Medrol 4MG Dosepak 21's

So I have had a pretty gnarly sinus infection for a month or so. This go round the doc prescribed me the medication in the Subject. Because it was so late in the day 4:40 pm when he gave me the script, he told me to take 3 of the 6 tablets for day one as soon as I got them from the pharmacy. And then the other 3 around 9:00 pm. I tested my sugar when I left his office and was 189, so I corrected and drove to the pharmacy. I took my dose at 5:25 pm. I tested after dinner (around 6:30 pm) and my sugar was 589. Bewildered I tested again and same result. So I dosed and went along with my nightly fatherly duties. At 9:00 I tested and was back down to 147. Took the 3 pills and drank a few glasses of water. No other food or drink that would have raised my sugar. At 10:30 I tested before bed and it said HI. WTF so I corrected for a 599 and tested again at 1:00 am. It was down to 225 so I went to bed. Woke up this morning and it was 188 so I dosed for a small correction and for my coffee. Took my pills, made it to work and tested. 369. :( ??????? Then I read the insert with these pills, and it states "Increased requirements may be needed for insulin or oral hypoglycimic agents in diabetics".

I have never had this kind of a jump in sugar levels with any medication, (other than the sugar water mixture the emt's gave me via IV that one time). How would I go about dosing for this? Just wait until I get a spike and adjust?

Just got off of the phone with the doc, He said that anytime a diabetic is put on this kind of medication there is a risk of fluctuating sugar levels. Some people will react different than others. And it appears I am on the Crazier side of things. And to up my basal rate and also bolus higher for my meals. It is something about metabolic reactions with this medication and it should get better as the days go on. Crossing my fingers

I haven’t used this antibiotic before but I’ve used several others. My experience is that blood sugars, when I have an infection like a sinus infection, become very insulin resistant. I’ve taken large correction doses and worried about going hypo, but that never happened.

Once the infection is knocked down, I’ve found that reasonable BG control returns. In fact, stubborn highs combined with other symptoms are a reliable indicator that I have an infection.

The drug you were given is a version of prednisone. In other words an oral steroid not an antibiotic. It will spike you as long as you are taking it. Have you talked to your doc about a non steroid option? Have you told him how high you are spiking? With numbers that high you can be at risk for DKA, was the prescribing doc aware of your T1?

If you are not on an antibiotic then it is given for its anti inflammatory action. Nasal medications rather than oral/systemic medications might be an option.

If your stuck with the prednisone then you have the option not to take it due to the side effects.
Have you talked to your Endo about how to dose?

Most steroids will elevate BG, some more, some less. So this makes total sense.

I was told Steriods do that too.

Steroids are bad news for blood sugars. I find it incredibly irresponsible that the physician didn't warn you of these side effects. Or the pharmacy for that matter. I agree that everyone reacts differently but that's basic info that should have been given to you. I've taken care of patients without diabetes that get blood sugar spikes from steroids. The Medrol dose pack is for 5 days or something like that so you might consider increasing your basal rates for those days since you will be taking the med daily. It took me a few rounds of steroids to figure out what worked for me. I would increase my rate on the very first day before I even started the steroids and sometimes I was running 50% higher on my basal rates to cover the increases, it was a real roller coaster. Now I try to exhaust all other options before taking them.

I am not stuck with it. But in the last 8 years, I get at least 3 sinus infections a year, some mild, and some like this one that are intense. In the past nothing has helped. So that is why he put me on this steroid. And it is working. So I am just maintaining my bg as best as i can. I only have 2 more pills to take and I will be done. Just have the hoarse pill Augmentin 875mg left to take.

It states on the Pharmacy label that it may cause a fluctuation in sugar levels for diabetics. I just have never had one mess with it this bad before.

Just curious was this from your primary? Have you been seen by ENT doc as well as allergy/immunology?
Some times chronic allergies can be an underlying cause, and fixing the allergy stops the sinus infections. That worked for my son. Claritin, singular and flonase helped him a lot.
Other thought is that there may be a structural problem that sets you up, like deviated septum etc. Ear,Nose and throat doc can help there. Fancy term is otolaryingoligist.

My primary said the ent is my next step. My nose has been broken multiple times and he thinks that may be what is causing the infections.

I would be calling for ENT appointment, especially as it can take more than a few weeks to get an appointment at a lot of practices these days.
Even if you clear this bout, getting the nose corrected so you have better drainage may help to prevent/decrease the frequency/severity in the future.