Sir/Madam, This is regarding my mother who was diagnosed with Autoimmune hepatitis on 26th Sep. Her treatment is going very well. On 14th Sep, before her treatment started, her SGPT and SGOT were 616 IU/L and 361 IU/L respectively. Liver biopsy confirmed Autoimmune hepatitis. Her treatment started on 3rd Oct. Doctor started her treatment with Wysolone - 30 mg (1-0-0) for the first 2 months and when her SGPT and SGOT came under 50 IU/L, he switched to Budesonide (6 mg-0-3 mg). My query is regarding the side effects of the steroid use. My mother has been diabetic for the past 5 years for which she took glimestar M1. When the Doctor started her on Wysolone, in less than a week, the side effects started to show. Her blood sugar started to fluctuate uncontrollably. It goes from as high as 500 mg/dl to as low as 55 mg/dl. Doctor put her on Insulin (NovoMix 30 Flexpen). I was advised to constantly monitor her sugar and vary the units of Insulin as per her sugar level and that's what I have been doing ever since the treatment started. This sugar fluctuation thing is very unpredictable, so unpredictable that I have to constantly stay with my mother all the time. We don't even travel anywhere because of it. I have been telling our Doctor to do something about it but he says the same thing every time, control the sugar with Insulin. Is there any other way to minimize her sugar level fluctuation? Can you advice any medicine. Thank you.
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Hi Steroids have a very bad effect on Diabetes. You are right, it shows a varied fluctuation in the values. Insulin is safe and the best option. Instead of taking a premixed insulin (works for 12 hours) that is your novomix 30, I would suggest she takes short acting insulin (works for 5-6 hrs) before breakfast, lunch and dinner and long acting insulin (works for 18-24 hrs) at bedtime. Though she needs to take insulin 4 times a day, this pattern will help in reducing her fluctuations and at the same time it would be easier to monitor her blood sugars and adjust the insulin dose. Once she gets used to this pattern she can manage it without any worry. This would be the best for her as she needs to stay on steroids.
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, With steroid treatment blood glucose does increase, because corticosteroids are diabetogenic. One of the possible ways is to reduce the dose of steroid to minimum possible, plus use a long acting Insulin like Basalog (Glargine) plus a short acting insulin to control post breakfast & post lunch surges of glucose Thanks.
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