, but not for her"...I've had cortisone injections in my knees,probably 8 total, and had the elevated bg's....but with this round of orals, it was horrible...I know the injections work and so very happy that you got the relief you wanted. For me, sorry to say, I didn't get any relief, and had the HIGH bg's to work with also. Good luck!
I'll say that prayer too. We do what we gotta do, and if you don't work, well, bills (including medical) don't get paid....I hope you can find the relief you need and get the bg's under control again
I second or third or fourth increasing the basal rates if you are on a pump by 125% or more. I have had to do this. Even with increased basal, my numbers still were in the 200s for about a week or so...sometimes with ketones....
I am due for a shot in my shoulder joint and am putting it off because I do not want to deal with the high blood sugars....
Yes, my ortho indicated in some circumstances that oral steroids might be used. But this would not be what he would choose for me or any diabetic with frozen shoulder. By targeting only the joint needing relief and injecting just there, the total steroid dose was much smaller and I could manage.
I think that each person responds differently. so, no one can tell you how your BG will react. I think it may depend on how easy your db is to control as well as how tight is your carb intake. for a recent knee injection (not arthritis) of 30 mg Kenalog injectable, I had a miserable week plus afterwords. I increased basal and also found where several on here had said they doubled their boluses. i tripled my boluses and still had high BGs for a week.
My db is no doubt different from yours, and everyone else's. So, I think it is best to test often and pre-treat as safely as you can. I, for one, will never take that dose again! I had only ever had one steroid injection before and I am sure it was much smaller than this one. It worked for a month though! And, overall, helped about 75% longterm for my knee issue.
I had 3 cortisone shots in the past month. First I had one for trigger finger and one for DeQuervain's in my wrist- both on the same day. I was running a 250% basal starting a couple of hours after the shots, and then slowly decreasing the basal for about a week. My usual total daily dose is between 20 and 25 units per day. During that week, my total daily dose shot up to 40 to 45 units per day. For my next shot (again for trigger finger), I waited a few weeks and only had ONE shot. It was much easier to handle. I was only on a 150% basal for a few days and I managed my sugars much better than I did the first time. Unfortunately, I think it's one of those things that you just have to do trial and error with to see how your body reacts. I will definitely say that the pain relief and regained ability to use my hands and wrists made the shots/couple days of high sugars TOTALLY worth it (for me). I'm curious about your statement that your Type 1 was triggered by corticosteroid use. I've never heard of that before.
I didn’t know I was going to be getting a cortisone shot (for knee pain) the other day or I would have searched for posts on this topic beforehand! My bedtime BG is running higher than normal, ditto my fasting, so I increased my Lantus dose. Daytime I am doing OK 'cos of my activity level, I think. Always something new to learn!
Reviving old topic as it has been very helpful and I wanted to share my strategies. I am getting nerve blocks and recently had an epidural for upper back pain and fibromyalgia.
I should have raised my bolus right after the shots instead of waiting for the highs the next day. They were around 15+mmol (high 200’s and 300) and I just could not get them down.
My pump (Medtronic 630G) only goes to a 200% temp basal. So I started with that. Numbers still high and giving lots of corrections and bolusing extra for meals. I then went into “Bolus Wizard” and lowered all my carb ratios by one. Also decreased sensitivity factor from 3.0 to 2.5.
I was still in the 11’s (~200-215) the next day so I decreased all carb ratios by one and sensitivity to 2.0.
I’m now in a good range now (Thursday - shots done Monday) so imagine that I will start to reverse this process. I would be so nice to have a set formula to adjust for this, but it seems you have to feel it out for yourself. I will take note of the changes I made and set up a basal pattern specifically for cortisone shots.
I would like to contact my doc and get the doses and specific drugs if I do this again. The up side is that with the decreased pain, I have been able to do some physio on my shoulders, which I didn’t even attempt before.
