Sinusitis - prednisone or a third anitbiotic?, What would you do? Options

[Linda B]

I need an opinion. Sorry this is a bit long.

I have been living with a sore throat and ear infection for 7 weeks. When I first realized I probably had strep, it was on a weekend so I went to an Urgent Care and was put on Amoxicillin for 10 days. I thought I was better, went on a cruise one week after finishing the medicine, and came back with an ear infection. Saw a different Urgent Care Doctor cause I was unhappy that I was still sick, and she put me on Ceftin but only for 7 days. Once again I thought I was better, but it came back.
I went to my own PCP. He said he didn't see an infection but he definitely saw fluid in my ears and redness in my throat. He put me on Astellin for 7 days and sent me home with an RX for an antibiotic 'in case I needed it'. I started the antibiotic on the 6th day, but couldn't tolerate it - it gave me awful indigestion and stomach cramps. Of course, that was on the weekend.
I saw him yesterday, and he said I definitely still have an infection, fluid in my ear, pus in my throat, and even some nasal congestion. He said 'I wish I could put you on prednisone, it would knock this right out of you'. I told him I thought I could up my insulin dosage to cover for it, but he wasn't interested. He had prescribed another antibiotic (ceclor er) for 10 days. I didn't fill it yet, and the more I think about it, the more I think I want the prednisone.

I took prednisone 3 years ago for a muscle problem and just found the RX date and ran a One Touch report - my average BG was 156 and that was without CGMS.

I am thinking about calling this AM and insisting on the Prednisone. But then I think maybe I should just try the antibiotic - I should know in a few days if it helps.

WHAT WOULD YOU DO?

Linda B.

[Arlene S.]

I need an opinion. Sorry this is a bit long.

I have been living with a sore throat and ear infection for 7 weeks. When I first realized I probably had strep, it was on a weekend so I went to an Urgent Care and was put on Amoxicillin for 10 days. I thought I was better, went on a cruise one week after finishing the medicine, and came back with an ear infection. Saw a different Urgent Care Doctor cause I was unhappy that I was still sick, and she put me on Ceftin but only for 7 days. Once again I thought I was better, but it came back.
I went to my own PCP. He said he didn't see an infection but he definitely saw fluid in my ears and redness in my throat. He put me on Astellin for 7 days and sent me home with an RX for an antibiotic 'in case I needed it'. I started the antibiotic on the 6th day, but couldn't tolerate it - it gave me awful indigestion and stomach cramps. Of course, that was on the weekend.
I saw him yesterday, and he said I definitely still have an infection, fluid in my ear, pus in my throat, and even some nasal congestion. He said 'I wish I could put you on prednisone, it would knock this right out of you'. I told him I thought I could up my insulin dosage to cover for it, but he wasn't interested. He had prescribed another antibiotic (ceclor er) for 10 days. I didn't fill it yet, and the more I think about it, the more I think I want the prednisone.

I took prednisone 3 years ago for a muscle problem and just found the RX date and ran a One Touch report - my average BG was 156 and that was without CGMS.



I am thinking about calling this AM and insisting on the Prednisone. But then I think maybe I should just try the antibiotic - I should know in a few days if it helps.

WHAT WOULD YOU DO?

Linda B.

Under the circumstances I would go to an ENT. Having had severe stomach reactions from prolonged use of antibiotics, especially amoxicillin and ceftin I was sent to an ENT who scoped my nose and throat and prescribed appropriate meds and not antibiotics. The prednisone might help if it's an allergy problem but as a diabetic you need to consider not what it did for your blood sugars in the past but what it might do now. If it's necessary it's one thing but it sounds like he doesn't think so. Mind you, this is not a medical opinion. It's an answer to "What would you do?" BTW, I use (my ENT's advice) Neilmed sinus rinse with a bit of liquid cortisone along with a saline pack in warm distilled water and that doesn't raise my bg levels. However, a shot in my finger raised my levels for two to three weeks. I don't know how pills would work.

[Liz]

I have not had to use prednisone, but I personally think I'd risk it and run my BGs higher rather than feeling miserable and taking one antibiotic after another, especially when the problem keeps returning.

[Linda B]

Arlene and Liz,
Thank you both for your thoughts.

The doctor just called back and agreed to prescribe the prednisone.
I have a friend with chronic sinusitis who has seen ENT specialists, and prednisone works for him.

I am going to crank up my basal and give it a try. If it does not work, then I will definitely head to the ENT office.

Linda B.

[GA Hiker]

Arlene and Liz,
Thank you both for your thoughts.

The doctor just called back and agreed to prescribe the prednisone.
I have a friend with chronic sinusitis who has seen ENT specialists, and prednisone works for him.

I am going to crank up my basal and give it a try. If it does not work, then I will definitely head to the ENT office.

Linda B.

Saw my orthopedist today re my recent knee surgery and we talked about a cortisone shot if it does not improve enough. How much will you crank up your basal to start with?
Barbara

[Linda B]

Saw my orthopedist today re my recent knee surgery and we talked about a cortisone shot if it does not improve enough. How much will you crank up your basal to start with?
Barbara

I'm going to start with 150%, and hope that with that I will be able to use regular bolus amounts.
I am lucky that I have the numbers from the last time. The only thing is I don't know how much I had it cranked up then. What I can see is that my numbers were mostly between 150 - 300. So obviously I didn't do as good as I could have then. I also didn't have CGMS and I'm sure I was worried about lows. I was probably only running around 125% then.
Wish me luck!

Linda B.

[Arlene S.]

Arlene and Liz,
Thank you both for your thoughts.

The doctor just called back and agreed to prescribe the prednisone.
I have a friend with chronic sinusitis who has seen ENT specialists, and prednisone works for him.

I am going to crank up my basal and give it a try. If it does not work, then I will definitely head to the ENT office.

Linda B.

Hi Linda,

Good luck! The CGM should help. It did help me when I had the finger injection.

[GA Hiker]

I'm going to start with 150%, and hope that with that I will be able to use regular bolus amounts.
I am lucky that I have the numbers from the last time. The only thing is I don't know how much I had it cranked up then. What I can see is that my numbers were mostly between 150 - 300. So obviously I didn't do as good as I could have then. I also didn't have CGMS and I'm sure I was worried about lows. I was probably only running around 125% then.
Wish me luck!

Linda B.

GOOD LUCK!!

Barbara

[Linda B]

Here's An Update:
For the first 4 hours, the 150% basal seemed to be working. Then after dinner my BG shot up - I did not increase my bolus (what a mistake)! I was up to 180 by bedtime. I took my second pill, ate it with Special K Protein Plus cereal and milk (it says take with food or milk), and increased my bolus by 50%.

I upped the basal to 165% using a program so I wouldn't have a vibrate every hour and went to bed. During the night by BG would not get below 200. I woke up at 1:10 with a 258 and decided to change my basal to almost 200% and doubled the bolus correction. Twice during the night I trusted my CGMS and took an extra 1 unit with the easy bolus. I woke at 109 HOORAY!

I am getting ready to eat breakfast now. I will post an update later. My ears and throat both feel a little better, but I definitely still have symptoms.

Please keep in mind that this is very very much a YMMV thing. I would not have the nerve to double my basal without a CGMS.

Linda B.

[JohnG]

Here's An Update:
For the first 4 hours, the 150% basal seemed to be working. Then after dinner my BG shot up - I did not increase my bolus (what a mistake)! I was up to 180 by bedtime. I took my second pill, ate it with Special K Protein Plus cereal and milk (it says take with food or milk), and increased my bolus by 50%.

I upped the basal to 165% using a program so I wouldn't have a vibrate every hour and went to bed. During the night by BG would not get below 200. I woke up at 1:10 with a 258 and decided to change my basal to almost 200% and doubled the bolus correction. Twice during the night I trusted my CGMS and took an extra 1 unit with the easy bolus. I woke at 109 HOORAY!

I am getting ready to eat breakfast now. I will post an update later. My ears and throat both feel a little better, but I definitely still have symptoms.

Please keep in mind that this is very very much a YMMV thing. I would not have the nerve to double my basal without a CGMS.

Linda B.

Just wondering how many days are you going to take it.

[Linda B]

Just wondering how many days are you going to take it.

Dr. prescribed 20 mg pills, twice a day for 5 days.
BUT everything I ever read said you have to wean off of these.
I googled prednisone dose for sinusitis and it always showed a gradual decline in dosage. They always started with 40 mg for 3 days, and said to get off of it as soon as symptoms are gone. Most did a decline of 10mg at a time, some went down to 5 mg but I can't do that with these 20 mg pills.

SO
I am planning to do 40 mg for 3 days, 30 mg (cut pill in half) for 1 day, 20 mg for 1 day, and 10 mg (the half pill left over) for 1 day.

It's one day longer than the doctor prescribed, but I feel better using the declining dose regimen.


Linda B.

[JohnG]

Dr. prescribed 20 mg pills, twice a day for 5 days.
BUT everything I ever read said you have to wean off of these.
I googled prednisone dose for sinusitis and it always showed a gradual decline in dosage. They always started with 40 mg for 3 days, and said to get off of it as soon as symptoms are gone. Most did a decline of 10mg at a time, some went down to 5 mg but I can't do that with these 20 mg pills.

SO
I am planning to do 40 mg for 3 days, 30 mg (cut pill in half) for 1 day, 20 mg for 1 day, and 10 mg (the half pill left over) for 1 day.

It's one day longer than the doctor prescribed, but I feel better using the declining dose regimen.
Linda B.

It's not a problem unless your going to take it over 7 days.

[Linda B]

Another update:
WOW - this is not as easy as I thought it would be. My BG has been high all day. I started out good this morning, but after many boluses during the night, and one just 3 hours before I woke with my 109.
Took a pill with breakfast.
Lunch was not too bad - 135, with no extra bolus between breakfast and lunch (but my breakfast bolus was twice the usual amount).
After lunch = 215 at 3:12 corrected with 1.6
190 at 4:27 corrected with 1.0
179 at 5:22 bolused for dinner

It seems like my basal must not be high enough, because those corrections weren't doing anything. So I upped my basal by another .2

To top it off, my sensor crapped late this morning after only one good day. I uploaded to carelink and called it in and the tech agreed it was 'waffling'. The ISIG dropped from 14 to 8 in a half hour and then climbed back up to 12 and then dropped again an hour later. Told me to pull it and they want to see it. So I'm warming up another sensor now but I'm not sure if it will be wet enough to work overnight. I'll just have to get out of bed and check whenever I wake during the night. (sometimes I just check my SG and roll back over and go back to sleep).
BUMMER.

I guess keeping my BG under 225 isn't that bad, but I really was hoping to keep it closer to normal. My basal is a full 200% now, and I have been doubling every bolus wizard estimate. I may have to be more agressive with the boluses.

Linda B.

[Arlene S.]

Another update:
WOW - this is not as easy as I thought it would be. My BG has been high all day. I started out good this morning, but after many boluses during the night, and one just 3 hours before I woke with my 109.
Took a pill with breakfast.
Lunch was not too bad - 135, with no extra bolus between breakfast and lunch (but my breakfast bolus was twice the usual amount).
After lunch = 215 at 3:12 corrected with 1.6
190 at 4:27 corrected with 1.0
179 at 5:22 bolused for dinner

It seems like my basal must not be high enough, because those corrections weren't doing anything. So I upped my basal by another .2

To top it off, my sensor crapped late this morning after only one good day. I uploaded to carelink and called it in and the tech agreed it was 'waffling'. The ISIG dropped from 14 to 8 in a half hour and then climbed back up to 12 and then dropped again an hour later. Told me to pull it and they want to see it. So I'm warming up another sensor now but I'm not sure if it will be wet enough to work overnight. I'll just have to get out of bed and check whenever I wake during the night. (sometimes I just check my SG and roll back over and go back to sleep).
BUMMER.

I guess keeping my BG under 225 isn't that bad, but I really was hoping to keep it closer to normal. My basal is a full 200% now, and I have been doubling every bolus wizard estimate. I may have to be more agressive with the boluses.

Linda B.

I'm sorry to hear that it has been so difficult for you to control your BGs. I had the same problem with the shot back in 2007.

As for the sensors, I find that when my I'm having trouble controlling my BGs the sensors crap out sooner than usual.

Are you feeling any better?

[Linda B]

I'm sorry to hear that it has been so difficult for you to control your BGs. I had the same problem with the shot back in 2007.

As for the sensors, I find that when my I'm having trouble controlling my BGs the sensors crap out sooner than usual.

Are you feeling any better?

I AM feeling better, thank goodness! I am no longer aware of the fluid in my ears, so I assume they have dried up. My laryngitis is almost gone, and my throat doesn't hurt at all. The only bad thing is I have had a bad headache most of the day. I did not have that before.

I agree that sometimes the sensors don't act well when BG is out of control. But this was different. It worked great over night last night, and then just did this crazy yo-yo showing I was low when I was 140 and 180. The tech agreed ISIGs should not change as rapidly as this one did, and it did it twice. I put the new one in around 5:00 but I can't start it now because my BG is changing too fast. I was 269 an hour and a half ago and I'm 179 now (I took a huge correction). I just took the second prednisone for today and am eating my Special K again (taking it with milk AND food instead of milk OR food).

We'll see what happens tonight without a working sensor. If I think I've been stable I will start it up during the night.

Tomorrow I cut back to 30 mg instead of 40. I am hoping the lower dose might be better for my BG.

I also changed my Silhouette just now, in case maybe it was contributing to my higher numbers. I had it in my upper butt, something I haven't done for a long time. I guess this wasn't the right time to try a new infusion site! I put the new one back in my stomach.

I hope I don't go low if this new Sil works better than the old one. I will check anytime I wake up.

Linda B.

[Linda B]

Good news and bad news:

My new Sil seemed to be doing much better. I woke 3 times between midnight and 4:30 and was in the low 100s all three times. The bad news: I adjusted the basal down from 200% to 150 % thinking that I didn't need so much basal after all, and I woke with 187!

My sensor was still warming up so I didn't get any warnings as I climbed from 114 at 4:30 to 187 at 6:45. BUMMER.

I put the basal up to 175%, but will probably have to go back up to 200%. I was able to start my sensor, so once I confirm that I can count on it I will up the basal back to 200%.

My TDD yesterday was 50; my usual is 22.

Linda B.

[tedm]

Tomorrow I cut back to 30 mg instead of 40. I am hoping the lower dose might be better for my BG.

My experience with steroids is that the BG effect can linger on for days or weeks after stopping it. YMMV, of course, but be prepared to keep fighting your BG levels for a while.

[Linda B]

My experience with steroids is that the BG effect can linger on for days or weeks after stopping it. YMMV, of course, but be prepared to keep fighting your BG levels for a while.

Thanks for the warning. I am feeling better, but am a little sorry that I did this after all. I think the Flonase nasal spray may have worked if I gave it a little more time.
My BG has been right around 200 all day today. I keep pumping more corrections (doubling the suggested amount) but it's still not enough. Going out tonight, have to drive, don't want a hypo. At least my CGMS seems to be working now, so I can be a bit more aggressive.
I doubt I will do this again.

Linda B.

[choochoo]

It is true the effect on BG might last a while. I had shots in my hips and had elevated BG for about 4 weeks - am Type 2 and was on oral meds at the time, but had to add Lantus and Novolog for three weeks. Now on a pump and with your experience it should be easier to deal with this with a pump than on MDI like I was. Keep up thye fight. Hope everything goes well. I fought sinusites and multiple infections for over a year. Eventually had surgery to clean out the sinus. Now doing well. Good luck. You may want to see an ENT.

[Linda B]

It is true the effect on BG might last a while. I had shots in my hips and had elevated BG for about 4 weeks - am Type 2 and was on oral meds at the time, but had to add Lantus and Novolog for three weeks.

I realize we are all different, and you are a type 2, but how much total insulin did you add per day? I am just curious.

Yesterday was another struggle. I just kept taking insulin. We were at a cocktail party and then went out to eat. I was down to 100 just before eating and panicked because I had taken so much insulin during the previous two hours. We had already ordered, so I just ate one glucose tablet (not sure what I thought that small amount would do) but it's a good thing I didn't take more. By the time I got home from dinner two hours later I was back up to 265 despite taking twice my dinner bolus and running a basal more than 200% of my normal. I managed to get back down to 150 by 1 AM and woke at 119, so that's better than yesterday morning when I woke with 197.

I am curious if anyone can explain why this happens? What is the physiology? Does the prednisone stop our bodies from absorbing insulin? Or does it make our livers dump glycogen?

Anyone who has been there, done this, when the high BGs finally stop, was it a sudden drop or a gradual one? I am scared to death literally that I will crash at some point.

Meantime I am halfway there, 3 days down, 3 more with less prednisone each day to go. I took 40 mg for 2 days, 30 yesterday, 20 today, 10 tomorrow and the next day and then I'll be done. Originally I was going to do 40 x 2 days 30 x 3 days 20 x 1 day and 10 x 1 day but since my symptoms are gone I am going to try to get off this stuff ASAP.


Linda B.