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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, November 20, 2009
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, November 20, 2009
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Diabetes |
Prednisone withdrawal/ cortisone/ imuran11/15/2006 |
My mother has been undergoing prednisone withdrawal for quite some time--she is down from 100mg of prednisone every other day to 7 1/2mg every other day.Recently, she had a cortisone injection for bursitis. Shortly thereafter she developed low blood sugar.
I know that prednisone usually increases rather than decreases blood sugar levels. Is my mother`s prednisone "withdrawal", therefore, responsible for her "low" blood sugar problems now--and/or does the cortisone injection, in your opinion, have anything to do with it?
My mother never had any blood sugar problems in her life until now. She is 81 and has been through the ringer with prednisone--and, by the way, she is also taking imuran.
Could the imuran have anything to do with her low blood sugar?
To summarize: What do you think is causing my mother`s low blood sugar problems--prednisone withdrawal, the cortisone injection--or both--or does it have to do with the imuran?
Thank you for any clarity you could shed on this.
I think there is a good chance that there is a relationship between the prednisone withdrawal and the hypoglycemia: the purpose of alternate day steroids is to reduce the degree of suppression of the adrenal glands which make cortisol, the hormone for which prednisone is a potent treatment substitute. By using alternate day therapy, treatment steroid is present at some times when steroid is needed and not at others and that creates a stimulus for the adrenal gland to recover. It is less likely that the imuran is related.
The decision about what to do depends on whether the low sugar is recurrent and severe or isolated and asymptomatic. If the symptoms aren't a problem, then that is one of the problems one accepts in carrying out the withdrawal. The more severe the problem, the more one would consider an alternate plan. The alternatives include changing the timing and dose or the nature of the steroid used to reduce symptoms and reduce the risk of going into adrenal insufficiency or adrenal crisis. An endocrinologist may be helpful in that setting.
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Robert M. Cohen, MD Associate Professor Division of Endocrinology and Metabolism Department of Internal Medicine College of Medicine University of Cincinnati |
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