The impact of Prednisone on A1C

Posted by alan bruce @alanbruce, Apr 18 10:03pm

I am on PMR for the second time and taking Prednisone. At the same time I am trying to reduce my AIC and keep my blood sugar under control. What impact will long term Prednisone have on my effort to control my blood sugar.

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I saw my endocrinologist yesterday. My glucose was 147 on last test. He said that prednisone does impact levels. I am off prednisone now and he recommended a fasting blood test in a few weeks.

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I hope someone in the group has an answer to your query. I feel at times I become borderline pre-diabetic (ie a result of moving less and eating more sugar) but then I start walking regularly, and the problem dissipates. My Xmas shortbread excess a possible trigger? Presently waiting for blood test results.

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@annhowledavis

I saw my endocrinologist yesterday. My glucose was 147 on last test. He said that prednisone does impact levels. I am off prednisone now and he recommended a fasting blood test in a few weeks.

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One of the first things my endocrinologist checked was my insulin level. He suspected my insulin level would be high even though I had never been diagnosed with diabetes or prediabetes.
https://physicians.dukehealth.org/articles/even-low-doses-prednisone-creates-insulin-resistance
My endocrinologist was correct because my insulin level was high but my HbA1c and glucose levels were always borderline normal while I was taking prednisone. Nobody had ever checked my insulin level before.

My endocrinologist started me on Metformin because it is suppose to help prevent insulin resistance. He added that I should have been on Metformin during the entire time that I was taking prednisone for PMR. He said a high insulin level was a precursor to diabetes.
https://www.cdc.gov/diabetes/basics/insulin-resistance.html
My endocrinologist said that Metformin will only help with insulin resistance. My endocrinologist thinks that staying off prednisone along with diet and exercise will help more. Now I have to explain to other doctors why I take Metformin when I haven't been diagnosed with diabetes. I think Metformin is helping because now my HbA1C and glucose levels are well within the normal range and aren't borderline anymore. I will ask my endocrinologist to recheck my insulin level when I see him again.

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@dadcue

One of the first things my endocrinologist checked was my insulin level. He suspected my insulin level would be high even though I had never been diagnosed with diabetes or prediabetes.
https://physicians.dukehealth.org/articles/even-low-doses-prednisone-creates-insulin-resistance
My endocrinologist was correct because my insulin level was high but my HbA1c and glucose levels were always borderline normal while I was taking prednisone. Nobody had ever checked my insulin level before.

My endocrinologist started me on Metformin because it is suppose to help prevent insulin resistance. He added that I should have been on Metformin during the entire time that I was taking prednisone for PMR. He said a high insulin level was a precursor to diabetes.
https://www.cdc.gov/diabetes/basics/insulin-resistance.html
My endocrinologist said that Metformin will only help with insulin resistance. My endocrinologist thinks that staying off prednisone along with diet and exercise will help more. Now I have to explain to other doctors why I take Metformin when I haven't been diagnosed with diabetes. I think Metformin is helping because now my HbA1C and glucose levels are well within the normal range and aren't borderline anymore. I will ask my endocrinologist to recheck my insulin level when I see him again.

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Thank you – I am sure my issue is related to prednisone – no one on either side of my family has ever had diabetes, for starters. The weight gain has not helped either. My rheumatologist has not suggested anything about this and when I asked her to to test my blood sugar levels, she said that was up to my GP. I do not understand this division of labour, but were I to start complaining about gaps/problems with medical treat, well, I would probably never stop. When my Blood test results come through, I will decide about Metformin.

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@joycecosgrove

Thank you – I am sure my issue is related to prednisone – no one on either side of my family has ever had diabetes, for starters. The weight gain has not helped either. My rheumatologist has not suggested anything about this and when I asked her to to test my blood sugar levels, she said that was up to my GP. I do not understand this division of labour, but were I to start complaining about gaps/problems with medical treat, well, I would probably never stop. When my Blood test results come through, I will decide about Metformin.

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I would agree that doctors are overly specialized. I have experienced a wide variety of side effects from prednisone. The problems I had were all well known side effects of long term prednisone use.

An ophthalmologist did bilateral lens implants at a young age for premature cataract formation.

A cardiologist prescribed 3 blood pressure medications for extremely high blood pressure in excess of 200/100 resulting in left ventricular hypertrophy (LVH). The cardiologist said my heart was being "stretched" and was causing an arrhythmia. No prior history of hypertension or cardiac problems until I started prednisone. Ditto for the extensive and bilateral pulmonary embolism that was called "unprovoked" by a pulmonologist. The pulmonologist said I would need to take lifelong warfarin so it wouldn't happen again.

I had extremely high cholesterol levels probably caused by prednisone. I'm sure the 50# weight gain within a year was prednisone induced. My GP started me on 40 mg of atorvastatin. My GP deferred to my rheumatologist for getting me off prednisone.

Finally, when I was able to taper off prednisone after 12 years, an endocrinologist found the high insulin level and diagnosed insulin resistance. That was in addition to a low cortisol level and adrenal insufficiency along with "metabolic syndrome" likely caused by long term prednisone use.

My rheumatologist prescribed the prednisone but there were many other specialists who dealt with all the side effects. My rheumatologist "strongly encouraged" me to taper off prednisone and said prednisone was putting me at risk of infections and other things. I had to finally tell my rheumatologist that my body was dependent on prednisone after 12 years and I was unable to to taper off.

I will give my rheumatologist credit for making sure I never ran out of prednisone for 12 years. I will give even more credit for belatedly prescribing a biologic for PMR that allowed me to taper off prednisone in 12 months.

I have been off prednisone for a couple of years. I no longer have a low cortisol level. All three blood pressure medications have been stopped. My atorvastatin dose has been cut from 40 mg to 10 mg. My quality of life has greatly improved. I have no known side effects from the biologic except it might be responsible for keeping my cholesterol level slightly elevated.

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Thank you for your response. When you mentioned “biological” helping you in tapering off from prednisone, can you tell me what these biologics are ? Thank you. I’ve been on prednisone for 2 years currently on 7.5 mg. But my weight and puffy face have almost “ disfigured “ me and my self esteem. Any info would be greatly appreciated.

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@dadcue

One of the first things my endocrinologist checked was my insulin level. He suspected my insulin level would be high even though I had never been diagnosed with diabetes or prediabetes.
https://physicians.dukehealth.org/articles/even-low-doses-prednisone-creates-insulin-resistance
My endocrinologist was correct because my insulin level was high but my HbA1c and glucose levels were always borderline normal while I was taking prednisone. Nobody had ever checked my insulin level before.

My endocrinologist started me on Metformin because it is suppose to help prevent insulin resistance. He added that I should have been on Metformin during the entire time that I was taking prednisone for PMR. He said a high insulin level was a precursor to diabetes.
https://www.cdc.gov/diabetes/basics/insulin-resistance.html
My endocrinologist said that Metformin will only help with insulin resistance. My endocrinologist thinks that staying off prednisone along with diet and exercise will help more. Now I have to explain to other doctors why I take Metformin when I haven't been diagnosed with diabetes. I think Metformin is helping because now my HbA1C and glucose levels are well within the normal range and aren't borderline anymore. I will ask my endocrinologist to recheck my insulin level when I see him again.

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dadcue,
I agree with what you're saying. At the beginning of my PMR all my HbA1C and glucose levels were fine. About 6 months later I had a complete lab screen and suddenly I was "pre-diabetic" which was a shock until the rheumy explained that it was very common for those on prednisone. I've been on Metformin since and my levels have dropped back down. I'm still taking it although my pred dose is only 2 mg now and that's fine with me.

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@ella0515

Thank you for your response. When you mentioned “biological” helping you in tapering off from prednisone, can you tell me what these biologics are ? Thank you. I’ve been on prednisone for 2 years currently on 7.5 mg. But my weight and puffy face have almost “ disfigured “ me and my self esteem. Any info would be greatly appreciated.

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I personally take a biologic called Actemra (tocilizumab).

My rheumatologist had to get authorization to prescribe it to me. Actemra isn't FDA approved for PMR. However, Actemra is FDA approved for GCA so my rheumatologist believed that Actemra should work for PMR too.

There is ongoing research being done. This link gets too technical for me but it is still interesting.
https://www.cureus.com/articles/99487-is-tocilizumab-effective-and-safe-in-polymyalgia-rheumatica-and-giant-cell-arteritis-with-polymyalgia-rheumatica#!/
I hope this helps.

There is another biologic medication that targets the same IL-6 inflammation pathway. This biologic was recently approved by the FDA for the treatment of PMR.
https://investor.regeneron.com/news-releases/news-release-details/kevzarar-sarilumab-approved-fda-first-and-only-biologic#:~:text=(NASDAQ%3A%20REGN)%20and%20Sanofi,corticosteroids%20or%20who%20cannot%20tolerate
Neither of these two biologics work perfectly. However, I think a more targeted approach to the treatment of PMR/GCA is a step in the right direction.

Actemra (tocilizumab) is sometimes abbreviated TCZ — it works for me. I was able to taper off prednisone in 12 months after taking prednisone for 12 years. I don't have anywhere near the problems I had when I was taking prednisone for PMR. That is just my experience … when my rheumatologist suggested Actemra to me, there were no guarantees it would work.

Another problem is these biologics are very expensive. My rheumatologist made the case that all other less expensive alternatives didn't work for me. He didn't think taking prednisone for the rest of my life was a viable option.

Part of my difficulty was multiple autoimmune problems. My rheumatologist has acknowledged it would be impossible to adequately treat everything the was happening.

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Actemra is expensive indeed.

To partially offset this, Genentech, the corporation that produces Actemra, covers up to $15K/year for its costs. In my case, with my insurance, that is covering all my costs other than a $5 copay. Genentech requires it to be to treat an FDA approved disease, which would likely mean Giant Cell Arteritis for those reading here, a disease which is closely related to PMR. It seems enforcement of this restriction is limited to the administrator asking you what disease you have when you call them.

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@redboat

Actemra is expensive indeed.

To partially offset this, Genentech, the corporation that produces Actemra, covers up to $15K/year for its costs. In my case, with my insurance, that is covering all my costs other than a $5 copay. Genentech requires it to be to treat an FDA approved disease, which would likely mean Giant Cell Arteritis for those reading here, a disease which is closely related to PMR. It seems enforcement of this restriction is limited to the administrator asking you what disease you have when you call them.

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There was a study published in New England J of Medicine that indicated Actemra is helpful in tapering off Prednisone, reducing relapses, and lessening the adverse events when compared to Prednisone alone. This was for Giant Cell Arteritis, which has a very similar pathology to PMR, but I understand Actemra is commonly used to treat PMR. I've been diagnosed with both GCA and PMR, although the GCA diagnosis is less certain. All we have is our symptoms and lab tests; the actual diagnosis is always just a guess.
https://www.nejm.org/doi/full/10.1056/nejmcp1214825

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