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How does your pain come back when decreasing dosage?
Polymyalgia Rheumatica (PMR) | Last Active: 5 days ago | Replies (57)Comment receiving replies
I’ve come to the same conclusions re: adrenal insufficiency probably
causing the Hypoglycaemia to manifest…but your suggestion about the
prednisone is a great idea …no one has suggested anything to do with it but
this problem has become worse with this last drop to 1 mg…I’ll go back to 2
mg and see if things improve as I won’t see a specialist for a long time
(months) and this seems to be a relatively harmless trial …thanks ! I see
my Rhuematologist in late December and will cover these points then…thanks
again
Replies to "I’ve come to the same conclusions re: adrenal insufficiency probably causing the Hypoglycaemia to manifest…but your..."
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@nancy334
The cortisol issue when we try to taper off Prednisone is rarely mentioned by rheumatologists or any doctor for that matter. It came as a shock to me when an endocrinolgist told me that I shouldn't taper my Prednisone dose at all when my cortisol level was low. Until then, the only thing I was ever told was to taper off prednisone slowly. I didn't realize that I might need to completely stop my prednisone taper if my cortisol level was low.
Everyone worries about a flare when their prednisone dose gets too low. There are many other things to worry about when our prednisone dose gets lower than the physiological dose of cortisol. Just look at everything that cortisol regulates. The diagram in the link below only gives the basics about everything that a high or a low cortisol level can do.
https://my.clevelandclinic.org/health/articles/22187-cortisol
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After prednisone replaces cortisol, our body relies on us to take the correct amount of Prednisone to meet our needs. Too much Prednisone is just as bad as too little Prednisone when our adrenal function is shut down.
It is also true that too much cortisol is just as bad and too little cortisol. However, our bodies have an elaborate mechanism to regulate how much cortisol our adrenals produce. My decision about how much Prednisone I needed wasn't elaborate at all ... when it hurt more ... take more prednisone.
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I had no idea that Prednisone causes so many metabolic problems. The link above states:
"Cortisol affects your metabolism by helping regulate how your body uses glucose (sugar) for energy. The hormone does this in many ways. For example, cortisol triggers your pancreas to decrease insulin and increase glucagon. Insulin lowers blood glucose (sugar). Glucagon raises it. Cortisol also acts on other bodily tissues to manage glucose use, including your:
Adipose tissue (body fat)
Liver
Muscle
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I know some people advocate for an ultra low carbohydrate diet when we are on prednisone. Does that mean we should increase our carbohydrate intake again when we try to taper off Prednisone? In any case ... nobody should be telling anyone else to make drastic changes in their diet without consulting a doctor or a dietitian.