Glucocorticoids can markedly affect blood sugar levels, and I am posting this in the hope that my experience helps other PWDs who need to take glucocorticoids.
I am a 67-year-old man diagnosed 30 years ago with Type 1 diabetes. I was recently diagnosed with Rheumatoid Arthritis. Both Type 1 and RA are autoimmune diseases. From my reading on this forum and other sources, comorbidity of Type 1 and RA do occur but are not necessarily common.
The usual course for initial treatment for RA is methotrexate, an immunosuppressant medication that tamps down the immune system. I will likely be taking methotrexate for the rest of my life; with the covid-19 epidemic, it is not a good time to be immunosuppressed, but that is the way it is. The other initial treatment for RA is usually a course of glucocorticoids, typically only for one month. One should only take glucocorticoids for the short term, as there are severe negative consequences to long term use. My rheumatologist and I discussed glucocorticoids but decided not to use them because of my diabetes.
On my one month follow up visit, the pain and swelling in my hands were still quite severe. We again discussed glucocorticoids, but we decided to give them a try. She prescribed 5 mg Prednisone; I could go up to two pills per day, or I could stop taking the drug if my blood sugars went completely out of control.
I read the medical literature, and discovered that Prednisone is a short-acting glucocorticoid and that its “hyperglycemic effect is most pronounced during the first 8 to 12 hours after the dose, especially after meals.”
I have been using an insulin pump for 16 years, first a Medtronics, and now a Tandem pump. The pump has been especially good for me, as I discovered that I need twice as much basal insulin at night as I do during the day. I have seen posts on this forum asking how many different basal rates do you have during the day, and I am chagrined to report that I have 8 different time periods. For many years I have kept a spreadsheet where I keep track of my pump settings: basal rates, correction factors, and carb ratios. When I make changes, I copy/paste my previous setting, enter the changes, and record the date. Like most people, my basal requirements go through seasonal changes, and having my past settings recorded has been very helpful.
I took my “Standard” Personal Profile on my pump, duplicated it, and then renamed it “Steroid,” and started making changes. Initially, I increased the basal from 5 AM to 5 PM, since the drug is supposed to act for the 8 - 12 hours. I typically wake up at 6.30 AM and eat at 7 AM. I take the 5 mg Prednisone at 7 AM since it should be taken with food. Every couple of days I made adjustments to the “Steroid” pump profile. I needed to increase my basal overnight, and I needed to lower the daytime insulin. I have been taking the Prednisone for 10 days now, and I have made 8 iterative changes over this time period. I think I have it pretty well dialed in right now. My Time in Range has been 87% over the past two days.
As always, Your Mileage May Vary, but I found a daytime increase of 1.6-1.8 was good, and a nighttime increase of about 1.25 worked well. Below is a screenshot of my spreadsheet showing my “Standard” Profile on the left and my most recent “Steroid” Profile. The right hand most column has the ratio of the “Standard” Profile on the left and my most recent “Steroid” Profile.
BTW, I have been taking the Prednisone for about 10 days now, and it has made a tremendous difference in the pain and swelling in my hands. I may take it for another week, and then I will revert to my “Standard” Pump Profile.