Dr. appt. lost 36 lbs. A1C 6.4 (still)--still won't go down--has to be the steroids


#1

Hi all, sorry I've been off the radar lately. Life has gotten in the way--work, family, sick (RA), etc. Anyway, went to endo last Friday. He wasn't happy because my A1C still holding at 6.4 for the past 3 blood tests (since August). Well, what can you say, at least I'm consistent. He asked was I ready to start shots and I said no, and he was shocked. But...he fail to check my weight from my last visit and when he did, he was shocked. Then he asked if it was from the metformin and I said no. I can't take either the regular or the extended he prescribed. He asked why and I told him the same thing I always tell him--it keeps me in the bathroom.

Then he wanted to know how I lost the 36 lbs--dropped all starches--eating nothing but veggies and protein, and exercising as much as the RA will let me. He said he would wait a while before checking me again.

The only thing I can think of that's still got my glucose levels up is my RA and my prednisone--I've had 2 flares and had to take steroid shots and up my prednisone to get over the flares. But I'm back on my maintenance dose of 5 mg a day.

I'm trying hard to not take any shots---Victoza or anything, but I don't know what else to do.


Prednisone...Help!
#2

Yea. I cant even take prednisone. I tried for a shoulder injury and My sugars were in the high 200s for the entire time even with almost doubling my insulin.
I think it just causes insulin resistance in some people.
Maybe there is another drug that your doc can prescribe for you for the RA symptoms,


#3

OK, I am probably an exception here but I just don't see why a 6.4 isn't wonderful. And the weight loss is excellent also. I clearly am not a "normal A1c" striver but research indicates that an A1c under 7, and especially at or under 6.5, is on target to limit complications. I also know that 'normal' control does not entirely prevent complications though it has been shown to reduce them.
But, if you are on steroids, that certainly is a logical explanation for a slightly above normal A1c. If I have to take it, temporarily and rarely, my BG goes through the roof.
I was supremely happy with a 6.8 for my latest A1c, down from 7.1.
Congratulations is all I can say to you!


#4

It's most likely the prednisone. I cannot take any medications with steroids. It skyrockets my BG. Not sure why you don't want to take shots. Insulin pen needles (or Victoza, for that matter) are so thin you often don't feel them at all.

Great job on the weight loss and diet changes!

#5

6.4 is pretty good actually. Not sure if you are doing bg checks too.

I have had steroid shots and they elevated my bg and greatly increased my insulin needs.


#6

Thanks Nell. I thought 6.4 was pretty good too. My last visit my doctor had said if I couldn't lose weight that we would revisit shots so I was happy that I was losing weight. He had said the prednisone was a given, so go figure.

Glad I'm not alone in my thinking.


#7

Unfortunately I can't shake the prednisone monster, Uncle Arthur refuses to behave without it. Fortunately I've weaned myself down from 20 mg a day back to 5 mg a day, but I'm still on plaquenil, topamax, cymbalta, and remicade to keep the monster in its cage.

I think some of it comes from pride and just not wanting any more meds on my "plate"--maybe this is something I can control for a while with diet and exercise. Even though eventually I know I'll have to have shots--diabetes runs strong in my family. My mom's had for over 30 years and her parents both had it. My dad's mom had it. So it's a given.

Thanks for the support.


#8

That's something he endo never gave me guidelines on--if he wanted me to check and where he wants my bgs. He's given my mom strict guidelines 4x/day and a range, but he still hasn't say a thing to me. I even asked him and he said it wasn't necessary. Just diet and exercise.

What's funny is that when I first saw him many years ago, it wasn't for diabetes but for hypoglycemia. That was when I was first diagnosed as an RA patient.

Go figure.


#9

Oh I wish I could get off prednisone. I've ran the gamuet of RA drugs. I can't even volunteer to be a guinea pig since I had so many "failed" drugs. :-(


#10

i'm a type 1 so i don't know if it's different in terms of A1C goals for a type 2...but for a type 1, insulin dependent, an A1C of 6.4% is pretty darn good.


#11

I'm sorry Kate. That's no fun to manage. It sounds like you've got your hands full. I was apprehensive about starting insulin too, but when I did I was tremendously relieved. It helped me achieve control quickly and decisively. It is an amazing drug - but maybe that's not even the right term for it, as it's essentially the same as what your body produces. It sounds to me like you might be served well by a small morning and bedtime basal injection to help relieve your pancreas of doing all the work and bring you to your desired A1c. Bear in mind, a 6.4% suggests average BG of 137 and glucotoxicity is said to begin at sustained levels of 140 and above which destroys beta cells. Basal insulin now might help mitigate further progression. It's worth considering.


#12

Prednisone is notorious for raising blood sugar and It kills mine. I mean I go wacko into the 400's plus sometimes.

I do not know your treatment regiment for RA, but I would certainly ask to make sure new biologic's are not out as yet. I am surprised you are not taking a biologic plus methotrexate or methotrexate by itself? The methotrexate takes some serious adjustments to get right. The biologics (there are many) will get you off of prednisone and it will ultimate make your blood sugar for more effective if you can find one that works.

your Rheumatologist should have a treatment plan worked out. Generally speaking for a patient with RA the Arthritis guidelines generally suggest that doctors use prednisone as a first line of defense to stabilize the patient. Then get to a biologic solution within 6 months of diagnosis. Obviously sometimes things vary a bit and your doctor should know the various options.

I hope you are being treated by a Rhuematologist. Rheumatology is a very specialized field, it is true a GP or internist can treat you but to understand the various biologic drug options you need a specialist.

In some cases Prednisone is the preferred treatment, but usually only after most biologics and methotreaxate have failed. If your doctor has not tried all biologic medications including new ones and you have been DX'd with RA for more than 6 months I would definitely get a different board certified Rhumatologist. For me the biologics saved my life. Now for Terrie (also a member) she has had to remain on Prednisone because of poor reacitons to the biologic medications. That is understandable. If however the combinaiton of methorexate and a biologic drug is nto working please ask why?

Long term use of prednisone can be dangerous. Thus having a specialist not a GP or Endo is the only way to go with this disease.

Not that I am the know it all but here is a blog I wrote some weeks ago that might be helpful.

http://www.tudiabetes.org/profiles/blogs/what-is-rheumatoid-arthritis

I have had RA for about 17 years now and I am a mere child compared to my good friend Terrie who has battles the disease longer. pleas ask us any questions. Reading your question i can say I am concerned. This is a specialized area and yes it takes a very specialized doctor. I have been lucky to find two in my life but good ones are tough to find in the US.

Good luck

rick


#13

Steroids: Invoke terror in the hearts of diabetics everywhere. Gaming companies need to make a Zombie Apocalypse-like game for diabetics with zombies chasing you with syringes full of prednisone.

Utter terror.

I truly fear getting something like RA, as I simply can not take steroids. At all. My BG goes through the roof, I'm dizzy, etc.

I also say a prayer of thanks whenever the issue comes up that I am surprisingly insensitive to Poison Oak. Surprising because my immune system otherwise seems to be on hair trigger, allergic to just about everything else in the plant world. My wife is going through a bad rash of it right now (pun intended) from our dogs getting in it some where. She's been on prednisone for a week. I don't have a smidgen of it, petty, hugging, and rough-housing with my buds much more than she does.


#14

I see a lot of confusion over normal A1C's. Dr Bernstein says that normal is below 5.0 and that you need normalize your blood glucose to avoid complications. That also means keeping your blood glucose tightly controlled around 83 mg/dL. Blood glucose spikes can do a lot of damage.

Personally I have got my A1C down to 4.9 and hope to get it even lower.


#15

My endo tested me and swears that I'm not T1 or T1.5 but I do wonder sometimes, I've been hypothyroid since I was 14 (thryoid went wacko from Graves to hypo--2 rounds of radio active iodine to kill it), then allergies at 20--like massive hives over my body, then RA diagnosed during an allergic reaction testing with the allergist. He promptly zipped me to the rheumatologist who I've been with for close to 20 years.
He calls me his "special" patient.

My PCP won't even touch me for anything remotely "weird"--automatic referral. He only checks me for colds and annual physicals. Go figure.


#16

Thanks OldTech. I didn't know that...really good to know. Explains why my endo's got ants in his pants--I'm always the exception to the rule with doctors. He's not going to be a happy camper with me. :-(


#17

In Indiana a doctor cannot call themselves a rhuematologist unless they are board certified. However any doctor can and some do prescribe biologics without being board certified. It is uncommon as most doctors do not understand or fear prescribing some of the immuno suppressants.

In terms of issue that not all drugs work for all people. I agree with that. I have been on 6 of these drugs. The first one worked well (remiciade I used for 9 years) then I ripped through them like crap through a goose. This latest one is really my last hope I am using Rituxan. I can no longer use TNF inhibitors as I had a lupus like reaction to my last one.

The truth is there is no 100% guarantee. Some work some do not. But there is some research that says the first one tends to work the best. The second works slightly less and so on. By the time I got down to number 5 i was a mess.

Terrie, the person I go too for help has also run through the various drugs and has come out on the other side unable to use the biologics. I believe she is using prednisone but we woudl need to ask her that question.

I have often wondered if we have enough people for an RA group. Any thoughts anyone ?


#18

I've decided that if the next blood test comes back the same, I'm just going to have to bite the bullet and start the shots. I've been around them all my life so it's not like I'd be starting from scratch. I gave myself biologic shots (Humira, Enbrel, Symponi, Methotrexate, etc.) for RA until I started IV drugs (Orencia, Actemra, and now Remicade).

Mom swears I'll feel better with more energy.


#19

Topamax has been a godsend for me. Lyrica was killing me and helping the prednisone add pounds. I was having even more pain in my feet, back, and hips.

NSAID do nothing for me but upset my stomach. I wish I could take them. I've been on the hard stuff since the beginning. My joints don't look bad--but you can hear the grinding in my shoulders, hips, and knees with lots of swelling.

Each month I take a cortisteroid shot in my IV with my Remicade and my 5 mg of prednisone maintenance every day. I think that is what is keeping my glucose levels high; but in all fairness I've come down from 6.7 to 6.4. I just need to come down and maintain at decent number at or below 6.0, and I don't think that's possible without help if I stay on prednisone which I need to function daily.


#20

Dave, my blood sugar will be about 500 by this Friday evening and I will fight it all weekend. The reason is that I will be having a rituxan infusion on Friday and I will sick as a lame dog come Saturday morning. Rituxan includes IV steroids and yes my blood sugar will go nuts.

The thing is we do not have much choice. In some ways it is like Diabetes no one wants it but you get used to the awful outcomes. I mean what choice do we have?

I will say that I thought diabetes was the tough disease? Diabetes seems tame in comparison. I hope you never face it as well.

rrick