Beware Cortisone!

Today's e-mailbag brought a letter from someone who reported that their blood sugar deteriorated significantly after a single shot of cortisone administered by an orthopedic doctor and that, even two months later, it has not returned to the level it was before the shot.

I wish this were an isolated, oddball occurrence, but sadly, it is not. Years ago when I posted a question on the old alt.support.diabetes newsgroup about the events leading up to a Type 2 diabetes diagnosis, I heard from several people who said that their blood sugars, which had been marginal before a cortisone treatment, became fully diabetic afterwards.

It was only then that I connected my own diabetes diagnosis with the ten day long course of prednisone I'd been given the previous year and and realized that it was only after that treatment that I'd developed the raging hunger and uncontrollable weight gain that seems to have signaled that my blood sugars had crossed over some disastrous boundary.

Every doctor I've mentioned this too has pooh-poohed it. Yes, they say, cortisone temporarily raises blood sugars, but they should go back to normal afterwards. But my doctor said the same thing, even when faced with the evidence that I'd suddenly developed much stronger symptoms of diabetes.

So it is possible that doctors believe that cortisone will not worsen diabetes and because of that belief attribute the worsening when it occurs to something else! Alternatively, because cortisone is often given by orthopedic doctors who don't monitor a patients' blood sugar, it is possible that they don't ever learn of the effect of their shots on the patients.

My belief, after dealing with several rheumatologists and orthopedic doctors, is that these doctors often administer a shot of cortisone so that the patient--who is being billed well over $200 for the appointment--will feel that the doctor did something, since without cortisone, mostly all the doctor can do is advise patience.

Whatever the explanation, while I don't question that there are people with diabetes whose blood sugars return to normal after a cortisone treatment, I think we all need to be aware that cortisone can worsen our blood sugar, permanently. And if we have managed to get our blood sugars under control--especially if we've done it with diet and exercise, we should know that a single cortisone shot or course of prednisone may make it impossible to retain that good control without adding insulin.

That said, cortisone is a powerful drug that can dramatically improve symptoms of some severe autoimmune disorders and even, in some cases, save lives. If you need it for a serious autoimmune disease or to counter brain swelling, well, you'll just have to deal with any associated blood sugar issues. And they can be dealt with--usually by going on insulin.

But the tragic thing about cortisone is that it is often used in situations where the research makes it clear that it is nothing more than a placebo. Even worse, the conditions in which it is least likely to help are precisely those that many Type 2s are likely to develop: tendon problems like Frozen Shoulder and Carpal Tunnel syndrome.

While a cortisone shot may occasionally give some pain relief for frozen shoulder, the research shows that it does not shorten the healing time! The same is true of other tendon-related problems.

Here is a study that found that while cortisone shots produce short term improvement in frozen shoulder, three months later, the people who did NOT get the shots were in better shape!

http://ard.bmj.com/cgi/content/abstract/63/11/1460
Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.
R Buchbinder, J L Hoving, S Green, S Hall, A Forbes and P Nash
Annals of the Rheumatic Diseases 2004;63:1460-1469

I was also assured by a doctor that electrophoresis would deliver cortisone to another injured tendon--in my foot this time--and not raise my blood sugar and was dumb enough to believe it. The blood sugars I saw over the next week were much higher than usual. And it may or may not be coincidental that my fasting blood sugar, which until then had been controlled on a low carb diet, started to deteriorate.

Questions to Ask Before Taking a Cortisone Treatment

Before you go to any doctor about a joint- or spine-related problem--the ones most likely to result in a cortisone treatment, read up about your condition on the web.

Then answer these questions:

1. Does cortisone have an impact on the healing time for this condition or is it only being used as a pain relief strategy? If the latter, ask your doctor for alternative pain treatments. When I did this my family doctor was able to find a safe drug for me to use that made the pain bearable until nature healed the tendon problem.
   
   
2. Are there alternative treatments that have as good an impact on the underlying condition that won't raise blood sugar?
   
   
3. If you have a condition, like an autoimmune disease, where cortisone drugs are effective and perhaps life or joint-saving, will your doctor prescribe insulin to control the dramatic blood sugar spikes cortisone will cause? Insulin is the only treatment that can prevent these very high blood sugars which will kill your remaining beta cells. Lowering your carbs, sadly, will not. But there's some reason to believe that using insulin to lower these blood sugars may help preserve the cells.
   

Remember, at blood sugars over 200 mg/dl beta cells succumb to "glucose toxicity" i.e. sugar poisoning. If you're down to having 25% of your beta cell mass functional, losing that last 5% may be all it takes to make it impossible to control with diet alone.

If your doctor won't prescribe insulin demand to know why, and if the reason isn't a very good one, find a doctor more respectful of your health.


Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.