Question from Atlanta, Georgia, USA:

I am a 48 year old female who is on 25 mg of prednisone along with 200 mg. of Imuran daily, and a week ago, I found out I have diabetes. When my liver specialist has attempted to lower the prednisone, my liver panels quickly become highly elevated.

I know that prednisone makes me very insulin resistant, so I am taking Regular insulin and attempting to work with the dramatic blood glucose rise that happens about an hour after I take it. I want to closely monitor my blood glucose, I am motivated, and have the financial resources to cover the additional expense of more medical supplies. I have tried taking 30 Units of Regular in the morning, waiting 30 minutes, then taking the prednisone and eating breakfast. This slows the creep of the blood glucose, but I still wind up in the 245-345 mg/dl [13.6-19.1 mmol/L] range three to four hours later. This morning, I took the 30 Units, then two hours later took another 15 Units. The creep seems slower according to my blood glucose readings, but is still creeping, and I want to keep the low blood glucose away (had that experience in the ER when they treated me too aggressively — ugh!). I know it is also very dangerous.

Since the prednisone causes such a dramatic blood glucose increase, I think I would have to take a lot of insulin in the morning to cause the hypo thing, especially since my first am blood glucose in always (so far) over 167 mg/dl [9.3 mmol/L]. I have used up to 60 Units (not all at one injection!). I also am learning that food combinations and types make a difference. I think I am on the right track.

How much insulin can someone use in a day? Is there a good formula for timing of food, insulin, and prednisone I can use to work effectively, so I can keep my blood glucose levels more level? I am told I have a very good team here, but hospital resources are tight and I have to wait for the classes and more in-depth education.