Frozen shoulder, my BG experience after a steroid shot

[Terry4]

I’ve been doctoring since last fall with what was eventually diagnosed as adhesive capsulitis or frozen shoulder. I went to physical therapy for a few months and didn’t make much progress in terms of reduced pain or large improvements in range of motion.

The physical therapist recommended that I see my primary care provider for another consult. My provider referred my to a sports medicine specialist and following x-rays and an exam, she gave me the frozen shoulder diagnosis. She thought I would benefit from a corticosteroid injection into my right shoulder joint.

Her theory is that this will give me the opportunity to work the joint, muscles, and soft tissue more fully. She warned however, that if I didn’t put a full effort into the post-injection physical therapy, then when the steroid shot effects wear off, my shoulder would likely feel worse than it does now.

My biggest concern with the steroid injection was the havoc it could create with my blood glucose. I consulted with my diabetes doctor and she said the hyperglycemia would likely be limited to the first three or four days post-injection. I figured I could deal with that and decided to get the cortisone injection.

I had read some comments in a few diabetes online communities and learned that increasing the basal insulin could counteract the increased insulin reisistance that comes from the shot.

I decided to increase all my pump basal rates by 50% or 1.5 times my current basal rates. I did this one hour before the injection and have been pleasantly surprised with the results. I know that this type of thing can easily vary from person to person but I thought I’d share my results. I should also note that I use an automated insulin dosing system that dynamically adjust programmed pump basal rates up and down as needed. This system has actually increased my +50% basal rates even more.

I received my steroid injection at noon yesterday, May 16. I’m especially pleased with my overnight trace that stayed in range and didn’t drive me hypo. Here are the traces from yesterday and today.

Was this just beginner’s luck or have other people had similar results post cortisone injection?

My physical therapy plan is to visit the therapist 2x/week for the first three weeks and then make a decision from there. I’ve got my work cut out for me, but considering my doctor’s warning that things would be worse if I didn’t apply myself, I’m grateful for the opportunity.

[Jen]

Great blood sugars.

I had a steroid shot earlier this year for severe allergies. I decided to wait until I saw an effect on my blood sugar to raise my basal rates, and am glad I did, because in the end it had NO impact whatsoever. In fact, I actually had to lower my basal rates.

I learned that steroid shots can have no effect, a mild effect, or a more pronounced effect in different people and even the same person at different times. My other theory is that maybe allergies were stressing my body out enough (from lack of sleep, not breathing well, etc.) that it was causing more insulin resistance than the steroid shot itself caused.

I’ve been offered oral steroids and steroid shots several times before for allergies and have always turned them down because I was scared of the effects on my BG. I will never turn them down in future after my experience and knowing that even if they did have an impact on my BG, I could probably handle it with raised nasals and more corrections.

I hope your good control continues and that the shot is helpful to your shoulder.

[Terry4]

@Jen

I learned that steroid shots can have no effect, a mild effect, or a more pronounced effect in different people and even the same person at different times.

Well, I am taking an increased total daily dose of insulin so I know that my insulin resistance did go up. It always helps to be lucky!

Prior to this experience, I thought that BGs always went up with steroid meds. I guess it’s just another flavor of “your diabetes may vary.”

[Jen]

I also take several topical steroid medications on a daily basis, and I believe they do have an impact on my BG (I notice that if I miss a dose I often go low and need quite a few carbs to keep myself up for hours). So I wonder if my basal rates are already somewhat calibrated to steroids. Maybe a combination or my above two theories. Or maybe just luck.

I’m glad your basal increase was exactly what your body needed! Are you still using Loop? I’m curious what it did to your insulin doses if you are.

[Terry4]

@Jen

Are you still using Loop? I’m curious what it did to your insulin doses if you are.

Yes, I’m still using Loop. My +50% basal rates equal 19.7 units per day. Loop adds and subtracts to that programmed pump basal rates. The net effect in the last 24 hours after adding the aggregate of the positive temp basals and subtracting the aggregate of the negative temp basal adds about another 7 units basal.

I haven’t changed my insulin to carb mealtime bolus calculation. The Loop initiated temp basals likely compensate to some extent for keeping the bolus ratio fixed.

Here’s a Nightscout graph of yesterday’s events.

This graph reminds me that I also used Afrezza (4 unit dose) three times yesterday.

[Tim12]

Sorry about your frozen shoulder. I had it in both shoulders (not at same time) and during the inflammatory phase it was hurting so bad that I would wake up in the night crying. The ONLY thing that helped was Steroid injections into the joint, and the Doc crafted the brew to not mess up my bgs too much. I did have to boost my insulin doses 25 percent or so but it was totally worth it.

In my experience, physical therapy is worthwhile but best to wait until the worst of the inflammation begins to die down. If the steroids help you take down the inflammation then PT now could work out fine.

[Terry4]

@Tim12

In my experience, physical therapy is worthwhile but best to wait until the worst of the inflammation begins to die down.

Thanks for the comment, Tim. I’m not clear what phase of this condition I’m in right now. I started feeling symptoms last September. I’ve read that the average duration of frozen is 30 months!

I’m going to give the physical therapy a good effort and hope for the best. My doctor said to plan on daily exercise therapy for one year.

[Terry4]

I had my first meal around noon today and the bolus insulin resistance has really ramped up. My evening meal yesterday saw my BG rise above the 140+ (7.8+) level for about an hour and topping at 162 (9) before it returned in range.

Todays meal gave me a run for the money. It rose to 140+ (7.8) territory and stayed there for almost four hours topping off at 171 (9.5). As my blood sugar rapidly rose to 140 (7.8) ninety minutes after eating, I took a 40-minute walk. This action alone would have returned me to in-range in prior days.

Immediately after I finished walking, at 2:20 p.m. with blood glucose trending into the 150s (8.3), I took a 4 unit IM (intra-muscular) correction along with an Afrezza 4U correction. The force on the other side was not impressed. I followed with 4U Afrezza corrections at 3:24 p.m. and 4:28 p.m. In addition to these corrections, I’m also biasing my Loop system to be more aggressive with its high temp basal rates by moving the target down to 65 (3.6) instead of the usual 83 (4.6). Am I breaking any insulin-stacking rules? Good.

Prior to this meal, I thought that my basal increases provided me with a solid platform to use normal insulin to carb ratios to keep meals under control. It didn’t work out that way. And it makes sense. If steroids increase insulin resistance, that resistance should be apparent with both the basal and bolus doses.

I’ve decided to skip the last meal of the day today and do an intermittent 24-hour fast. Fasts for me always increase insulin sensitivity. I will go out for a 30-minute walk this evening, too.

Fighting this high reminds of times in the past trying to control BGs when enduring an infection. It’s a little bit daunting throwing all those insulin darts at the hyper-trend but that’s what it takes. My doctor seemed to think that the insulin resistance should start to fade around four days post injection. I’m only at 30 hours, so I have ways to go to ride this out.

I’m pleased that I was able to hold the rising trend under 180 (10). Tomorrow is another day.

[MM1]

My first steroid injection was while on NPH,REG. No mention from doctor that BG would go up, so was hesitant to add too much insulin. It was a long, high BG week, above what was already in the days of ‘normal’ expected A1C for T1D to be 8-9ish.

[Rphil2]

Shots of steroids in joints have a small risk for raising blood sugar. Yes it does happen, but with a much lower icidence. The issue of steroids and diabetes typically revolves around sustained or IV use.

As a guy who gets a steroid IV every 4 months, even that only drives my blood sugar for about 36 hours.

[Terry4]

@Rphil2

The issue of steroids and diabetes typically revolves around sustained or IV use.

I’m lucky I didn’t have to deal with sustained or IV use. I’ve watched my insulin needs go up by a fair amount in this episode. Thanks for your comment.

Skipping my meal and going for a walk was just the ticket. I’m at 82 (4.6) and going sideways now. I did have to eat one glucose tab to break a downward trend.

[Terry4]

@MM1

My first steroid injection was while on NPH,REG.

I think the biggest missing tech back then was the CGM. If you didn’t have a meter, you were totally flying blind.

[MM1]

And faster acting insulin. It was dangerous to do huge bolus of Regular, that could last 4-6 hrs, especially in the evening.

[Terry4]

@MM1

It was dangerous to do huge bolus of Regular, that could last 4-6 hrs,

Using Regular did teach me the ill-effects of stacking. It had a long tail.

[Tim12]

I think your docs are being nice and progressive. Giving the joint a steroid shot to enable physical therapy to start working, I hope that moves recovery along more quickly for you.

For me the most useful thing when I couldn’t actually lift my arm up, was a pulley contraption I built in the basement to let me use my good arm to pull up/stretch up my shoulder. I copied this off a machine from physical therapy. There are also some good exercises involving a pole to push up your bad arm, or using a door frame to stretch the bad shoulder up.

[Terry4]

Thanks for the helpful suggestions, @Tim12. My doctor doesn’t want me to start physical therapy for a week so I’m feeling cautious about starting any routines at home until a week has gone by. Knowing the overly-cautious advice we sometimes get from our diabetes doctors, I’m skeptical but don’t want to get hasty or too impatient. Starting next Friday I will be attending physical therapy 2x/week for at least three weeks. I intend to give it my full attention and do the homework at least 2x/day.

[Terry4]

I skipped my evening meal yesterday and took a 30-minute evening walk to help with insulin sensitivity. My BGs remained in-range the rest of the evening and overnight as well. I did have to eat one glucose tab around 7:30 p.m. to pull up from a trending low.

Here’s my overnight line. I am still maintaining my +50% basal rate I initiated one hour before my noon Wednesday May 16 steroid shot. It appears to be working well.

Noon today will mark the 48-hour mark after my injection. I note @Rphil2’s comment about steroid joint injections not being nearly as bad as sustained or IV use. So far, my insulin resistance has markedly increased and I think it is significant at this point. I’m grateful to not be faced with what sounds like the much greater challenge of other steroid therapy.

My plan for my first meal today is to change my insulin to carb ratio from 1:4 to the more aggressive 1:2. I eat the same breakfast almost every day so this should be an interesting experiment. I arrived at this 1:2 ratio by adding in all the post-meal correction doses that I needed to take yesterday. I’ll still follow the meal with a 40-minute walk.

I intend to post updates until the steroid induced insulin resistance returns to my pre-steroid pattern.

[DrBB]

I was still on R/N last (only) time I had one, also for a shoulder problem, and my recollection is that it took about 3 weeks to stop affecting my BG. Much harder to adjust for on that stuff, of course, though I tried, once I realized what was actually causing the problem. From what you say I might consider it, now that I’m on a pump, though it would have to be a last-resort situation.

[Terry4]

@DrBB

I was still on R/N last (only) time I had one, also for a shoulder problem, and my recollection is that it took about 3 weeks to stop affecting my BG.

Yeah, my doctor said the steroid BG influence should wear off in 3-4 days. I’m thinking there is much more variability in the population. That’s one of the reasons why I wanted to document this. I realize my report is simply anecdotal but it may give others a starting point for their expectations. And I always give more respect to an anecdotal report that comes from me.

My sports medicine doc who gave me the steroid injection told me that I could request another one if that’s what’s needed for my physical therapy. This thread will help me when my memory goes foggy about this instance.

[Micki2]

For me, one steroid shot in my foot for gout raised my BS like crazy. 400+ and I had to triple my dose of basal and then just not eat carbs for several weeks. I guess I’m one of “those people” lol