Steroids and BG

Type 1 and LADA
#1

Long story short, I have an allergic condition called eosinophilic esophagitis. Since my diagnosis in January I've gone through having my esophagus dilated (where they actually stick a tube down your throat to physically dilate it), allergy testing and eliminating foods I'm allergic to, and swallowing steroids from an asthma inhaler (instead of inhaling them). My throat is still pretty horrible - when I eat I can feel food scraping down the sides and need to drink water frequently to help push the food all the way down. I've had at least one instance where my throat swelled completely shut. My throat also feels swollen and irritated even when I'm not eating.

I saw my allergist today and he wants me to try swallowing a liquid form of Pulmicort, which is a steroid usually used in nebulizers. So, I wonder if anyone knows whether this might affect my blood sugars. I've been on lots of topical steroids before, and am actually currently on several (lotion, nasal spray, inhaler), but since I'm swallowing this liquid I wonder if it'll have a noticable impact. Probably no one knows - Google came up with information about this treatment but no information on whether it might affect blood sugar for people with diabetes - but I thought I'd ask anyway. My diabetes control is currently terrible - I wouldn't be surprised if my next A1c is above 8%. It's partly due to changes in my diet, partly due to the fact that I am gravitating towards foods that are easy to swallow, and partly that I'm feeling extremely burned out with health stuff in general right now.

My doctor also wants me to take a proton pump inhibitor in case acid reflux is irritating my throat. I am REALLY hoping this new plan helps, because if it doesn't my allergist mentioned the possibility of oral steroids for a short time to calm the inflammation in my throat down, and my gastroenterologist mentioned the possibility of dilating my esophagus again - both things I would really rather avoid.

#2

I had steroids in 2008, after I got my pump. I had a cough that turned into bronchitis and was pretty horrible. I'd been through a round of antibiotics, lots of cough syrup and quarts of tea to no avail so they rx'ed steroids, I think like a dosepak type of thingy. I ended up running my basal at 200% (it took a day or so...150? hmmm nope, 175? nope...I hope 200% works as it won't go any higher) but it seemed to work and then the meds worked and I got better. It's not the same thing but the way I think about it, the answer to elevated BG is usually more insulin which can be very challenging. Good luck with that and I hope it helps you feel better!!!

#3

Thanks! Hopefuly pulmicort won't have that much of an effect (I am currently struggling not to spike to 17+ on a daily basis...) and hopefully I can avoid prednisone. I pick it up from the pharmacy tonight, so here's hoping!

#4

Try checking for the active ingredient on this web page
http://www.diabetesincontrol.com/tools/tools-for-your-practice/9625-drugs-that-can-affect-blood-glucose-levels

#5

I have needed high dose oral steroids for my asthma sometimes for several weeks. What I’ve noticed in myself the longer I try conservative therapy that fails the worse and more stubborn the underlying inflammation gets and my blood sugar control is lousy either way. During the initial few days of steroids my sugars are awful but once the inflammation subsides my blood sugars do much much better even if the steroid dose is still high.



I don’t think I have ever regretted going on steroids but there have been times I wished I had done it sooner because in the big picture it helped tremendously and delaying has has cost me several weeks of suboptimal control thinking things would get better eventually but they didn’t.



Your case may be different in that your sugars may not be affected by inflammation as much as mine are. Or maybe the steroids will be worse for you. You’ll never know until you try though and it sure seems like you’ve been dealing with this for a long time.

Also swallowing pulmicort would probably be more similar to a topical steroid vs systemic I would think. I could be wrong not familiar with that use.

Good luck with your decision

#6

You know, I never even thought that my blood sugars could be connected to inflammation, but of course that makes sense. I also posted in a community of people with eosinophilic disorders and a lot of them said go for steroids, apparently it helps a lot, but so far I have wanted to be conservative. I'll follow through with the plan my doctor came up with, but if I'm not better by the time I see him next (and I see my gastroenterologist in between that so may get another gastroscopy done to see how my throat is doing) I think I'll give the steroids a try. Thanks for your insight!

#7

I took prednisone for viral hives this summer. The BG was definitely a bit higher, although the meds made me crazy and anxious and I didn't sleep for 3 days, which probably had a huge impact. Although they did give me an enormous dose… Anyway, carefully monitor your BG and see if you notice a pattern. If it's wonky for a week, you'll be fine. That's all I can advise.