Frozen shoulder, my BG experience after a steroid shot


#21

Thanks for your comment, @Micki2. I started this with increasing all my basal rates by 1.5x or +50%. My last meal, however, has punctured the 200+ level even with much more aggressive bolus insulin. So I just upped all my basal rates by 2.0x or +100%, a doubling of the pre-steroid rate.

Yesterday I decided to only eat one meal; I skipped the evening meal. That worked out real well BG-wise. I was going to eat an evening meal tonight but I think I’m going to repeat yesterday’s evening fast.

I’m now 52 hours out from the injection and it looks like the insulin resistance is still moving upward. I’ll continue to monitor.

We’re each an individual with our BG response to steroids. I think the best thing is to monitor closely and don’t be afraid to make some bold insulin changes. I’ve got my Dexcom and my dog to back me up.


#22

Will be anxious to hear, Terry4.


#23

@Terry4, that looks very very good. Your expertise has pulled you through remarkably well!


#24

Thanks for the encouragement, Richard.

I’ve had some challenges around meal insulin dosing. My Thursday graph above shows how I had to add a lot of correction insulin after eating. So, on Friday I added all that correction insulin to my meal dose but my automated insulin dosing system had a “max bolus” setting of eight units and my system gave me only eight units upfront and the rest with higher temp basals. That didn’t work out too well.

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That spike topped out at 202 and I was above 140 for two hours and forty minutes. So today I got another opportunity to try this meal again. I elevated the max bolus setting to 15 units and was able to deliver 12 units upfront. That greatly increased dose plus a forty minute walk did the trick. My pre-steroid shot typical meal dose is around 5-6 units.

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Today I took my insulin at 11:19 a.m. and ate at 11:50 a.m. and walked from 1:20 p.m. to 2:00 p.m. I seem to have a handle on what my increased insulin dose and timing needs are to keep things reined in. This steroid shot is definitely increasing my insulin needs. I hope to cut back on my doses as soon as I can but will let my body decided when that’s going to happen. I think I have benefitted a lot by cutting back my meals the last two days from two to one. I’m looking forward to eating again this evening, however.


#25

Nice improvement! You are handling your steroid experience very well. Good luck with your frozen shoulder problem.


#26

I had frozen shoulder in both shoulders at different times, OH! the pain is something I have never felt before.
I got online and found a procedure called Hydrodistension, I took the article to my PT and I asked him if he has ever
heard of this, he said he did not but pointed me to a orthopedic Dr. that might. At that time I lived in California, I called
the Dr and asked if they did this procedure and they said yes! What I found out was almost all the articles I read
where in the UK and they said that there where very few Dr.'s in the US did it. I was just lucky because the Dr. that did this
was the only one in about a 100 mile radius from where I lived. I asked the Dr. for an appointment and they got me in the next day.
Hydrodistention involves stretching the capsule of the joint by injecting a mixture of sterile saline, local anaesthetic and steroid into the joint, then there was a pop in the shoulder. This opens up the joint and releases sticky adhesions within the joint.
What a relief! I was sore for a couple of days after and continued with my PT. for about a month. A year later I got it in my left shoulder and had the treatment done again, that was 10 years ago.
There is 90% in improving pain and 70% in improving the movement of the shoulder. Many people will feel immediate relief, but for others it can take a couple of weeks to achieve full benefit. The needle was a small price to pay for something so painful.
If you have frozen shoulder you might want to consider this type of treatment, it will take some effort on your part to
locate a Dr. that will do it. I’m so glad I did!
I am a T2 diabetic and my blood sugars where out of wack for a few days after the treatment but well worth it.
It may not work for everyone, so ask your Dr. if it’s an option for you.

You can look online for Frozen Shoulder Hydrodistention?


#27

Knowing I am prone to having problems with any medications half the time, when they prescribed me 5 days of 20mg prednisone pills for a back issue, I decided since I know medications can just affect me, but also knowing steroids could affect my blood sugar, I decided to break them into quarters. Sure enough 5 mg sent my blood sugar to over 300 from a low 100 range. No matter not eating or eating very little that lasted a couple of days. I would get it to drop and it would shoot back up. I was not on a pump or CGM so it was more difficult to control anyway.

So I tried 2.5 mg and 2.5 mg actually dropped my blood sugars as long as I only took 1 a day. It did help my issue tremendously . A few years after that I had to get a cortisone shot for an allergic reaction and I asked them to go the lightest dose they could and sure enough my sugars soared over 300 again but the problem only lasted for a couple days again.

I will of course use it if it’s an emergency situation again and just deal with it. But I seem to be really sensitive to it.


#28

Thanks for that info, @Daisy6. I have not heard of this procedure. I need to do more reading about it and see if it’s even available locally. Almost every treatment for frozen shoulder that I’ve read about comes with caveats. It’s odd that even choosing to forgo any medical treatment produces good outcomes for a significant slice of the population.

I’m committed now to my current plan of a steroid shot followed by a persistent course of physical therapy. My physical therapy starts next Friday, 9 days post-injection. I’m now four days post-steroid injection and I’m feeling very good pain relief. My spirit and cognitive function have both improved. It’s amazing how much pain can take away from quality of life, even if the pain level is moderate.

I appreciate your sharing your experience. It’s good to know that there are other treatment options.


#29

It seems that oral steroids are more problematic for blood glucose than a steroid injection. I think you were smart to try to minimize the negative effects of hyperglycemia excursions. I know we can’t always control BG swings cause by needed medical therapy but I think it’s well worth it to limit hypers as much as possible.

Thank you for reading and making a comment!


#30

Yesterday was a good BG day for me. I did spend more time hypo than I like but all my hypo-time was spent in the less critical “hypo-alert” range, for me from 54-64 mg/dL (3-3.6). I consider this hypo-alert range as a buffer for me when I need it.

I don’t take large counteractions to hypos until they sink below 54 mg/dL (3.0). I know it makes doctors nervous, but it is my diabetes and I’m pretty good at exploiting this without it harming me. Even without steroid shots or other illness, I seek to keep my time below 54 mg/dL to 0% and time in the alert hypo range to less than 5%.

Here’s yesterday’s trace and my overnight line.

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I experienced low excursions in the early morning hours as well as the late afternoon time frame. Since I’ve doubled all my pump basal rates, I decided that these hypos suggest that I may start marginally pulling down a few basal rates. I lowered rates at 5 a.m. and 4 p.m.

At four days out from my steroid shot, my pain is much improved and I’m starting to see a lessening of my insulin resistance. I need to look at my meal insulin to carb ratios and consider taking some of them down, too.


#31

Wow, Terry4. You are such an inspiration. Thank you for sharing your experience. I always learn from your posts.


#32

Frozen shoulder about 35 years ago - 3 or 4 weeks of PT. The other froze about 30 years ago - steroid shot only. Steroid shot (no doctor warning) worked best and that shoulder gives least problems today BUT both do occasionally bother me with reduced reach behind my back, momentary pain with some arm movements upwards and working overhead can be very uncomfortable - stretching to the point of pain does help. Did not notice increased BG, probably d/t poor record keeping.
Recent steroids (for a bad rash) have been a pill regimen (no doctor warning) with reducing dose each day and a month later typical steroid cream (with doctor warning). Now using CGM, I immediately noticed requirement to increase Lantus by 25% and Apidra by 50%.


#33

I’ve been doing some reading on frozen shoulder today. My biggest conclusion is that it’s hard to point to any therapy with a proven track record. There are very few studies about this condition although it is common enough.

One interesting notion is that some people with frozen shoulder don’t actually have a functional limitation but that it is neurologically driven. In other words the brain stops sending signal to move that joint simply because it thinks it can’t. Atrophy and frozen shoulder follow.

I have enjoyed and learned from this Frozen Shoulder Guide.

It’s written for lay-people like me in language I can understand, yet it also makes citations to anything helpful in the medical literature. It did explain the hydrodistention therapy used by @Daisy6 but like all therapies covered in this guide, none of them appear to be the magic bullet.


#34

Thanks - Have to read thru it. Would love to be able to scratch back with either hand rather than just the left.

Terry4

    May 21

JJM1:
Frozen shoulder about 35 years ago - 3 or 4 weeks of PT. The other froze about 30 years ago - steroid shot only. Steroid shot (no doctor warning) worked best and that shoulder gives least problems today

I’ve been doing some reading on frozen shoulder today. My biggest conclusion is that it’s hard to point to any therapy with a proven track record. There are very few studies about this condition although it is common enough.

One interesting notion is that some people with frozen shoulder don’t actually have a functional limitation but that it is neurologically driven. In other words the brain stops sending signal to move that joint simply because it thinks it can’t. Atrophy and frozen shoulder follow.

I have enjoyed and learned from this Frozen Shoulder Guide.

  [www.PainScience.com](https://www.painscience.com/tutorials/frozen-shoulder.php)

Frozen Shoulder Guide (2017)

Frozen shoulder is a painful loss of shoulder movement due to a mysterious contracture of the connective tissue around the joint, which may last for years or even forever. There are no proven treatments.

It’s written for lay-people like me in language I can understand, yet it also makes citations to anything helpful in the medical literature. It did explain the hydrodistention therapy used by @Daisy6 but like all therapies covered in this guide, none of them appear to be the magic bullet.


#35

Frozen shoulder is very real and not just neurological in origin. Now it does have a complicated interaction with how we think about our and use our shoulders after it occurs. If you’ve only ever had one frozen shoulder, then you probably favor the other shoulder unconsciously even after the frozen shoulder has (largely) cleared up. For those of us who have had frozen shoulder in both shoulders (probably one after the other) the second bad shoulder sure is good motivation to start using the first shoulder more effectively. So maybe we are lucky that we are more “balanced” when we are done. Hah, the luck of having two frozen shoulders, I wouldn’t wish it on anyone!

In my case (and I think in many others cases too) it wasn’t just the shoulder joint, I also had severe tendonitis which may have been even more pain-and-jarring sensitive than the joint itself. Some folks may want to argue, did the frozen shoulder cause the tendonitis, or did the tendonitis cause the frozen shoulder. I would differ with everyone else, by saying that an overall inflammation in the area was the cause of everything! And it’s also possible that the inflammation is some sort of auto-immune thing (although I have no proof of it!).

It was interesting seeing docs while I had frozen shoulder. I could tell the good docs because they weren’t just looking at my shoulder, they were also looking at my face and my whole body as they approached my bad shoulder. They could tell that I was sort of wincing and girding myself for pain whenever they got close to my bad shoulder. I think the pain for me was more extreme than for you. In particular at its worse part of inflammation, simply any jarring motion anywhere in my body, that remotely jarred or shook that shoulder, caused excruciating pain.

As to overall therapy, I think PT has limited value while the shoulder is still “Frozen” and super duper sensitive to motion and jarring. Having gone through frozen shoulder in both shoulders, for me the big step forward was getting a steroid shot that allowed the worst most inflammatory part of the pain to go away, such that I could do the physical therapy and get benefits from it. I think the steroid shot not just reduced the pain, it actually reduced the underlying inflammation as well, and that was super important.

While I feel that PT really did help me in recovery, I think that the underlying inflammation was really the core issue. Having talked with others, they tell me that they aren’t so sure PT did anything but hurt them, that they just had to let the inflammation run its course and clear up.


#36

I like reading the experiences of others who have lived with frozen shoulder. I’m getting a definite sense that clinical medicine is somewhat baffled by this condition. There doesn’t appear to be any therapy that really shines.

I’m now five days out from my steroid shot. I am definitely enjoying pain relief but I’m surprised at how much my mood has brightened and my brain works more clearly. Getting thoughts from my brain out through my fingers and onto the computer screen is more fluid today than it was before the shot. I’m happy for that alone.

In the reading I’ve done, I’m beginning to understand that the shoulder capsule has become fibrous and thicker than its usually healthy state. They use the word “contracture” to describe this. This explanation makes sense to me and provides a basis for thinking about my shoulder physiology.

This contracture fits in with plantar fasciitis I struggled with a few years back. I think we, as diabetics, with our hyperglycemia, can expose our connective tissues to excess glucose and the tissue becomes glycated and sticky, kind of like our hemoglobin becomes glycated and can be measured to produce an A1c number.

Diabetics also suffer more frequently that the non-D population from a condition known as Dupuytren’s contracture, a condition that expresses itself in the hands.

I’ve enjoyed more good glucose traces as I continue to back off the doubling of insulin delivery post-steroid shot. I’m pulling down both basal and bolus insulin as mild hypos indicate where to trim.

15%20PM


#37

Tim - sounds like we had similar Frozen Shoulder experiences. My shoulder was pretty much locked, ultra-sensitive to any sort of jarring, Cortisone shots and forced manipulation resulted in only temporary relief. Ultimately I need surgery to provide a return to normal (a six year process). Anyone getting repeated cortisone injections should be more concerned with the bone and cartilage damage it causes than imbalances to BS.


#38

Thank-you for that tip, Tim. This was my first cortisone shot and I’m just learning about it. I will look for more information about bone and cartilage damage. I worry that I’ll need another injection as frozen shoulder lasts so long in many people. It has given me such great pain relief.

I am happy to read that even your severe case resolved, albeit with surgery, and you’re back to better health.


#39

My insulin resistance caused by the steroid shot continues to pull back. Yesterday, I experienced a couple of significant hypos, particularly the one in the afternoon. I confirmed with fingersticks the depth of the afternoon low. I was down to the low 40’s (2.2).

It’s resistance to glucose treatments verified to me that this was a basal low. I find basal lows to materially differ from a bolus low in that it is more tenacious and requires multiple treatments. The tricky part is not over-treating it. I did slightly overtreat and you can see the rebound hyper that followed.

I continue to pull basal rates down and have responded to yesterday’s hypos with changes to my basal profile. I look forward to getting back to my old baseline control, but will keep my eyes open to wrestle this challenge to the ground. I’m at one week post-injection.


#40

You know you have really good control when 150-200 for a couple hours is unusual. I can’t imagine doing as well with a steroid shot, no matter what my diet was.
Hope your shoulder is feeling better!