September 12, 2007

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.

23 comments:

nonegiven said...

My DH had 4 shots of cortisone for plantar fasciitis over several months time, shortly before being diagnosed with diabetes. He had to drive 45 miles home from the doctor, every time he got one he felt sicker on the way home, the last time he had to pull over and rest a while. It didn't occur to me at first that it was a BG problem that made him feel sick but it probably was.

Anonymous said...

Over twenty years ago my brother Eric had received a cortisone shot
from his
doctor, as a means to fight poison ivy. Shortly afterwards he had lost a lot of weight,
and was diagnosed with type 1 diabetes. Eric was the first, in
my
families history to have been diagnosed with this disease. This has had
a
great impact on his life. He now has to prick his finger to draw blood
at
least three times a day, in order to test his blood sugars. He also has
to
inject insulin at least twice a day to sustain his blood sugar levels
and
prevent any further health problems.

As for myself ,

It is almost six year's ago that I was working as a sawer, clearing
out
fire trials for the state of California, when I cut into a patch of
poison
oak. I came down with a terrible rash that kept me out of work for
over a
month. My doctor suggested a cortisone injection. I followed through
with
his suggestion, hoping that this would speed my recovery. Less than a
week
after I received this injection I lost 10lbs, and my blood sugars were
over
600. I was admitted to the intensive care unit in Ojai California;
where I
was then diagnosed with type 1 diabetes.
Like my brother Eric, my life is forever changed. I have to test
my
blood sugars and inject insulin to prevent ketoacidosis; which can lead
to a
coma or possibly something worse.

It was my suspicion after it happened to me that it was the cortisone that was given to both my
brother and I, that caused our diabetes. After extensive research, I
have
learned of other cases very similar to our own. I have actually
found
proof of cortisone leading to diabetes. I am outraged!

Both myself and my brother have now learned to live, and cope with this
disease. We have excepted the fact that we will never again lead our
once
normal healthy lifestyle. We are however, horrified to have learn that
this
could have been prevented, with more research of this drug.

I have decided to come forth with the information that I have gathered,
in
hopes to prevent this disease from spreading; due to lack of research
and
responsibility of the makers cortisone.

I am looking for others that have had this happen to them , and any solid proof that cortisone can cause diabetes,
Any info will be greatly appreciated,sincerely Alexander hutchins diabetesresearch7281@yahoo.com

Anonymous said...

last week I had a cortisone shot in my knee after they drain fluid from it. That knight I wound up in the hospital with a blood pressure reading of 150/100 and a pulse rate of 155 When checked at the hospital I had a blood sugar level of 170 and had sugar in my urine.. All of this happened a feww hours after the cortisone shot. I am now taking a beta blocker for the blood pressure and heart rate and monitoring my blood sugar which has seemed to return to normal (89 to 107).

Anonymous said...

I was given a cortisone shot (in the shoulder) Monday morning (9:40am) and basically only had a salad during the day. Today (Tuesday), I took my sugar count about 11am and it was 304!! I was shocked. With my meds, I have been able to keep it around 140 or so. That's when I looked on line for the effect of cortisone. I have recently eaten lunch so it is too early to test again but I am stunned with what I have read and don't understand why orthos don't have more info on this problem. I had filled out a form before my appt. so diabetes was marked.

AutoInstructor said...

Yesterday I got a cortisone shot in my shoulder. Got home, was unusually hot (sweaty). Wife suggests that I check my BG. I find it is 210! This hasn't occured for some time since i have gotten my BG under control using oral meds (i was diagnosed with type 2 diabetes in 2003). Apparently, cortisone has different effects on people, but the fact remains that it is possible that cortisone shots will effect BG. This morning the BG was 168. I just checked it and it is now 223. I usually don't get reading like this at this time of the day. Apparantly doctors don't associate high BG and cortisone. I will monitor it for the next few days, and see what happens.

Anonymous said...

I would advise Diabetics to stay far, far away from cortisone. I had bronchitis. I went to see a normal GP who had injected me with cortisone.
I had spoken to my diabetic specialist and she advised that whenever you do get a shot it will take 4-5 days to work out of your system.
My blood sugar is out of control since the injection. It has almost doubled my readings and no matter how much insulin I inject it doesn't really go down. I am worried though that alot of people get injected with cortisone and this causes them to become diabetic?

STEVIE said...

I have been an insulin dependent diabetic for 20 years. I had my first ever cortison injection for a worn out knee. For 5 days after the injection my blood sugar levels ran between 450 and 600. No matter how much fast acting insulin I took, it would not go down. The injection did its job. My knee pain in gone for now. It will be a tough decesion when it's time to take another injection. They need a sugar free cortisone.

Jenny said...

Stevie,

Cortisone doesn't raise blood sugar because it contains sugar. It raises it because it is a hormone whose JOB is, among other things, to raise blood sugar. There is no way to make it not raise blood sugar and still have it do the other things it does, like turn off the inflammation response.

STEVIE said...

Thanks so much for the info Jenny. I wish they had something that works as well as cortisone. I would rather have that, than a knee replacement.

pramod said...

Hi this is pramod and i am 20 years old. i was administered with cortisone for a period of 6 months and now that i am a type 1 diabetic for 10 years. no one in my family history have been diagnosed with this disease.

David & Robin said...

I got a cortisone shot in my knee Thursday and felt awful. My sugar went up from 114 TO 468. My blood pressure was also high for me. today my sugar is in the 311-260. how long does the effect of the shot last?

Jenny said...

The shot should last no more than a week. I hope your blood sugar and pressure go back down. Often they will.

Bernadette said...

My friends mother aged 86 died last week within 24 hours of a Cortisone injection. She had Diabetes II and was on blood pressure medication. She was given a Cortisone injection for her shoulder which was aching from a fall the previous year.
Her case has gone to a the Corenor and my friend has been told to go ahead with funeral arrangements.
He doesnt know whether to have the cremation this monday or not.
Can anyone assist helping us with what to do? Organisations etc that may tell us whether to hold fire with the funeral - to wait for the Coroners verdict or what?

Jenny said...

I would guess that your friend should contact the coroner's office and ask them for instructions.

JandR said...

I received several cortisone shots when I was ages 6-9. When I was 13 I got Type 1 Diabetes. Now, 15 years later, I am reading other people's posts and wondering if there is a connection.

Jenny said...

JanR,

Cortisone would have been an appropriate treatment for an autoimmune attack and should not have led to Type 1 diabetes. It's likely that the immune response that caused you to need cortisone was part of a systemic response that took out your beta cells.

647a2076-e099-11e1-975a-000bcdca4d7a said...

Wow! I wish I had known all of this yesterday. I have type 1 diabetes. I've been diabetic for almost 30 years. I had a cortisone shot in my foot yesterday, and I was up all night taking extra Humolog injections. Before bed, I took 9 units expecting good levels all night, but I could not get my blood sugar under 300. I took double my normal dose and am still in the upper 200's. When I was debating getting the shot (worried about a needle in my foot) I even mentioned to the doctor that I was diabetic and could tolerate needles pretty well. He said nothing about high blood sugar.

Jenny said...

To the previous poster. Doctors--especially the younger doctors who have practiced entirely in the impersonal hurried system in use most places nowadays where they don't get to know their patients--are frighteningly ignorant about the side effects of the drugs they prescribe.

My experience in the past is that it takes up to a week for a cortisone shot to work its way out of the system entirely.

The other system I developed after a cortisone shot was extremely high pulse--high enough that my doctor thought I was experiencing a thyroid storm. (I wasn't, fortunately.) It took a week to fade out completely, but it did.

Scary stuff cortisone, though very useful for some conditions. But the way that doctors use it as a placebo for joint and tendon pain is of great concern.

graywolf said...

After a shoulder/neck injury three years ago I started getting trigger point injections on a monthly basis. They had no signifigant effect, so my pain management doctor started giving me series of nerve blocks. I had minimal to moderate relief with those. Two years into my treatment I started feeling even worse. Now I had nerve pain everywhere and on a weekly basis I was having bad headaches and hot flashes. Still all the while I was getting more injections in my shoulder/neck. Once I started dropping weight, getting extreme thirst, and blurry eyesight, I demanded I get blood work done to check my glucose levels. They were well over 300. I am now a type 2 diabetic who needs pills and insulin to control my levels. I had testing seven months prior and my levels were normal, nor was I pre- diabetic. I strongly believe these injections were what caused my diabetes. My doctors are at odds on whether this is the case. Its good to know there are others out there who feel the same.

Unknown said...

I have been suffering from terrible hip and leg pain since a fall 5 months ago. I was given a cortisone shot in my knee and it raised my BP and sugar considerably so I refused anymore. But a friend told me that cortisone without preservatives is safer for diabetics. My pain dr. tried a Novacaine shot to try and find out exactly where my pain is coming from and it is my hip. Even with Novacaine,my BP was erratic but not my sugar. He says he wants to try a different type of steroid to try and counter act this terrible pain but I am unsure. I am on Oxycontin and Dilaudid right now and want off of them. I have been to the ER 4 times and in the hospital once to try to counteract this terrible pain. It's just been terible pain. I can't walk,sleep and I cry all the time. They are trying very har to help me. I wish I could take cortisone because it might give me even 6 months pain free. But I am so afraid to. I have had physical therapy,15 sessions,until it just became excrutiating. They talked acupuncture. But they really want to try the steroids. Prednisone did not hurt my BP or sugar but it did not help the pain either. I have lost a lot of weight too.
I don't know what to do.

Jenny said...

Unknown,

Have you had an MRI of your spine? It is possible you have the kind of disc injury that responds well to surgery--those from accidents often do.

Otherwise, both acupuncture and the steroid shot are worth a try. Worst case your blood sugar rises, but that can be dealt with with insulin which is painless and effective. As I've written in this article there are times when cortisone is a legitimate treatment and it's worth dealing with any blood sugar issues. Your situation may be on.

Ben said...

Jenny I wish I had checked your site before I got my cortisone shot for my hip pain on the 30th. I've followed your advice for years and use exercise and a low carb diet to manage my numbers very effectively - even to a normal level. However, after my shot on December 30th I was alarmed to see my bs was 470 on New Year's Eve! I've never even had a reading above 250. Of course I couldn't get ahold of any doctors unless I went to the ER - which I would have done at 500.

Ben

I've never used insulin before, but I went to Walmart on the 1st and got Novolin-R and some needles because I felt I needed to lower that number (still 250-300, and bouncing around).

I'm hoping that after this hell-week things will settle down, and I can resume my normal lifestyle. I think the danger from cortisone may be higher for people like me, that control their sugar with diet and exercise, because we don't have the medication or experience to control these swings. I just hope I haven't suffered any irreparable damage!

Jenny said...

Ben,

With luck your blood sugars will settle down once the cortisone is out of your system. If not, you might try taking Co-Enzyme Q10 for a few weeks. It appears that corticosteorids cause mitochondrial dysfunctions, and sometimes Co-Enyzme q10 can improve it.

My own abrupt descent into full fledged diabetes occurred after a course of prednisone, and after many years my blood sugars improved very dramatically after taking 50 mg of CoQ 10 every day for a while. Since most people with diabetes don't have this response to CoQ10 I am starting to think it might be due to the cause of my blood sugars worsening. (They were prediabetic due to genetics until the Prednisone.)

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