Using steroids for bad rash on both arms, now in 7th week. Between 2 different scripts for different steroid pills and 2 different topical steroids I am sure my next A1C will be 8 instead of 7. I was advised that steroids do increase glucose levels but was not expecting such a large effect. Initially I did not have to increase insulin very much but now 1.5 times my long acting Lantus and more than double my rapid acting.
Along with Dawn Phenomenon it is now almost noon without eating while waiting for BG to get under 150 by my CGM.
I have had 1 week breaks without steroids but my insulin needs continued to be high. Any suggestions?
Can you control the rash by removing irritants? Soap and laundry powders are common problems. You can use Cetaphil or Dermaveen skin washes, which are made for people with rashes. Laundry powder, I find the liquid sorts less harsh and try to find a ‘green’ one. If you can reduce the steroid use it would help your bsg levels.
Early this year had a different rash on my back so switched to Dove soap and ECOS laundry soap as a precaution. Dawn still my dish soap of choice. 1st doctor thought I had poison ivy but dermatologist confirms it is not and just says contact dermatology.
@Terry4 wrote a really informative post on getting a steroid shot you might want to check out.
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One thing I learned about steroids and glucose control is that a steroid shot into a joint is different than topical application and an IV treatment. I think my situation was relatively simple compared to oral and other steroid routes. I did, however, have to double my insulin doses, both basal and bolus, to counteract the effect of my steroid injection. The effects only lasted for about a week.
The only suggestion I can offer is to more closely monitor your BG levels and don’t be afraid to increase your insulin doses in response to elevated BGs. I think your CGM is especially important while you deal with the after-effects of the steroid treatments.
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Do I follow that the steroid shot effects to BG lingered for about a week after each injection? That would explain why my insulin has been increased even during week long breaks.
Yes, contact dermatitis is what I have had for nearly 40 years. I found Dove soap to be very harsh. The foaming agent in soaps, detergents, shampoos is made from petro-chemical waste product. I use the complete range of Cetaphil, shampoo, conditioner, skin wash, moisturiser, face cream, hand cream, deodorant. I moisturise any rash as soon as it appears, and keep my skin fairly clear. My aim is to avoid any cortisone creams, tablets, etc. Wearing cotton clothes, using cotton sheets, etc. are also good. Washing powders and dishwashing liquids are difficult, you just have to experiment to find the least offensive. There is a lot of information on various eczema sites. Stress also causes dermatitis to flare up, and you are stressing about your blood glucose numbers.
Hit the problem both ways! Good luck.
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Steroids elevate blood sugar levels. Diabetics receiving renal transplants, of whom there are many, have to undergo heavy-dose prednisone treatment to induce immunosuppression at the outset of the transplant, and their insulin dose during this brief time period has to be massive.
Any suggestion of what is best to help sleep thru the night rather than waking every hour or 2 wanting to scratch the rash?? Benedryl (generic) pills don’t seem to help.
@JJM1 I have very sensitive skin and when I have flares my doctor prescribes Atarax (Hydroxyzine Hcl) for the itching (this rx is 40 years old - it started with chronic uticaria - giant hives that joins into one huge hive… not fun). I have it in two strengths; when the skin is real bad; the 25mg will take the itch away by putting me to sleep. A lower dose helps at those times when you can’t sleep, but have to work; it has helped me through some pretty awful times. If these don’t work, I learned while on my honeymoon, I can go to the ER and they will give me an injection of Benedryl; that takes the itch away and puts me to sleep too. Perhaps your doc can give you a rx dose of Atarax or Benedryl?
@Pastelpainter mentioned they use Cetaphil or Dermaveen. I’ve used Cetaphil, but I’m more prone to using Aveeno and Almay products. Also, with laundry products I use hypoallergenic, dye/scent free.
I know it is not a pleasant experience; at times I’ve … let’s just say … it isn’t pleasant.
One time there was a Eucerin spray which helped to ease the itch (it had eucalyptus in it). I haven’t been able to find it in years, but a few years ago I came across Gold Bond Pain and Itch Relief Antiseptic Spray. It helps me. Eucerin is another product that helps moisten my skin. Refocusing my attention can help with the itch too. When I don’t have anything to take or apply and the itch wakes me up, I do housework or book work or … or … anything to help distract my mind until it passes. Cool, not warm baths or showers can help; remember to blot, not rub to keep the skin as unaffected as possible.
Steroids are no fun. I’ve only had to deal with them a few times and can’t recall anything other than the high bgs leveled off and things went back to normal. @Terry4 I had frozen shoulder; I’m going to read your post.
@JJM1 Hopefully you find some relief in some of the suggestion from everyone.
I wish you all the best and will pray that this bout passes soon and doesn’t return!
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Those are good suggestions from Tapestry. I have never been prescribed anything to stop the itch, apart from cortisone creams, but sometimes a cool (never hot) shower followed by application of one of the suggested moisturisers (basically they are all about the same, I just buy the one on special offer). Never use soap or shower gel, just one of the special skin cleansers. Didn’t your dermatologist tell you these things? Oh and cotton bedding, pjs, etc. Anything polycotton, vicose or bamboo will be uncomfortable for you. Its a huge nuisance, but when you are set up you should be able to keep yourself comfortable except for when you get a flare up.
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Good suggestion @Tapestry, I have a friend going through same, I will have him read this
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I’ve had at least 3 docs want to give me steroids (oral or shots) and I’ve declined, because when given, for example, a standard dose of prednisone, my bg’s will shoot up to above 270 and stay above 200 even when I take at least 3X my normal amount of insulin. You read that right-- THREE times my normal insulin dose. I can drain a pump in less than 36 hours. If taking that much insulin would keep me closer to 100, it wouldn’t be the end of the world, but to remain above 200, even when taking crazy-amounts of insulin just isn’t something I agree to . One time I had chronic hives for 7 months, and near the beginning of that, one doc put me on prednisone. I had to get off of it quickly due to bg issues. I dealt with the hives by taking a ton of oral and topical Benadryl. When I told the doc I was taking 12 pills a day he couldn’t understand why I wasn’t asleep. LOL! Most people get very sleepy on a far smaller dose.
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Thanks for all suggestions. Need to closely examine all again. Last night after 2 Benedryl, 2 Dramamine & 2 Mint tea (Lemon Balm, Peppermint, Spearmint & catmint) I slept a bit better but still up 2 or 3 times itching. As mentioned, when mind and hands are busy it is tolerable until slow down to watch TV or sleep.
OTCs that provided temporary relief but most became ineffective after a few days: Aloe leaf, Aloe gel with Lidocaine, Benedryl gel, Calamine, Caladryl, Aveeno Bath (worked better with packet in pot of water & soaked hand towel wrapped around arm for 15 minutes), Aveeno moisturizer, Suave Soothing with Aloe, Aloe gel blended with essential oils (Tea Tree, Myrrh, Lavender, Rosemary & Peppermint), Colloidal Silver soaked cloth wrap, and Triple antibiotic.
Initial Scripts from reg doctor (thought it was poison ivy despite my doubts: Triamcinolone Cream 0.1%, then Steroid Dose pack & Desoximetasone Creme 0.25%. (Steroid Dose helped quite a bit.)
Now from Dermatologist for contact dermatitis: Triamcinolone Ointment 0.1% and Prednisone (decreasing dosage every 4 days for 2 weeks. And with orders to not use anything else except benedryl pills and stop chloresterol meds and blood pressure meds (unless BP measures above 150/90) as potential that some of the extras might be irritants.
BTW - I did take anti-viral and antibiotic pills that I already had. Also when wash arms with Hydrogen Peroxide would get lots of bubbles (read however that doing so with a rash can result in bubbles under the skin surface).
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Might just be coincidence but noticing 2.5 day trend. Take Prednisone at suppertime, bedtime BGs at 90 (+/- 30), 8 hours after Pred BGs rising above 150 so take rapid insulin, BGs level off at 220 (+/- 30), morning take (large doses) insulins and BGs rise 30 points more with morning phenomenon (or the coffee). Wait 3 - 4 hours to drop below 150 for 1st meal.
Afternoon I can get reasonable BGs but do have to graze more than normal, indicating I might be taking too much Lantus &/or should have started splitting the Lantus dose.
Almost afraid to take more rapid during the overnight rise BUT I guess if I did drop low I would catch it when itch wakes me &/or Dexcom yells at me.
You are smart to closely watch your BGs and respond with appropriate action. I think it’s hard for us to increase insulin doses to the high amounts that steroids sometimes require. We know how potent insulin usually is and the lows it can cause. You might consider taking the extra rapid insulin during the night and setting an alarm clock to wake you up to check when it peaks. Just a thought, I know you need your rest, too, but the extra safety with the alarm clock might help you give the overnight correction dose.
Good luck! I think you are coping very well.
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We’re all different. I can’t get low when on Prednisone, IIRC. No matter how much insulin I take, it acts like water. My wife’s bg’s are affected for a short time when given steroids and not to the extreme that I’m affected.
When I’ve had steroid injections, I’ve had to increase my basal dose dramatically (+50%) for about a week after the injection, and even then, was still needing to correct aggressively at times. The last time I had an injection it was definitely worth it, but I will only do them if it seems absolutely necessary for this reason.
Also, I’m sure you’re doing this, but have you done all the things like switched to a super gentle/fragrance-free laundry detergent (and NO dryer sheets! they are the worst in so many ways) and gentle/fragrance-free soap, etc?
Until 8 months ago I have never had a rash last longer than a week, other than childhood diseases Measles and Chicken Pox. And that’s while growing up in the country wandering thru overgrown fields and thick woods as well as gardening and doing all my yard work. But things do change and have to accept that.
Yes I changed to recommended Dove Sensitive Skin and Free & Clear Hypoallergenic ECOS laundry detergent.
OK so now my Insulin use: Increased long acting Lantus by 50%. Doubled rapid acting Apidra. And last night (Prednasone at 8PM) when itching woke me (2nd time) at 2AM my BG was rising and I dared to double Apidra from what I normally would do and did find that BG had dropped and leveled at around 100.
Interesting to hear about this result. I’ve had one steroid injection (for an orthopedic problem) and swore never again! because my BG didn’t normalize for almost three weeks. But I’ve used topical steroids–well, usually just cortisone–for skin things many times and never saw any effect. Matter of fact I’m taking one now–fluocininide–since about two weeks ago, and not having any out of the ordinary problems. What steroid are you actually taking, and have you taken others before? Sounds like this is the first time you’ve experienced the problem.