Ask D’Mine: Managing Blood Sugars on Steroids, Considering Whether to Stick with Your Meds

Meds, meds, meds. What’s a PWD to do?  They can be confusing and scary, and leave you wondering if the benefits outweigh the risks. We’re no doctors, but we can talk about known side effects and the trade-off’s many patients have to make.

Join us this week for a pill-popping edition of our diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Joanne from Texas, type 2, writes: I have bronchitis really bad so my doctor put me on prednisone and my sugars have been running outrageously high!  Do you have any suggestions for handling blood sugars while on steroid medications like this?

Wil@Ask D’Mine answers: Prednisone is a steroid, well, technically a corticosteroid, that’s notorious for kicking blood sugar through the roof. It’s used to treat all kinds of different ailments ranging from arthritis, to allergic reactions, to lupus, to some cancers, and even for muscle spasms—which is how I came to experience it for myself a bit over a year ago.

The ER doc told me, “Too bad you’re diabetic.”

OK, so there’s not really any good way to respond to that, now is there?

So I just said, “Because?…” Where upon he told me that if I weren’t diabetic he’d just use prednisone to fix me right up. Where upon I assured him that I wasn’t really a diabetic so much as a superbetic with a pump and a CGM and extraordinary knowledge of all things diabetes and he should just whip out his prescription pad and let me worry about the silly blood sugar.

My mother has a saying that pride cometh before a banana peel.

I took my first prednisone pill at a blood sugar of 96 mg/dL. An hour later I was at 552 mg/dL. I ran my insulin pump dry fighting the blood sugar. My insulin might as well have been water.

And you know what? The damn prednisone worked. It fixed my muscle spasms right up, as promised. Oh. Right. The blood sugars! And then there was that other little side effect: it also wiped out my immune system for a couple of weeks. And we type 1s don’t have the greatest immune systems to start with.

But for you, my sick friend, it comes down to a couple of things to consider. Yeah, your sugars will continue to run outrageously high as long as you are taking the prednisone, but at least you’re only on it for an acute illness, which means you only need to deal with this for a little while. And stay away from places full of sick people like hospitals, doctor’s offices, and daycare centers (baby germs are the worst!) until you get better. I don’t want your bronchitis becoming pneumonia.

As to the blood sugar, there’re several options. Check with your doc to see if the meds you’re currently taking for your diabetes are the kinds that can be doubled up on. Some of the pills for type 2s can be temporarily increased and others can’t. Depending on how long you’re going to be taking the steroids, you can also consider the temporary use of insulin. As I’ve experienced, even insulin, our most powerful diabetes medication, is puny compared to the awesome power of prednisone—but it will at least take the edge off.

And a final note: short-term high blood sugars won’t kill you. They’ll make you a bear to live with. And you will be at risk of dehydration, so drink lots of water. But short-term predisone use won’t cause you any lasting harm in the long run. Of course, avoid high carb foods and beverages while your blood sugar is high and, if you’re up for it, some light exercise in a germ-free environment can help too.

(Attention type 1 brothers and sisters: don’t flame me in comments, as a T2 she’s not at risk of going DKA from a little exercise when high like we are.)

But the bottom line is that you may just have to batten down the hatches and ride out the predni-storm.

Heidi from Alabama, who has gestational diabetes, writes: I have stomach ulcers that land me in the hospital quiet often…also Irritable Bowel Syndrome…not a good combination…what can I do naturally for this? I do not like taking the medication they have me on (Bentyl).

Wil@Ask D’Mine answers: We say it a lot, but I need to remind you that I’m not a medical doctor. My mail-order PhD in Underwater Basket Weaving is just not as much help with this gig as I thought it would be. So take my advice with a grain of salt, OK?

First off, I’m sorry to hear that you’re facing so many overlapping health issues. I think that ulcers or Irritable Bowel Syndrome (IBS) or pregnancy would be enough. But all three? Yikers! But frankly, it’s the pregnancy that’s guiding my thinking about your question.

Honestly, I don’t know that much about IBS or your medication so I looked up the FDA listing on it and found that Bentyl, a.k.a. dicyclomine, carries a category B pregnancy warning from the FDA. What that means is that animal studies didn’t reveal any major worries, but human studies haven’t been done; not even the ones that just look retrospectively at data from pregnant women who’ve taken the drug. Quoting the FDA here: “Dicyclomine is only recommended for use during pregnancy when benefit outweighs risk.” That probably sounds a lot scarier than it really is, as it was written by CYA-influenced lawyers—but more ominous is the fact that this med is flatly contra-indicated with breast-feeding because it’s excreted into breast milk. That means if you’re taking it and breastfeeding, your baby is taking the med too. And that’s bad because apparently Bentyl can make babies stop breathing.

So if you are planning on breast-feeding your baby, why take the risk at all in the first place?

In terms of natural options, most of the literature seems to point to Peppermint oil as being the most studied and most likely to have some positive effect on IBS.

So hopefully, that information will answer your question, but I’m going to use your question to spring board into the larger issue of “I don’t like to take medications” that I hear a lot; both online and in person at the clinic.

I periodically get accused of being in Big Pharma’s pocket, since I insist that patients take their meds.  Let me set the record straight, right here, right now:

Remember that medicine is an art and not a science. There’s a lot we don’t know about illnesses and the best remedies for them. But the meds we have now are the best we’ve got. And some of them are “proactive” drugs, taken to prevent really bad health effects down the line, like heart medications ACE inhibitors and statins, which are part of the standards of care for folks with diabetes.

I don’t make these things up. I’m not paid to promote them. Well, actually, that may not quite be true. At the clinic where I work, part of my responsibilities are to ensure that our patients are receiving the standards of care so that we can show the feds we are treating our patients in line with the current scientific thought. And for those of you who think that’s bunk, I ask you if you’d like to go back to the pre-DCCT days of treatment?

Some people simply refuse to take medications “on principle.” If you’ve educated yourself and made a carefully reasoned decision, I’m fine with that. Or if you’ve had a bad reaction to a specific med, I’m fine with that. But blind prejudice against the best evidence science has to offer to date? That doesn’t make much sense…

I think that’s cutting off your nose to spite your face.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.