Steroid Infused Diabetes
Diabetes and steroids (prednisone) are not exactly a fun mix. Steroids can make your body resistant to insulin and the for some people the drug acts similarly to cortisol, a hormone your body produces in response to stress, which can also raise blood sugar.
Many providers rightly avoid the use of steroids for type I diabetics, however in my case, we used them to provide temporary relief as sarcoidosis symptoms progressed throughout my body. Their use would also inform future immune suppression therapy strategies as a long-term treatment of sarcoid.
I’m not a medical doctor and the content of my blog should not be considered medical advice.
If you’re faced with the reality of steroids, my first suggestion is to have your provider increase your insulin prescription, to account for the additional insulin you’ll need.
Pre-steroids, I averaged 50u of insulin per day (not including pump primes)
With the use of steroids, I averaged 125u per day (not including pump primes)
Highest total daily dose was 154u
I began a daily dose of 40mg of prednisone, taken as soon as I woke up, which was usually between 5:30 and 6:30 am.
By 9am I would start to see a rise in blood sugar
Insulin resistance peaked between 2 - 4pm
By 9pm the effects dwindled, however a temp basal was still required
I use a tandem insulin pump with control IQ. While the software is brilliant, control IQ simply can’t keep up with the stress on your body, much like when you’re sick. I exited control IQ and manually set a temp basal rate, which I decreased throughout the day as the impact of the steroid softened.
9am-4pm: temp rate of 200 - 250% of a normal basal rate
4pm-11pm: temp rate of 150% of a normal basal rate
11pm-9am: 100 - 125% temp rate of a normal basal rate
I didn't eat a ton during the treatment, however for meals and corrections I followed the approach of small incremental boluses.
One thing to note is the above strategy was with a dose of 40mg a day. As I slowly tapered my steroid dosage, I also cut back on the percentage of my temp basal rates.
*I am not a medical doctor and the content of this post should not be considered medical advice.
