Perhaps this should be in the diabetes tips, but here it is. I’ve been on immunotherapy for nearly a year and developed the classic itchy rash. It’s the most annoying side effect but the least dangerous.
Anyway it’s becoming progressively worse. Both my oncologist and I tried to avoid oral prednisone knowing it would jack my BG through the roof.
I’ve not adjusted my Tandem pump settings, adding 3 daily doses of Lantus. I also do override meal bolused and corrections. If BG continues to rise I’ll bolus 2u IM.
It ain’t great but is helping.
I have 1 more infusion next week. I hope the rash is completely cleared by April. This stuff has a half-life of 24 days.
2 things the prednisone is doing 1. Increases insulin resistance. 2. Increases appetite especially for carbohydrates.
@CarlosLuis Sorry you’re going thru that! Would one of us knew a way around it, but I’d probably have asked you. If you find a method that helps (like the exercise mentioned), please post and let us know for others benefit. Is the prednisone long term or hopefully just during the infusions?
It’s just for 5 days. We’ve avoided it but this 2nd to last infusion caused the rash to flare really bad. I took the last dose of prednisone Thursday and have my last infusion next Thursday. I have another course if it flares bad again. Hopefully I won’t need it.
I feel for any of our tribe that has to be on long term steroids.
Carlos,
You don’t mention if this is an allergic reaction, or is a known side effect of the active agent in the chemo. Some small molecule targeted therapies affect skin cells causing skin issues. It sounds like (24 days) it is the active ingredient. Does the prednisone help at all?
I wonder whether Flonase + an antihistamine compounded into a thick cream and applied topically might help. Biotin supports skin/nails; eat eggs or jello.
When I have had to take prednisone packs, or injections into joints, I found that I had to increase my basel 20%.
Take care,
Mike
It’s a known reaction to immunotherapy which boosts the immune system into hyperdrive. It’s not chemo. The dangerous side effects concern the liver, kidneys and thyroid, so far all tests good.
One other thing is to cause type 1 diabetes. That may actually be in people with undiagnosed LADA/LADY and the boosted immune system more aggressively attacks the Beta cells.
I did spray some Flonase on the hot spots when I got home. It helped.
My experience with oral prednisone over the years is that BGs and insulin needs return to normal once the last dose wears off (about 20-24 hours). In my case I’d increase basals across the board by 15% for every 5mg pill. As I tapered down from 30mg, I’d decrease basals accordingly each day, so on the day after my last pill I’d be back to normal basal rates and normal BGs. Of course YMMV.
An update on rash, prednisone, unstable BG, out of control appetite and weight gain.
This last course of prednisone was 2 weeks of 40mg per day followed by a 5 week taper of 1 week minus 5mg each week.
As to BG issues, I left my pump setting as is. I would use extended bolus at 100% higher than the pump recommended. Usually when the extended bolus finished BG would spike alarming high. Response to pump correction did not stop the rise.
I got some 100u syringes with half inch needles. Doing an IM injection in the deltoids of 4-6u would slow and after a while bring BG down.
The other thing I did was as much as 30 units of Lantus split 3 ways. At 30mg prednisone for 3 days I needed to reduce the Lantus. Had to treat an overnight hypo 2 nights in a row.
The Opdivo rash is about 80-90% cleared.
The prednisone caused me to crave carbs. That along with all the insulin has increased my weight by 12-15 pounds.
My oncology NP said that in all the patients receiving Opdivo and Keytruda most had mild rashes if at all. There are 2 of us. The worst was a young woman who had no reaction until her last infusion. She had a severe rash over her whole body and had to be treated in a. Burn center. I was number two.
With the taper off I’m having to make continuous adjustments. Cut the Lantus to 1 10u injection in the morning, that’s it. My TDD has dropped 16u per the pump. I’m on day 4 of this cartridge/set with still 50u available. I guess I’ll decrease the amount I load from 250u to maybe 160u. My appetite is more under control.
The immunotherapy rash which is the reason for the prednisone is still improving.
2 things I learned about take high doses of prednisone:
Take in the morning to help prevent insomnia.
Take Pepcid 15-60 minutes before eating and take the prednisone with food. Prednisone can cause a stomach ulcer.
Postprandial spike after lunch. I thought I would try to use pump insulin to bring it down. I guess the IM injection is still the way to go. Not now with so many insulin on board. But next time.
I hope it does what it’s suppose to do without too much hyperglycemia.