February 21, 2013
Disclaimer- I am not a medical professional or nutritionist, but I do have diabetes and have become really good at controlling my blood sugar with diet since I cannot take the diabetes meds.
Having to deal with diabetes sucks bad enough, but sometimes you have to get prednisone shots or go on a medrol pack for allergies or autoimmune flare ups or goodness knows what else, and then diabetes can turn into a real nightmare. Steroid meds force your adrenal glands to squeeze out more cortisol, which in turn makes other hormones and chemicals do stuff, and while this can be wonderfully life-saving, it also makes your liver dump out its glucose backup, originally meant for fight or flight emergencies, into your bloodstream *right now*.
Steroid meds are awesome when we need them, even when they temporarily make us gain weight and lose sleep. But a diabetic person on steroid meds is in a catch-22 situation when their blood sugar spikes a hundred or more points and stays that way while on steroid treatment. Increasing your diabetes meds without strict monitoring can get dangerous, and then you wind up on a roller coaster between high spikes and low drops. This is especially dangerous in traffic. I have no proof of that, but I'm sure doctors and highway patrol would agree, because low blood sugar drastically affects decision making and reaction time, kind of like being drunk or sleepy.
I have a solution! And it works! I confess it's not my idea, bit it's brilliant, and I can help you.
The best thing I ever found for easily controlling blood sugar spikes during steroid treatment is the Rosedale Diet. (I'm not being paid to say this, and I bought nothing from them but a used book off Amazon.) Dr. Rosedale takes the time to list foods you can eat that don't spike your blood sugar. There are plenty of foods out there in the form of proteins and healthy fats that you can rely on. The problem is that our world nowadays is so saturated with carbohydrates (sugars and starches) that it seems almost impossible to know what to eat during times of illness and stress, when a diabetic's blood sugar goes the highest.
Other easy ways to learn what 'carbs' to avoid is by following the South Beach Diet or by learning the glycemic index. Even people without diabetes find they lose weight faster and in a more healthy way when they simply limit the amount of carbs they eat. Diabetes websites such as American Diabetes Association also recommend 'counting carbs'. But that sounds like a lot of work, you say. Nope, it's EASY. Food labels show you how many grams of carbohydrates per serving. Rule of thumb is 10-15 carbs or less per meal or snack. You get 11 carbs in one cup of milk, for instance (that's half of a tall glass).
I had the opportunity to try this myself recently after an ER trip with IV prednisone, benadryl, and pepcid for unknown cause that could have been anything from allergic reaction to lupus flare up. I also had to take a pain pill on an empty stomach there, so they gave me 4 crackers, which normally won't spike my blood sugar much at all because it's just under 10 carbs. Since I hadn't eaten in several hours, my blood sugar was most likely below 100 before I got the prednisone shot. (I'm able to control with diet since I can't take diabetes meds, and therefore test regularly, so I know pretty well how it goes for me.) After I went home I got my glucose monitor out and a piece of paper to keep track. My blood sugar had jumped up to 148 from only 4 crackers on an empty stomach. I knew better than to eat any more carbs that evening, so I scrambled a couple of eggs and ate a piece of cheese. My blood sugar held steady like that for about 12 hours. When it finally came down the next morning (tested 111), I had some coffee with a little milk and a half tsp. of sugar in it and did ok, but I still stuck to mostly proteins and healthy fats until I was sure it was going to stay down through the afternoon. THEN I went back to 10 carbs per meal and snack. But then when it was time to take prednisone pills that evening (24 hours after the shot), I stopped all carbs again about an hour before I took the pills and didn't eat anything else through the night. The next morning my blood sugar was down to 115, so I was able to handle a small amount of carbs with breakfast, and then eat normally as the day wore on.
This worked fantastically until the fourth evening. My brain fell out, I wasn't thinking, I remembered my prednisone and took it without waiting after I ate, and 30 minutes later suddenly decided to polish off the rest of some chocolate milk I had left over, about a cup. *WORST*NIGHT*EVER*. ~omg~ My blood sugar must have spiked over 250 and stayed there for hours, because I was miserable, up every hour to pee, tossing around feeling like my heart was beating too hard, felt too hot, finally got a nasty headache that went down into a neck spasm and I had to get an ice pack out at one in the morning just to be able to lay back down. It didn't even dawn on me until I woke up again at 3:15 with a nasty throbbing headache that I did that to myself. I totally forgot to count my carbs and slammed that prednisone down right in the middle of them. I took my blood sugar right then and it was 142, so at least it was on the way back down, and was 118 by 5:45, thank goodness. The next night I watched my carbs again and *slept great*.
Ideally, you want to keep your blood sugar below 120, preferably between 86 and 100. Blood sugar goes up and down all day as we eat, and that's normal, but it's not normal for it to go over 120 and stay way up there for hours, which is what prednisone will make it do, especially if you've just had a shot. So until that comes back down, NO CARBS, or you'll make it go way higher. A great site to get really good blood sugar information from another real person like me is Blood Sugar 101.
If you are diabetic and must spend a week or longer on steroid meds, here are a few quick rules of thumb until you can get your menu figured out-
*Avoid all sugared drinks, including soda pop, tea, and fruit juices.
*Cheese, cream cheese, and butter are ok, but cut down or avoid all other dairy, because lactose will spike your blood sugar, including cottage cheese and some other soft cheeses.
*Eggs, nuts, meats, poultry, and fish are awesome, but avoid eating them if they are breaded in any form, especially tempura. Breading (flour) will spike your blood sugar as much as sugar will. Peel the breading off. This goes for other breaded foods as well. NO onion rings or other breaded veggies like okra or mushrooms or jalapeno poppers! Also beware of sugared or honeyed nuts and main dishes with added sugar in any form, which happens in some Asian, Mexican, and Italian dishes. *note- IHOP uses pancake mix in their scrambled eggs and omelettes, which will spike your blood sugar. Check labels on frozen precooked meals.
*Avoid all grains in any form as much as possible until your blood sugar comes down, and then only in moderation because grains are super carby. This includes all pastries, cakes, cookies, pies, breads, buns, tortillas, gravies, sauces, pastas, and rice. I know this is really hard. *hug*
*Be very careful with all legumes. Beans will spike your blood sugar a little differently from grains, but will stay high for a long time if you eat a lot. This includes chick peas and tofu. This part is really tough for vegetarians who use legumes for protein, so please watch this and keep monitoring your glucose levels.
*Avoid potatoes and other high starch or high sugar root vegetables and gourds, such as squash, pumpkin, carrots, parsnips, and beets. Stick to leafy greens and cruciferous vegetables like broccoli, cauliflower, brussels sprouts, and radishes. NO french fries or chips! Corn is the worst, watch the peas, stick to green beans, unbreaded okra, and asparagus. *note- some restaurants soak lettuce and salad veggies in sugar water to freshen them up, which can spike your blood sugar. This has happened to me. It sucked. It's not fair when you can't count on 'healthy' low carb foods in restaurants because of poor practices, so be vigilant.
*Be careful with tomatoes and ketchup, very high in both natural and added sugar content. Avoid salsas, spaghetti and pizza sauces, basically stay away from concentrated tomato products if your blood sugar is already high.
*Cut out fruits until your blood sugar is under control, although you can probably eat most berries without much of a problem. NO watermelon! Fruits are naturally very high in sugar content and are as bad on spiking blood sugar during steroid meds as drinking soda pop. I think avocados are ok, half a banana or less, but since fruits aren't marked for carbs and are generally carb rich, it's easier to walk away if you haven't had the time to look it up.
DO NOT DESPAIR. Remind yourself this is temporary until you can figure out your blood sugar pattern, like I did, or until you can make sure your diabetes medication is working well for you while you are on steroid meds. The worst thing you can do on top of feeling sick or dealing with something like flare ups and meds is make your diabetes worse. When you don't feel well in the first place, it's very natural to grab and eat something that tricks your body into thinking it will feel better, like caffeine or quick sugars and starches. But that feeling is very temporary, and the consequences are not only miserating, but harmful and even dangerous if your blood sugar is spiking up into the 300's. YOU CAN CONTROL THIS. I've learned this because my own health depends on it, since I can't take the pills. A nice perk I've noticed is that when I carb count while on steroid meds, I don't have any new weight gain.
I'm not going to abandon you there. I have a lot of experience with making food yummy and keeping my blood sugar down. That list up there is for emergencies while you are trying to get through the next 24 hours (or week) of misery (because that is usually when I find articles like this myself, and probably why you are here, too). You need a reward for sticking through this far during such a sucky time! Let's make this easy!!!
I know what you're thinking- it's already sucking bad enough, but the thought of eating salad and no dessert when you need comfort food the most is about to send you through a black well of despair. If you absolutely must have something or go crazy, the dessert I have found that does the least harm is a very simple cheesecake, but you still need to keep the portion small so you won't make yourself sick. I got this recipe from a Philadelphia cream cheese box. Total carbs in the entire cheesecake is 224, and if you slice into 8 portions, each portion is 28. So eat half a slice of this cheesecake and get only 16 carbs, which is fantastic compared to most desserts having 30 or much more.
Crust- 1 1/4 graham cracker crumbs, 1/4 c sugar, 1/3 cup melted butter, stirred together and patted into pie plate.
Filling- Mix together 2 8-oz blocks of cream cheese, 1/2 c sugar and 1 tsp vanilla, then mix in two eggs. Pour into crust and bake at 350 for 35-40 minutes. Do NOT add a topping when it's done unless a label says it has no carbs because it's been replaced with artificial sweeteners. Fresh berries are ok if you don't add sugar to them, but please use your glucose meter to verify this and not my word.
One of the biggest challenges in switching to a low carb diet is thinking you have to sacrifice flavor and feeling comfortably full, if you are used to filling up the empty corners on breads and desserts. One of the myths of good health is that fats will kill you, when in fact the sugar is already doing it much faster. The body craves healthy fats because they are essential to good nerve conduction and proper metabolism, among many other things. Because fats have lots of flavor and calories, a little bit of fat replaces a whole lot of sugar and starch and your body is much more quickly satisfied when you eat them. When you eat sugars and starches and play the game of spiking your blood sugar, your body sends out an alarm when your blood sugar starts to drop, and if you are diabetic, this alarm is sent out prematurely because your system is wonky, and bing, you're hungry again even when you've had more calories than you need and it hasn't been that long since you've eaten. This vicious cycle can be broken without the horrible suffering you imagine, simply by eating more proteins and fats. Treat yourself to some delicious food as you limit your carbs while you are on steroid meds, and you will feel so much better in both the short and long term. I have a few recipes of my own linked right here that work wonderfully for me.
campfire scrambled eggs- add more veggies if you like, it only gets more delicious
restaurant quality alfredo sauce- if you need a low carb sauce or gravy to go over grilled meat or poultry (do not add pasta)
Italian Chicken Fingers- the breading is half parmesan cheese for low carb
really good chicken soup- super low carb unless you add carby stuff like potatoes and rice
I wish you all the best, and I hope this was helpful.
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