Reduce Steroids if Blood Sugar too high?

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SEWHAPPY
Posts: 86
Joined: Tue Nov 15, 2016 4:25 pm

Reduce Steroids if Blood Sugar too high?

Postby SEWHAPPY » Tue Jan 17, 2017 4:06 pm

Hello all! I took my 2nd FOLFOX treatment last week, which includes a bolus of dexamethasone in the infusion. On days 2,3 & 4 I take 4 mg in the morning and early afternoon. I am diabetic, but my A1C has stayed stable at 6.5 to 6.7 for years with primarily diet and exercise. I take 500 mg of Metformin every night with dinner.

I was warned that the steroid would mess with my blood sugars and it really did this time around. I was prepared with the sliding scale insulin pen and have been testing and taking insulin 3X a day before main meals. To me though, my sugars have been very high. Over 200 each time on days 1-4 and as high as 295. At the same time, I have not had much in the way of nausea Cold sensitivity yes and diarrhea on days 5-7, but not really nausea. I have been tired and feel best with a little something in my stomach, but nothing drastic. I have 2 other anti-nausea prescriptions already filled and waiting but have not needed either.

So here is the question: Which is worse for my body - taking the steroid and having the resulting blood sugar issues or asking to decrease the steroids and risking nausea? Any thoughts?

Thanks! Laurie
Female age 51.
CC diagnosed 10/13/16 at first colonoscopy.
Lap colon resection 11/21/16, removed ovary & fallopian tube.
T4N0M0, stage IIC.
Lynch negative.
Power port installed 12/19/16.
12 rounds FOLFOX done 6/16/17.

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Reduce Steroids if Blood Sugar too high?

Postby MissMolly » Tue Jan 17, 2017 4:38 pm

Hi Laurie:
I have been on corticosteroids for 20+ years. That's a lot of time in the company of steroids.

I have also had corticosteroid induced Type II diabetes. Fortunately, it was a transient occurrence. But I remember all too well having to take my blood sugar readings several times a day and adjust with injectable insulin.

I think your situation is more in a gray area, as opposed to a black and white question of steroids or no steroids. That is, I think your situation warrants discussion with your ordering physician (oncologist?) to reduce the total amount of steroid you are taking - either in the IV pre-med and/or as oral dosing in the days following your infusion.

4 mg of dexamethasone is a significant oral dose. Dexamethasone being one of the more potent corticosteroids. I would query your ordering physician to lower your dexamethasone dosing in the days following your infusion. If not 4 mg, maybe 2 mg of dexamethasone, so that you can reap the benefits wanted without overly raising your serum glucose levels.

Bottom Line: Talk with your physician about a lower dose of the oral dexamethasone and/or lower dose of IV pre-med to keep your blood sugars in a lower range of acceptable.
- karen -
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

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SEWHAPPY
Posts: 86
Joined: Tue Nov 15, 2016 4:25 pm

Re: Reduce Steroids if Blood Sugar too high?

Postby SEWHAPPY » Tue Jan 17, 2017 5:37 pm

Thanks Karen! It helps to know that that is a high-ish dose. I will speak with oncologist next week. I guess I just assumed that they started us out on the lowest dose possible, but obviously not so.
Female age 51.
CC diagnosed 10/13/16 at first colonoscopy.
Lap colon resection 11/21/16, removed ovary & fallopian tube.
T4N0M0, stage IIC.
Lynch negative.
Power port installed 12/19/16.
12 rounds FOLFOX done 6/16/17.

MissMolly
Posts: 645
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: Reduce Steroids if Blood Sugar too high?

Postby MissMolly » Tue Jan 17, 2017 6:31 pm

SewHappy:
Just to give you some perspective on corticosteroids and dosing . . . .

Your adrenal glands produce, on average, about 15-20 mg of cortisol a day. The adrenal glands produce cortisol by direction of the pituitary gland, in a negative-feedback loop. Cortisol is the body's stress hormone, allowing the body to adjust and adapt to varying stressors. Cortisol is also a powerful anti-inflammatory agent. Every cell of the body depends on cortisol. Cortisol is life-essential.

1 mg of dexamethasone = approximately 20 mg hydrocortisone/cortisol.

In 1 mg of dexamethasone, you are receiving about the same equivalent of what your body produces of cortisol in an average/non-stressed day.

Dexamethasone is one of the more potent/concentrated corticosteroids (small dose = magnified effect). It is also one of the longer-acting of the available corticosteorids. The half-life of dexamethasone is 36-40 hours. Meaning it stays in your body's system for a long time before being fully excreted.

Prednisone, as a comparative, is an intermediate time frame acting corticosteroid. 1 mg prednisone = approximately 4 mg hydrocortisone/cortisol. The half-life of prednisone is 16-18 hours. The half-life is the time interval in which half of the dose remains metabolically active in the body.

The point/demonstration: Of the available corticosteorids, there is a gradation of potency and effect. At the lower end is hydrocortisone, followed by prednisone, prednisolone, and dexamethasone. Dexamethasone is a potent corticosteroid per unit dosage/volume. It also has a long half-life in the body (meaning that its effects continue over a longer time horizon).

There is always room for discussion with one's ordering physician for individual dosing regimens of corticosteroids. A one-size-fits-all dosing does not well fit each individual.

Someone with underlying glucose intolerance - as you have - will be especially vulnerable to the insulin releasing effects of exogenous corticosteroids. I would talk with your ordering physician to see if there is a lower dosing of the IV infusion bolus and/or oral post-infusion dexamethasone tablets available to you that will enable you to ameliorate distressing side-effects of your chemotherapy while keeping the propensity for increased release of insulin (and increased serum glucose) in check. Talk with your ordering physician and discuss your glucose spikes.

The best medical care is medical care that is individually tailored.
- Karen -
Dear friend to Bella Piazza, former Colon Club member (NWGirl).
I have a permanent ileostomy and offer advice on living with an ostomy - in loving remembrance of Bella
I am on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression. I live a simple life due to frail health.

Ron50
Posts: 699
Joined: Fri Feb 10, 2006 7:04 pm

Re: Reduce Steroids if Blood Sugar too high?

Postby Ron50 » Wed Jan 18, 2017 6:49 am

I was suspected of having minimal change disease of the kidneys. The normal treatment is high dose prednisone. I was put on 75 mg of pred daily for nearly 18 months plus another six months taper to cater to rebound auto immune arthritis. I was dxed with type two diabetes and I am now on 1000 mg of metformin , 500 morning and night. My kidneys were biopsied three times but no dx was made as my results do not correspond to known kidney diseases. My liver functions also get out of whack very easily and my nephrologist has dxed me with auto immune nephrotic syndrome of the kidneys and also moderate auto immune hepatitis. My nephrotic syndrome ,untreated , sees me losing over seven grams of protein a day thru my urine. I take cyclosporine morning and night. The hep does not respond to cyclosporine on its own but needs some pred to beat it down. Even the smallest dose of pred now puts my blood sugars into a spike. It seems that the problem with steroids is that you are damned if you do and damned if you don't. Ron.
dx 1/98
st 3 c 6 nodes
48 sessions 5Fu/levamisole
no recurrence cea <.5
numerous l/t side effects of chemo

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LPL
Posts: 651
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Reduce Steroids if Blood Sugar too high?

Postby LPL » Wed Mar 15, 2017 7:19 am

SEWHAPPY wrote:
Hello all! I took my 2nd FOLFOX treatment last week, which includes a bolus of dexamethasone in the infusion. On days 2,3 & 4 I take 4 mg in the morning and early afternoon. I am diabetic, but my A1C has stayed stable at 6.5 to 6.7 for years with primarily diet and exercise. I take 500 mg of Metformin every night with dinner.

I was warned that the steroid would mess with my blood sugars and it really did this time around. I was prepared with the sliding scale insulin pen and have been testing and taking insulin 3X a day before main meals. To me though, my sugars have been very high. Over 200 each time on days 1-4 and as high as 295. At the same time, I have not had much in the way of nausea Cold sensitivity yes and diarrhea on days 5-7, but not really nausea. I have been tired and feel best with a little something in my stomach, but nothing drastic. I have 2 other anti-nausea prescriptions already filled and waiting but have not needed either.

So here is the question: Which is worse for my body - taking the steroid and having the resulting blood sugar issues or asking to decrease the steroids and risking nausea? Any thoughts?


Hi SEWHAPPY,
Don't know how I missed this post of yours...
How are you doing now? Did they lower or totally remove the steroids?
As you can see from my signature, my hubby also experienced Big problem with the steroids. His blood sugar became very high also, 295 - 334 - and 408 !! was what he had when he became hospitalized and treated for the hyperglycemia.
For him they totally removed the steroids after chemo #3 -> He never experienced any nausea.
All the best to you /LPL
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED->Jan-19 mets to lung NED again Oct-19 :)
:!: Steroid induced hyperglycemia dx after 3chemo
Surgeries 2016: 3/18 Emergency colostomy
5/23 Primary+gallbl+stoma reversal+port 9/1 Liver mets
RFA 2019: Feb & Oct lung mets

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SEWHAPPY
Posts: 86
Joined: Tue Nov 15, 2016 4:25 pm

Re: Reduce Steroids if Blood Sugar too high?

Postby SEWHAPPY » Wed Mar 15, 2017 11:59 am

My Onc was great - we took dropped the oral steroid was taking after round 2, but they are still in bag i take on infusion day. I have had nausea, but the ondansetron seems to work.

However, my sugars are creeping up again. I had round 5 7 days ago and morning fasting sugars were still mid 200s. I am needing my insulin for more days. I may talk to Onc about dropping steroids altogether. High sugars scare me more than nausea!

Thanks!
Female age 51.
CC diagnosed 10/13/16 at first colonoscopy.
Lap colon resection 11/21/16, removed ovary & fallopian tube.
T4N0M0, stage IIC.
Lynch negative.
Power port installed 12/19/16.
12 rounds FOLFOX done 6/16/17.

behconsult
Posts: 264
Joined: Fri Jul 04, 2014 4:53 pm

Re: Reduce Steroids if Blood Sugar too high?

Postby behconsult » Thu Mar 16, 2017 8:36 am

I became a diabetic because of the steroid infusion. I had to use the insulin on a whole new schedule and still do since I am on Xeloda and it screws with my blood sugar. Take a lot of meter readings and adjust accordingly with docs oversight. B
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT


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