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March 19, 2004

Other Illnesses, Thyroid

Question from Milford, Ohio, USA:

My daughter was recently diagnosed with Graves disease. Today, the doctors tell me she may have lupus. She is on 60 mg of prednisone and is being tapered off of it over the next two weeks. How do both of these diseases affect the diabetes? Or, how does the diabetes affect Graves and lupus?

Answer:

Any thyroid disorder is more common in those who have diabetes, especially type 1 diabetes. Both type 1 diabetes and Graves are kinds of autoimmune disorders. If the hyperthyroidism is out of control, then the blood glucose levels may also be difficult to control. Frequent monitoring will allow proper insulin adjustment. If prednisone is used for any disease, this will almost immediately, usually within six to eight hours, raise the insulin requirement since any cortisone like medications block how insulin works. Blood glucose levels can be controlled, but with more insulin. Here, again, frequent blood glucose testing lets one decide how to go about doing this. As the dose of prednisone is tapered, then the insulin doses will also need to be lowered concomitantly. Stay in close contact with your diabetes/endocrine team so that they can help you figure this all out. Lupus, by itself, does not have much direct effect on blood glucose levels except when steroids are needed as part of the treatment, or, if the lupus causes kidney damage.

SB