Pre-diabetes, likely due to long-term steroid use: Anyone else?

Posted by priscillat @priscillat, Mar 11, 2022

I was dismayed yesterday at a doctor’s visit, that my A1C was now is the “pre-diabetes” range. I knew this was a possible side effect from long term steroid use, but still it was a shocker. I’ve immediately put myself on a diabetes eating plan - and continue to walk 3 miles a day. My physician says this will resolve itself when I’m off prednisone, but on my super-slow taper, that’s about 3 more years. Wondering if anyone has had a similar experience - or success at lowering A1C on prednisone. Thank you.

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Hi @priscillat, I've always been labeled with pre-diabetes by my various Mayo primary care docs over the years. During that time I had 2 occurrences of PMR but never thought about the connection with prednisone since I was pre-diabetic before starting the prednisone. Here's some information on the topic that might be helpful to explain the effect.

"Does prednisone affect glucose levels? -- Some steroids, such as prednisone, can raise the glucose level for part of the day. This will be most noticeable if the prednisone is only taken once per day, such as in the morning. Before you take the morning prednisone pill, your glucose level might be the same as it usually is." --- Steroids And Diabetes: The Effect On Your Glucose Levels: https://www.medtronicdiabetes.com/loop-blog/steroids-diabetes-effect-glucose-levels/

I also started a similar eating plan a little over a year ago for weight loss and improving my A1C. My last A1C was 5.8 and it's always been below 6.0. I think the walking is good. I ride an exercise bike daily because I'm not able to walk for very long due to back issues but once in awhile get out and walk around the neighborhood for a mile or so. You might be interested in another discussion that I think is really key for those of us with pre-diabetes. --- Low-carb healthy fat living. Intermittent fasting. What’s your why?: https://connect.mayoclinic.org/discussion/low-carb-healthy-fat-living-intermittent-fasting-whats-your-why/

I've found several YouTube videos by Dr. Jay Wortman to be helpful on controlling and reversing diabetes. Here's one that you might find helpful - Dr Jay Wortman Diabetes Remission is Surprisingly Simple!

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Thanks John. I’m following a recommender diabetes diet (must admit, I’ve been lazy about my food choices in the past). I have another A1C test in 3 months. I’ll see how that goes. I’ve stopped eating within 3 hours of bedtime, so with a later “brunch” it’s like 16/8 intermittent fasting. We’ll see how this goes. Lack of sugar has reduced my pain and stiffness already. Hopefully, this was just a wake up call.

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I was diagnosed with pseudo cushings. It causes me to have abnormally high endogenous cortisol levels, but the source of it is idiopathic. No one knows why in my case as tumors were ruled out and I do not use any steroid meds. I was diagnosed with t2d around the same time. My cortisol is very cyclical, and I was investigated for cyclical cushings initially, but I am apparently pseudo. My blood sugar behaves completely normal when my cortisol is normal, when it’s not I range from prediabetic to diabetic glucose readings. I bombed an oral glucose tolerance test and will have terrible labs when my cortisol is abnormal. Yet like magic when my cortisol regulates, I have normal glucose levels after high carb loads. I think you have very good chance of having your glucose regulate once you taper off the steroids. I hope it all works out for you!

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@pinkrosebud

I was diagnosed with pseudo cushings. It causes me to have abnormally high endogenous cortisol levels, but the source of it is idiopathic. No one knows why in my case as tumors were ruled out and I do not use any steroid meds. I was diagnosed with t2d around the same time. My cortisol is very cyclical, and I was investigated for cyclical cushings initially, but I am apparently pseudo. My blood sugar behaves completely normal when my cortisol is normal, when it’s not I range from prediabetic to diabetic glucose readings. I bombed an oral glucose tolerance test and will have terrible labs when my cortisol is abnormal. Yet like magic when my cortisol regulates, I have normal glucose levels after high carb loads. I think you have very good chance of having your glucose regulate once you taper off the steroids. I hope it all works out for you!

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Also I want to add, as long as I stick to a very strict low carb diet, even if my cortisol is acting up, I don’t get huge blood sugar swings anymore. I just have to be extremely strict.

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