DeQuervain's and Trigger Finger- treatment with steroid injection resulting in hyperglycemia

Type 1 and LADA
#1

Hi ya'll,

So I've got miserable DeQuervain's and trigger finger, both in my left hand. The trigger finger has been happening for a few months but the DeQuervain's has been going on about a year. I've been using NSAIDs and acupuncture but it's just not touching the pain anymore, and I don't want to keep popping handfuls of Advil. My doctor has recommended 2 corticosteroid injections- one in my radial wrist for the DeQuervain's and one for the trigger finger. Everything I'm reading is saying that you get sky-high blood sugars for at least 5 days afterwards. Does anyone have experience with this? I'm thinking my pump would need to be on 150% of my normal dose or something like that. Advice? Or experience? I'm annoyed with diabetes today.

#2

I've had steroid shots into my shoulder for frozen shoulder. The doc doing it knew I had diabetes and chose a dose and steroid mix to minimize effects on my bg. Yes, I had to boost my insulin doses maybe 20-40% for several weeks afterwards.

BTW, for me at least, the Steroids were totally worth it.

#3

20 - 40% for weeks? Ack. Did you have any weight gain because of the extra insulin? Did your symptoms immediately resolve or was it over time?

#4

Actually I was losing weight in the weeks after the shot, eating less because my bg's were just a tad higher than optimal and I hadn't yet fully ramped up my insulin dose.

The steroids helped with the very worst pain from frozen shoulder, helped me sleep at night again, and I feel it put me in a position where I could actually work the joint to get flexibility back and break up the scar tissue. It was a turning point but there was still several months of professional physical therapy and more months after that of still practicing stretches at home to really get back to "pretty much good" for each shoulder. I'm not sure if the inflammation/recovery process for trigger finger/DeQuervain's is the same as frozen shoulder or not.


There are also some topical NSAID creams you might want to try. I used Voltaren gel on my shoulder, and it helped a little, but it wasn't the big turning point the steroid shots were.
#5

Thanks for that response. It was helpful. I struggle with bouncy blood sugars as it is and was wondering if it'd be worth it to get the shot or would cause more upset. My wrist and finger is just so painful though- I'm tired of feeling like my basic activities are limited because of it. I assume I'd have to do some physical therapy after as well..

#6

I got what I call 'sticky highs' for about 15 days following a series of steroids and NSAID's in my shoulder back in January. This was before I was on the pump, but I had to increase my insulin dose up to 300% to keep my blood sugars down below 150.

I just had an episode with a nasal steroid two weeks ago. I was 'guaranteed' by the ENT, my Endo and the pharmacist would not cause hyperglycemia. Well, I ended up in the ER 48 hours later with crazy high blood pressure and a persistent BG of around 200 despite increasing my basal to 200%. Stopped taking it and things returned to 'normal' a few days later.

Then, of course, I got a sinus infection and being sick caused me to need to increase my basal again. I generally check my BG every two hours when I'm on a temp basal, due to hypoglycemia unawareness. Well, I woke up a 1:00 to check my BG, it was 133 and I was on a temp basal of 150% as I had been for several days.

And as expected, this morning at 3:25 my pump alarmed with a BG of 47! Pretty normal for me when my body recovers from being sick, my insulin requirements drop like a rock very quickly.

But then again my doctors tell me I'm 'weird'. So please don't use me as a measuring stick.

#7

Thanks for sharing. I've heard some corticosteroid shots are worse than others when it comes to hyperglycemia. I am going to meet with an orthopedist to discuss options. It's too bad there aren't any physical therapy options for dealing with this stuff. I really want to be in less pain but the idea of high blood sugars for days is not that appealing....frown.

#8

Oh God, I will NEVER take steroids again unless my life depends on it. I've done it twice now for different things, once an oral course, once injected. Both times I had to up my pump dosage by 200-250% for weeks. As you can imagine I plumped up quite nicely. And the residual effect lasted a month after the benefits of the steroid wore off.

My other concern for you is that the NSAID's are damaging to the kidneys, and we don't need any other kidney issues going on. I have beginning stages of kidney disease and have been told to stay away from them going forward. I wish I had another option for you. Have you been to a physical therapist yet?

#9

Argh. I'm bummed to hear this. You had to up your pump dosing for weeks, not days? This is not good news. I have stopped using the NSAIDs and am just using acupuncture now. The problem is that it helps the pain during the session and for awhile after but it wears off. I haven't seen a physical therapist yet but I'm going to look into it. For De Quervain's, 83% of patients experience total remission with a combination of splinting and a one-time injection of Decadron. I haven't seen any studies that highlight the effectiveness of PT but I would totally try it. Ugh. Diabetes.

#10

Had ear surgery a month ago, the idiot anesthesiologist apparently is so incompetent in his profession that he did not know a diabetic should not be given barrels of steroids as part of the anesthesia (standard practice to reduce swelling and inflammation during and after the procedure). Sent my fasting, starting-at-85 BG to 250. After several gallons of insulin and 6 hours in recovery, we finally got it back down to 150, the dry-heaving subsided, and I was able to go home.

A surgery recovery that was supposed to take 1-2 hours.

Steroids are a nightmare. Be prepared to take a lot of insulin.

#11

for Voltaren. I use it as needed for neck strain. It's great stuff, and seems to work locally where its applied (rather than systemically).

#12

Which nasal steroid?

I've been using Nasacort to manage hayfever, and haven't had any BG problems. It would be interesting if this was affecting you differently.

If not Nasacort, then tell us so we can avoid it!

#13

Sounds like it would be worth the temporary diabetes hit, to me. It's not uncontrollable -- you'll just need to use a lot more insulin for a few weeks, and be careful about diet to minimize whatever potential weight gain effects might occur.

Also bear in mind that steroids cause water retention, so there's a certain amount of "phantom" weight gain that disappears more or less effortlessly over the weeks after things wear off.

#14

My brother has the trigger finger shots and it has no impact on his BG, he is completely insulin dependent like me. We work side by side every day and I'm sure they have no impact on him, the doctor says it's a common steroid, and he can only get the injection about twice a year...YMMV...the injections do give him some relief.

#15

I've had many steroid injections over the years. My rheumatologist finally figured out a way to keep my bg's from going high. I increase my basal rates (using the temp basal feature) to 130% immediatelyupon getting the injection. Then I test every hour for the rest of the day. If I see my numbers going up, I redo the temp basal to be higher (135%, 140%, etc.). Usually I don't have to go higher than 135% unless I have double injections, then I usually go to 150% of the regular basal.

For me, the effect on my bg levels only lasts for about 4-5 days. By day 4, I'm reducing the amount of the temp basal, and by day 5 I can usually go back to my normal basal.

The trick is...you've absolutely got to get ahead of the bg rise. Once it goes up from steroids, it's almost impossible to get it down, no matter how many corrections you do.

Ruth

P.S. No, I've never gained weight from the additional insulin. But as JohnG says, YMMV.

#16

Hi Ruth,
This is super helpful. Thank you for commenting. I have an appointment with my rheumatologist to discuss an approach- hopefully I can find something that works. I think you're right in that the key might be approaching the blood sugar rise at the onset rather than after the fact. Appreciate your point of view!

#17

I have had both, at separate times. did injections 3 times for trigger finger, didn't help much, had surgery to release. 1-1/2 yr later had DeQuervain's, asked dr to just fix it surgically. both were outpatient , and I had written instructions from my dr to allow me to self dose on the pump. I did not have to change settings for the surgeries, and my hand works great now, 2 years later. I did have high numbers with the steroids, and had to correct constantly.

#18

I have had a steroid injection into the bursa in my shoulder before D diagnosis. It was dramatic and allowed me to lift my arm immediately. I still had a lot of pain and did 3 months pt also. I know now the D was already coming out then but I don't know what effect that had on my bg since I wasn't testing then.

Since D my ortho doc has wanted to do injections in my knees and my other shoulder both of which I have declined so far due to not wanting to deal with possible high bg etc. I had severe pain breathing upon waking 3 weeks ago and now was told it may be bursitis in my right shoulder blade but they said a shot there is dangerous and needs a special procedure.

I wanted them to do a lidocaine trigger point injection since painkillers weren't helping much at first. Maybe you can do that instead as well as pt?

I don't think it is bursitis because it is already much better after various painkillers, tens, heat, ice, voltaren, rest and so on and I just started pt, however the massage has made me a bit worse.

Anyway, maybe you can manage the steroids and it will help you. This doc mentioned that steroid injections aren't as bad as oral, but I guess that will vary with each person. I also use nasacort occasionally and at first I thought it spiked me but now I'm not sure. I also felt like ventolin spiked me today, but again, I think it was probably something else and the pain I have been in has made my bg run higher I think.

#19

I was taking Dymista, which is Astelin & Flonase combined.

Nasacort (triamcinolone acetonide) and Flonase(Fluticasone propionate) are both glucocorticoids. I'm told that hyperglycemia is very rare with either.

It could have been the steroid combined with the antihistamine, It could have been the underlying, undiagnosed, sinus infection, who knows?

Years ago I was taking Astelin and do not recall any problems.

But then again, I'm 'weird', so if there is even a slight chance of adverse reactions, I'll be the one suffering from them.

#20

Steroids in any form are a disaster for diabetics, in my opinion. I had a bronchial infection a couple of years ago where I was prescribed an inhaler that contained a "minimal" amount of steroids. It doubled my insulin requirements. Since then I refuse to go near any drug that contains it.