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Old 10-07-2008, 11:17 AM   #1
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how long will cortisone injection cause elevated bgs?

I'm type 1 diabetic and on Friday (five days ago) I got a steroid injection for frozen shoulder. I was warned that my blood sugars would be elevated, but this is ridiculous. I use a pump and I have a temporary basal setting of 150%, and yet my bgs are still running near 300. And I"m eating like an Atkins convert -- avoiding carbs, hoping that will help. How long will this last?

 
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Old 10-07-2008, 11:36 AM   #2
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Re: how long will cortisone injection cause elevated bgs?

Quote:
Originally Posted by beanstock View Post
I'm type 1 diabetic and on Friday (five days ago) I got a steroid injection for frozen shoulder. I was warned that my blood sugars would be elevated, but this is ridiculous. I use a pump and I have a temporary basal setting of 150%, and yet my bgs are still running near 300. And I"m eating like an Atkins convert -- avoiding carbs, hoping that will help. How long will this last?
I don't know how long it will last, but my understanding with cortisone is that it causes insulin resistance as well as increases glucose production.

Insulin resistance may be something you have never dealt with ? I don't know if T1s struggle with it

A few different drugs have sent me for a loop.

The only way I know to immediately reduce the insulin resistance is through excercise.

Did you try a little extra walking or 15 mins on a treadmill ?

Go slow. I have experienced kind of like and insulin buildup that when I started excercising caused me to drop rapidly. As though the insulin was there, not being utilized and the excercise just opened the flood gates.

I once sat at 200 for like 4 hours and dropped to 70 within 20 minutes when I ran.

Please let us know. The effect of cortisone, cortisol and other steroids has a huge impact on us diabetics.

Last edited by itotito; 10-07-2008 at 11:40 AM.

 
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Old 10-07-2008, 11:38 AM   #3
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Re: how long will cortisone injection cause elevated bgs?

It depends somewhat on how much cortisone was injected, along with individual variations in body chemistry.

I just got a cortisone injection for a trigger finger yesterday, and I've got my temp basal set at 133%, and will keep it there until tomorrow evening, when I'll probably be able to set it back to about 120%. For me, the effects are usually gone within about 4 days, sometimes 5.

One of the things I've learned over the years (and with help from a really terrific rheumatologist) is that it's much easier to keep bg's from going high in the first place than it is to get them down once they've gone up there. For that reason, I usually set a temp basal at about 120% IMMEDIATELY upon receiving the shot, then set it up to 133% about 2-3 hours later, and keep it there until I start seeing lows...then I can start decreasing back to my normal basal rate.

Not sure if you increased right away, but if not, it'll probably take another day or two (or even 3-4 more days) to get back to normal. The one time I did not set my temp basal up right away was when I had hand surgery and wasn't told that they would be giving me a steroid to reduce swelling...I couldn't understand why my bg's were so high after surgery and why they wouldn't come down until the next day when I got the follow-up call from a nurse. When I mentioned that the only problem I was having was my bg control and said "gee, if I didn't know better, I'd think you guys had given me a cortisone shot while I was unconscious," she looked up what the anesthesiologist had given me and, sure enough...cortisone!!! I was royally p.o.'d, and ended up teaching the surgical suite manager my steroid protocol, which they are now using for all their diabetics...but they're also no longer giving steroids without first asking/informing their patients. Because they hadn't told me, and I therefore hadn't set my basal rate up right away, it took about 4 days before I could get my numbers back to anywhere near normal.

Good luck getting those numbers down...it's so frustrating, I know.

Ruth

Last edited by SamQKitty; 10-07-2008 at 11:41 AM.

 
Old 10-07-2008, 12:51 PM   #4
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Re: how long will cortisone injection cause elevated bgs?

Hi Ruth,

What role if any does insulin resistance play for T1s in such a situation ?

 
Old 10-07-2008, 01:27 PM   #5
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Re: how long will cortisone injection cause elevated bgs?

Itotito,

My own experience with insulin resistance is that, while insulin resistance itself is not a problem for me as a Type 1 (I think that's more symptomatic of T2s), certain things can make me insulin resistant. Like a high fat diet, or high blood sugar itself (once I'm high, it takes more insulin to get me back down than it would have taken to prevent said high) or, apparently, cortisone injections. So T1s definitely become insulin resistant in certain situations.

 
Old 10-07-2008, 02:00 PM   #6
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Re: how long will cortisone injection cause elevated bgs?

I'm not sure if it's insulin resistance, exactly, that's involved with the elevation of blood glucose levels caused by steroids. I do know, however, that for T1's, it can be dangerous to exercise if the blood sugar is over 250, especially if ketones are present.

And I don't think a high-fat diet necessarily causes you to be more insulin-resistant, Beanstock, but rather, the fat content slows the absorption of the carbohydrates you ingest; thus, there's a delay in when the blood sugar actually rises. If you're on shots, it's very difficult to time the insulin to a high-fat meal, but you can do so rather easily on the pump by using the dual-wave feature and giving yourself half the insulin up front and the other half over a 2-4 hour period. I've even been able to eat pizza and not have my bg go up over 150!

Ruth

 
Old 10-07-2008, 02:56 PM   #7
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Re: how long will cortisone injection cause elevated bgs?

Steroids DO cause insulin resistance in T1s. Depending on the amount of steroid injected, you can have higher resistance, which is probably why you're still running at 300 despite the 1.5x basal. I know it's not going to be the culprit, but it doesn't hurt to double check that you've changed your site recently, right? I think eating low carb can't hurt for a couple days. You might want to try SLOWLY upping your basals a little more, but be really careful that you don't plunge into lows. If you are really worried about it, call the endo, although we all know that diabetics tend to know more than their docs for the most part!

 
Old 10-07-2008, 05:25 PM   #8
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Re: how long will cortisone injection cause elevated bgs?

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Originally Posted by Wallis86 View Post
Steroids DO cause insulin resistance in T1s. Depending on the amount of steroid injected, you can have higher resistance, which is probably why you're still running at 300 despite the 1.5x basal. I know it's not going to be the culprit, but it doesn't hurt to double check that you've changed your site recently, right? I think eating low carb can't hurt for a couple days. You might want to try SLOWLY upping your basals a little more, but be really careful that you don't plunge into lows. If you are really worried about it, call the endo, although we all know that diabetics tend to know more than their docs for the most part!
Great info from Wallis, Ruth and Beanstock

This matches what I have read and experienced.

Here is my explanation for some of it. I don't know if it explains what you are seeing. Comments welcome.

The cortisone does 2 things. It does increase insulin resistance and it cause the liver to dump more glucose. Lots of litterature out there on this.

Cortisone apart, when glucose levels reach 200 mg/dl cells become even more insulin resistant. This is for T1s and T2s. I have a link to the science behind this but can't post it :-(

I know that if I let my glucose go into the 180s, they will come down in a reasonable time. If I let them go over 200, they will stay there for a long while. Preventing the levels from getting up in the first place are a way to avoid this situation from occurring. This was noted by beanstock and Ruth in their previous posts.

Once I did an OGTT on myself, it got over 200 for a few hours and when I ran to try and bring it down, it fell like a rock. This is when I started to research the why. There are some good articles on sport and diabetes that discuss this.

For me, excercise immediately decreases insulin resistance to the point I can go hypo because it.

Last edited by itotito; 10-07-2008 at 05:51 PM.

 
Old 10-08-2008, 01:31 PM   #9
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Re: how long will cortisone injection cause elevated bgs?

Good points, Itotito...especially that info about how really high blood sugar levels make even T1's more insulin resistant. I guess that's why it's so much more difficult to get blood sugar levels down once they've gone really high than it is to keep them from going that high in the first place. That was my point (and my rheumatologist's point) re setting the temp basal up IMMEDIATELY on getting a cortisone shot, and not waiting until your bg's go up. Once they've gone up, it's too late...it's near impossible to get them down to anything near normal until the cortisone gets out of your system.

Ruth

 
Old 10-08-2008, 03:22 PM   #10
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Re: how long will cortisone injection cause elevated bgs?

As for insulin resistance for T1s, this occurs due to increased ketone loads. You're probably having a an even harder time lowering your numbers now because not only is the cortisone making you insulin resistant, but since your numbers have been over 300, you're probably ketotic. Generally, the rule for ketones is to up your insulin requirements 1.5x (150%), although you're already doing that for the cortisone.

 
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