Need strategies while getting steroids

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Need strategies while getting steroids


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Old 08-12-2016, 13:12   #1
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Default Need strategies while getting steroids

So, I'll soon be starting chemotherapy treatments, which includes standard dosing with steroids via IV before getting the chemo drugs. Treatments will be every 2 weeks for 8 treatments.

I talked to the oncologist about the effect of steroids on blood sugar. While my type 2 diabetes is currently very well controlled with diet only (thanks to this forum!) with FBS in the 70's and postprandial under 120, steroids can send the blood sugar into the stratesphere. He said that I would need medications to control my blood sugar during treatment and recommended I see my GP. He did agree to reduce the dosage of steroids by a third and see how I do. He also agreed that he won't send me home with additional steroids between treatments (commonly done to help with nausea).

So, I have an appointment with my GP but considering how worthless he was when I was diagnosed with diabetes, I have very low confidence that he will be helpful. I suspect he will just say that I should call and let him know if/when chemo affects my blood sugar. What I WANT is strategies/treatments that I can use immediately when I test my blood sugar at 10 pm on Friday and find it at 375!

Also, just so I know, at what BS reading should I just head straight to the ER?

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Old 08-12-2016, 13:37   #2
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I'm so sorry you're having to go through chemo and steriods.

One of our members, moon, was doing similar. Her thread about how she coped and managed her blood sugar should be helpful to you.
http://www.diabetesforum.com/diabete...need-help.html

moon should be on the board later today and have some words of wisdom for you.

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Old 08-12-2016, 13:57   #3
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Here is a guide that you can use if you are asking if you should go to the ER:

When You Need to Go to The Emergency Room with High Blood Sugars | Blood Sugar 101

It sucks that this is happening and that you have to deal with it. **HUG** We will all be rooting for your speedy recovery and hoping that you don't suffer too much during treatment.

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Old 08-12-2016, 18:24   #4
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Very sorry to hear about your need for chemo, and that it includes steroids. Here's hoping it goes well for you.

I just finished 6 months chemo that required high dose weekly steroid, but oral. The action of IV is likely different, but hopefully has some consistency as oral does. With the oral, my bg would start rising 1-2 hours after taking, continue all day, and stay there through the night. It would start slowly declining Day 2 until Day 3 was close to normal.

My bg went to the mid-200's, so 125-150 point increase. My oncologist thought that was great because other patients did end up in the ER in the 500's - but I don't know where they started.

As I'm not a fan of oral meds, I went to an endo for insulin. Before that, I tried fasting on the day I took the steroid and eating only some meat and cheese on Day 2. That helped, but I wanted to eat more normally, and bring my bg down more.

I did find with insulin there was a point of diminishing returns where if I injected more basal, the very slight drop wasn't worth it. Using insulin with steroids is tricky because of the constantly-changing steroid effect, but that variability makes managing with anything equally tricky. Insulin at least gives one much better control than oral.

Hopefully with low-carb and having the numbers you do, you'll need not worry about the ER. But I'd track your bg nearly obsessively after your first IV to see if there's a predictable curve, how high it takes you - and then try to match the most appropriate med/insulin to your situation.

Please let us know how it goes - and here's hoping for few to zero side effects!

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A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 08-12-2016, 21:27   #5
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Wow, I'm consistently amazed at the responsiveness and support from the members of this forum. Thank you! I've recently joined a forum specific to my cancer and haven't had much luck with my questions there.

Thank you for the link to moon's earlier thread. That was very helpful to read through and I suspect I will be referring back to it as I move forward with my treatment. The link to emergency blood sugars was also helpful since I'm not happy with my GP advice (see below).

Thanks, moon! Hearing from someone who has traveled that road before is extremely helpful and reassuring (you came through the other side!) I do wonder about how different the IV steroids will be from the oral. I've found little information while Googling and that info has been contradictory.

So, I had my appointment with the GP today. It went pretty much as I expected. I hadn't seen him since he diagnosed me with diabetes 2 years ago (where does the time fly?). He was very surprised at my weight loss and blood sugar control via diet; used the word "excellent" a few times. Didn't scold me about ditching the metformin he prescribed. He commented that he almost never sees patients succeed in this way and asked if there was a particular diet that I was using. I wimped out and did not say "low carb-high fat". Instead, I hedged with "I eliminated all sugar, processed foods, and high carb foods." True but not the full story. He didn't react to this and didn't ask for more detail.

We discussed my cancer diagnosis and planned treatment that includes steroids. He understood the concern and agreed that steroid use does raise blood sugar levels. However, he seems to feel that since my levels are currently good and that the treatments will be transient, that I'll likely see increases but not dangerously high ones (open to interpretation, I know). As I suspected, he just wants me to call and report if/when my blood sugar increases and he will have me come in at that time. I said that I wasn't comfortable not having any tools to control my BS immediately and posed a hypothetical of testing my BS at 10 pm on a Friday and finding 375. He didn't think this was a problem at all, as I could come into their walk-in clinic Saturday morning. I pushed the levels and timing, trying to determine when he WOULD be concerned, which apparently is if my meter reads HIGH on a Saturday night or Sunday morning but instead of heading to the ER, I should still call the clinic's calling service and talk to the doctor on call.

He did take the time to explain his reasoning to not giving me something NOW. He can't know how I will react to the steroids since it depends on how well my pancreas is still able to produce insulin. He has no way of testing that. He has to wait and see what happens. He is concerned that it would be easy to over-correct with insulin and that would be more dangerous than running high. Plus, he is convinced that the odds of me seeing extreme BS values is exceedingly small.

On the only plus side, he did refer to using insulin as necessary. I was worried that his go-to would be to try one of the oral meds first, which I did not want.

Thanks again for the feedback and the well wishes. Seems a strange situation for me since I still feel (and think of myself) as strong and healthy!

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Old 08-12-2016, 21:58   #6
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My daily insulin is 70 IU I took oral steroids and my BG went to 285 and slowly came down during the day. so I took NPH hoping its effective curve would match the steroid curve. I started taking 20 IU of NPH (along with my normal insulin) and my BG was 280. I ended up taking 75 IU of NPH when I took the steroid, end result MY BG went to 285. by then my steroid use was over so I stopped my NPH and my BG was back to normall the next day.

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Old 08-13-2016, 20:58   #7
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Quote:
Originally Posted by Buttercup101 View Post
He has to wait and see what happens. He is concerned that it would be easy to over-correct with insulin and that would be more dangerous than running high. Plus, he is convinced that the odds of me seeing extreme BS values is exceedingly small.

On the only plus side, he did refer to using insulin as necessary. I was worried that his go-to would be to try one of the oral meds first, which I did not want.
From the reading I did on this, I also agree the odds of your bg going extremely high is remote. You're controlled. My sense is those who go into dangerous territory are uncontrolled to begin with.

To me your doc sounds reasonable. I'd also want to see what the steroid did first, and am hoping you already made an appt with him for something like 2 days after your first steroid IV That he thinks insulin is the best choice is such a blessing. At least you're not stuck with an uncooperative (or ignorant) doc!

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 08-15-2016, 02:30   #8
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Thanks again, moon. I'm feeling calmer now. Making an appointment for 2 days after my first steroid IV is a very good idea. I will follow up on that.

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