OK Tex (and everyone else who has an experience, thought or opinion to share on this):
I'm back on Budesonide, at least for a few months. One of my biggest complaints about it was that it caused me anxiety and blood sugar issues, or at least I think it did. And from searching and reading on here for the past 48 hours (almost non-stop) I see that it can and does affect blood sugar levels.
Is there a time of day or way I can take it that will reduce the impact it has on my sugar levels? For the record, I am not diabetic or even pre-diabetic, I just am very sensitive and have noticed that I have blood sugar spikes and crashes often if I'm not careful with my eating habits and they almost all seem to go away when I'm off Budesonide.
Since I am going back on for a bit, should I try a different time of day? Most of the time I was taking them with lunch, but the last go round I was taking them in the morning with my other meds on an empty stomach. Both times had the same result. Should I try bedtime? Does it matter if my stomach is empty or full? Should I try taking one in the morning and one in the evening to reduce the blood sugar effects?
Input, feedback, personal experience, observations would be greatly appreciated. The time of day that the spike and crash causes me the most problems is when I'm sitting at my table at home during lunch. Sometimes as quickly as even 2 bites into my lunch I will get a jolting dizzy spell that almost knocks me off my chair, followed by intense anxiety, then diarrhea, then exhaustion. The jolting dizziness might happen with dinner, too, but it's less noticeable because I'm usually on the couch and chalk it up to something else, but it really seems like the one that affects me most is mid-day, especially since I have to drag myself back to the office after the episode.
Thanks in advance.
Sue
Question regarding Budesonide = time of day
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Question regarding Budesonide = time of day
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Hi Sue,
Sorry to hear that you needed to restart a treatment. This is an interesting question. I'm not sure there's a satisfactory answer. Here's the problem:
The time to Tmax (maximum concentration in the blood) varies by the individual from 30 minutes to 10 hours. That's too great a spread to provide any useful information. The half-life of intravenously-administered budesonide is listed as 2 to 3.6 hours. So somewhere between half an hour and ten hours your blood level peaks, and about 2 to 4 hours later, about half will have been metabolized. But the point is that it takes a finite amount of time to become available (though it could be as little as maybe 10 minutes).
You say that the most serious problem occurs at noon, even if you take them at noon. That means that the blood sugar reaction in that case is probably based on the residual effects of previous doses, unless you are taking them before the meal. So the timing of the budesonide dose may have only a relatively small effect on the problem.
Do you eat any breakfast? I'm guessing you don't. If not, that might have a great deal to do with the problem. Intermittent fasting raises cortisol levels. Stress raises cortisol levels. So around noon, your cortisol level (which was supposed to peak in the morning soon after you got out of bed and slowly decline the rest of the day) peaks (because of skipping breakfast and the stress of work) creating a blood sugar spike that the budesonide increases (by boosting your cortisol level an additional amount).
Follow this six-point plan:
1. Take all of your budesonide soon after you get out of bed (or after breakfast if you prefer to take if with a meal). This will make your cortisol peak about when it's supposed to
2. Start the day with a substantial, high-protein breakfast (high protein helps to minimize the possibility of blood sugar spikes later)
3. Don't go to work, in order to minimize the stress — (okay just kidding with that one, but do try to minimize stress as much as possible)
4. Eat a midmorning snack — a snack that contains some protein, to minimize the risk of blood sugar spikes later (and if you're concerned about weight, eat part of your lunch)
5. Eat what's left of your lunch at noon (again, preferably a medium-to-high-protein lunch, to minimize the risk of blood sugar spikes later)
6. Eat a mid-afternoon snack (again, containing protein, and if you're concerned about weight, it can be part of what would have otherwise been your lunch or diner)
After that you can eat your dinner as you would normally and do whatever else you would normally do.
My point is, eating every 2-3 hours reduces the risk of blood sugar spikes because it minimizes the possibility of being affected by the stress hormones epinephrine and norepinephrine
You're very welcome. I hope this plan works well for you.
Tex
Sorry to hear that you needed to restart a treatment. This is an interesting question. I'm not sure there's a satisfactory answer. Here's the problem:
The time to Tmax (maximum concentration in the blood) varies by the individual from 30 minutes to 10 hours. That's too great a spread to provide any useful information. The half-life of intravenously-administered budesonide is listed as 2 to 3.6 hours. So somewhere between half an hour and ten hours your blood level peaks, and about 2 to 4 hours later, about half will have been metabolized. But the point is that it takes a finite amount of time to become available (though it could be as little as maybe 10 minutes).
You say that the most serious problem occurs at noon, even if you take them at noon. That means that the blood sugar reaction in that case is probably based on the residual effects of previous doses, unless you are taking them before the meal. So the timing of the budesonide dose may have only a relatively small effect on the problem.
Do you eat any breakfast? I'm guessing you don't. If not, that might have a great deal to do with the problem. Intermittent fasting raises cortisol levels. Stress raises cortisol levels. So around noon, your cortisol level (which was supposed to peak in the morning soon after you got out of bed and slowly decline the rest of the day) peaks (because of skipping breakfast and the stress of work) creating a blood sugar spike that the budesonide increases (by boosting your cortisol level an additional amount).
Follow this six-point plan:
1. Take all of your budesonide soon after you get out of bed (or after breakfast if you prefer to take if with a meal). This will make your cortisol peak about when it's supposed to
2. Start the day with a substantial, high-protein breakfast (high protein helps to minimize the possibility of blood sugar spikes later)
3. Don't go to work, in order to minimize the stress — (okay just kidding with that one, but do try to minimize stress as much as possible)
4. Eat a midmorning snack — a snack that contains some protein, to minimize the risk of blood sugar spikes later (and if you're concerned about weight, eat part of your lunch)
5. Eat what's left of your lunch at noon (again, preferably a medium-to-high-protein lunch, to minimize the risk of blood sugar spikes later)
6. Eat a mid-afternoon snack (again, containing protein, and if you're concerned about weight, it can be part of what would have otherwise been your lunch or diner)
After that you can eat your dinner as you would normally and do whatever else you would normally do.
My point is, eating every 2-3 hours reduces the risk of blood sugar spikes because it minimizes the possibility of being affected by the stress hormones epinephrine and norepinephrine
You're very welcome. I hope this plan works well for you.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Well look at you.... still right there responding to posts quickly with very helpful information, after all these years! You were always there for me 12 years ago and you still are.... amazing. 
Actually I have always been a breakfast person because of being what I think is reactive hypoglycemic. Everything you read says you need to "break the fast" so I always have. I was always making myself breakfast as soon as I got to the office and then my nutritionist suggested I do it as quickly after I woke up as possible. Since the quickest and easiest way to do that was to pop a hard-boiled egg in my mouth, that's what I would do. And BOY would that cause a crash (or something, but I always felt awful about the time I got to the office). So she then recommended that I wasn't eating enough and that just one egg was causing an insulin surge but I didn't have enough food there to justify all that insulin and suggested I eat two eggs upon rising. That did help a lot. Then my GP urged me to go Vegan so I gave up eggs. I would make oatmeal at the office but I would be starving within 45 minutes. I started adding chia seeds and almond butter and that would help, but then the calorie count really shoots up.
One day when I was stuck in meetings from first thing in the morning I didn't eat at all and was surprised at how good I felt! Hungry, yes, but not dizzy, not anxious, no spikes or crashes. So I researched intermittent fasting and read there are lots of benefits so gave it a try. I was doing really well like that for a few weeks, but some mornings the hunger mid morning would get so intense I couldn't even focus, so I'd breakdown and have steel cut oats. Unfortunately, I don't think eating or not eating breakfast made any difference during my lunchtime dizzy/anxiety/diarrhea/fatigue spells. The only thing that DID stop those was getting off the Entocort.
I have ordered an Enterolab kit so hopefully in a few weeks I'll know what to eat and what not to eat and perhaps you can help me with a breakfast plan. I have read about SCD, Low-Histamine, Low FODMAP, gluten free, meat free, dairy free, fructose free.... you name it, I've researched it and have no clue what will help and what the hell to eat anymore. Thus, pulling the expensive trigger on Enterolab.
That very large range of time to TMAX is mind-boggling! What does it depend on, I wonder? Individual metabolism?
I had blood drawn Friday to see how I would metabolize 6MP since my doc would like me to think about trying that. I don't suppose that would be an indicator of how I metabolize other things, would it?
Sue
Actually I have always been a breakfast person because of being what I think is reactive hypoglycemic. Everything you read says you need to "break the fast" so I always have. I was always making myself breakfast as soon as I got to the office and then my nutritionist suggested I do it as quickly after I woke up as possible. Since the quickest and easiest way to do that was to pop a hard-boiled egg in my mouth, that's what I would do. And BOY would that cause a crash (or something, but I always felt awful about the time I got to the office). So she then recommended that I wasn't eating enough and that just one egg was causing an insulin surge but I didn't have enough food there to justify all that insulin and suggested I eat two eggs upon rising. That did help a lot. Then my GP urged me to go Vegan so I gave up eggs. I would make oatmeal at the office but I would be starving within 45 minutes. I started adding chia seeds and almond butter and that would help, but then the calorie count really shoots up.
One day when I was stuck in meetings from first thing in the morning I didn't eat at all and was surprised at how good I felt! Hungry, yes, but not dizzy, not anxious, no spikes or crashes. So I researched intermittent fasting and read there are lots of benefits so gave it a try. I was doing really well like that for a few weeks, but some mornings the hunger mid morning would get so intense I couldn't even focus, so I'd breakdown and have steel cut oats. Unfortunately, I don't think eating or not eating breakfast made any difference during my lunchtime dizzy/anxiety/diarrhea/fatigue spells. The only thing that DID stop those was getting off the Entocort.
I have ordered an Enterolab kit so hopefully in a few weeks I'll know what to eat and what not to eat and perhaps you can help me with a breakfast plan. I have read about SCD, Low-Histamine, Low FODMAP, gluten free, meat free, dairy free, fructose free.... you name it, I've researched it and have no clue what will help and what the hell to eat anymore. Thus, pulling the expensive trigger on Enterolab.
That very large range of time to TMAX is mind-boggling! What does it depend on, I wonder? Individual metabolism?
I had blood drawn Friday to see how I would metabolize 6MP since my doc would like me to think about trying that. I don't suppose that would be an indicator of how I metabolize other things, would it?
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
I don't know for sure, but that's probably a very specific test. The EnteroLab test will tell you what's safe and what's not.
Tex
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Thanks. Waiting for my test kit to arrive, but the reason I asked about the blood test was because it would be really helpful for me to know how fast my Entocort is being metabolized. Then I could decide what time of day, all at once or space them out, etc. I actually thought that once you've been taking it for a few weeks that there was a pretty constant, consistent, steady dose of it in the system.tex wrote:I don't know for sure, but that's probably a very specific test. The EnteroLab test will tell you what's safe and what's not.
Tex
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
You're right, there is, but there is a also a cortisol boost soon after you take it on top of that residual effect. Most people who have tried to take it later in the day (especially at bedtime) have had trouble sleeping.
Tex
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
So if I took it twice a day I would get TWO cortisol boosts, but maybe each one would be less strong. Hmmmmm..... interesting. Wondering if playing with those variations would cause it to have less effect on my Synthroid medication, and maybe cause me less anxiety. From what I've read it doesn't matter if it's taken with food or without, is that you're understanding, too?
Sue
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Yes, according to the label, it can be taken with or without food, Label recommendations are for taking it first thing in the morning. Research shows that it is more effective for the purposes for which it is prescribed that way because taking it first thing in the morning allows it to take advantage of the natural cortisol increase in the mornings.
The mechanism by which corticosteroids in general are thought to work to reduce inflammation is by giving a big boost to the cortisol level and then allowing it to decay the rest of the day and night. That means you'll be reducing the effectiveness by splitting the dose and taking some later. You probably would get the same results by reducing the dose.
Tex
The mechanism by which corticosteroids in general are thought to work to reduce inflammation is by giving a big boost to the cortisol level and then allowing it to decay the rest of the day and night. That means you'll be reducing the effectiveness by splitting the dose and taking some later. You probably would get the same results by reducing the dose.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
OK, so I should probably take two first thing in the morning, but I was trying to put more distance between my Synthroid and this. I set my alarm for 6:00 a.m., take my Synthroid, and go back to sleep for another 60-90 minutes. Hopefully that's enough of a headstart for the Synthroid.
Sue
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Vitamin D: yes. Magnesium: No. Yesterday after reading all your posts about magnesium I got on Amazon and put a bottle of ReMag in my cart, but after reading MORE I see that it can make things worse before it makes them better, and getting the dosage, timing, etc. right would have a learning curve in itself. I decided I should wait on the mag until I get the flare under control, until my TSH does it's "Entocort" fluctuations, and any Entocort side effects have calmed down. If I throw too many changes into the mix all at once there will be no way of knowing what's causing what, and what needs to be modified.Gabes-Apg wrote:Sue
are you taking Vit D3 and magnesium??
magnesium is great for a multitude of reasons, one of which is helping to balance insulin/blood sugar etc
it also support adrenals for a more balanced function.
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
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Gabes-Apg
- Emperor Penguin
- Posts: 8332
- Joined: Mon Dec 21, 2009 3:12 pm
- Location: Hunter Valley NSW Australia
It doesnt make things worse for everybody.
doing low dose via epsom salt foot soaks / baths is a good starting point. Topical will work out better for you
given the adrenal issues and blood sugar issues you are experiencing I think it will benefit you way more than trying to adjust the budenside dosage times..
doing low dose via epsom salt foot soaks / baths is a good starting point. Topical will work out better for you
given the adrenal issues and blood sugar issues you are experiencing I think it will benefit you way more than trying to adjust the budenside dosage times..
Gabes Ryan
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
"Anything that contradicts experience and logic should be abandoned"
Dalai Lama
Sue,
Back when I was magnesium deficient one of my most puzzling symptoms was anxiety. I couldn't figure out why I was waking up in the wee hours of the morning with near panic attacks. I finally figured out it that it was because that was when I was running out of magnesium. You can read the details at:
Even ER Docs Don't Recognize The Importance Of Magnesium
Anxiety is a classic symptom of magnesium deficiency. I just assumed that you were taking it. I use Doctor's Best brand of magnesium glycinate. Take at least around the RDA (320 for women). 3 tablets of the Doctor's Best magnesium glycinate is 300 mg. You probably need more to resolve your deficiency, but we can only absorb so much at a time due to insulin limitations, so it's best to space it out during the day, preferably with meals. But as Gabes says, topical magnesium works too, if you want to go that route.
Download this short digital book (it's also available in print, on Amazon). It's free in digital form. Read chapters 2 and 3. It explains how a chronic magnesium deficiency causes insulin resistance and eventually diabetes.
https://www.smashwords.com/books/view/665808
The budesonide might not be a problem if you didn't have a magnesium deficiency. You probably already have insulin resistance, so the magnesium dosing may be critical, to overcome the insulin resistance without overworking your kidneys. That's why I didn't recommend that you start out by taking 600 or 700 mg of magnesium per day.
Tex
Back when I was magnesium deficient one of my most puzzling symptoms was anxiety. I couldn't figure out why I was waking up in the wee hours of the morning with near panic attacks. I finally figured out it that it was because that was when I was running out of magnesium. You can read the details at:
Even ER Docs Don't Recognize The Importance Of Magnesium
Anxiety is a classic symptom of magnesium deficiency. I just assumed that you were taking it. I use Doctor's Best brand of magnesium glycinate. Take at least around the RDA (320 for women). 3 tablets of the Doctor's Best magnesium glycinate is 300 mg. You probably need more to resolve your deficiency, but we can only absorb so much at a time due to insulin limitations, so it's best to space it out during the day, preferably with meals. But as Gabes says, topical magnesium works too, if you want to go that route.
Download this short digital book (it's also available in print, on Amazon). It's free in digital form. Read chapters 2 and 3. It explains how a chronic magnesium deficiency causes insulin resistance and eventually diabetes.
https://www.smashwords.com/books/view/665808
The budesonide might not be a problem if you didn't have a magnesium deficiency. You probably already have insulin resistance, so the magnesium dosing may be critical, to overcome the insulin resistance without overworking your kidneys. That's why I didn't recommend that you start out by taking 600 or 700 mg of magnesium per day.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Gabes and Tex:
This signature line: "It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis." probably applies to me very appropriately. I am strong-willed and stubborn, and only hear the things I choose to hear. I have been fighting "diet modifications" for years (as you well know) because the docs tell me it doesn't matter and that's the answer I WANTED to hear. I also tried to ignore all the articles about magnesium deficiency because I thought it was just yet one more complication to the equation that would confuse me and be difficult to monitor (pros, cons, benefits, disadvantages, side effects, etc.)
I am at the point where I've had ENOUGH of fighting all these issues (and even though my anxiety was practically non-existent for several years, it's back with a vengeance and I've HAD IT!). I am finally ready to do whatever I have to do to find relief and improvements. As you've probably read, I've ordered the Enterolab test (which I fought for years) and I'm intrigued and cautiously optimistic that magesium deficiency might be part of my problem.
I should probably know what my current magnesium level is before I start dosing, right? I have bugged my doctor for so many blood tests lately and I was just looking through pages and pages of results from the past few months but I don't see "Magnesium" as one of them. Is that normally part of a series or do I specifically have to ask for a magnesium test? She's going to think I'm nuts asking for yet another test but it's worth a try.
So what do you two think: oral or topical? I am your blank canvas so fix me, will ya?
Sue
This signature line: "It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis." probably applies to me very appropriately. I am strong-willed and stubborn, and only hear the things I choose to hear. I have been fighting "diet modifications" for years (as you well know) because the docs tell me it doesn't matter and that's the answer I WANTED to hear. I also tried to ignore all the articles about magnesium deficiency because I thought it was just yet one more complication to the equation that would confuse me and be difficult to monitor (pros, cons, benefits, disadvantages, side effects, etc.)
I am at the point where I've had ENOUGH of fighting all these issues (and even though my anxiety was practically non-existent for several years, it's back with a vengeance and I've HAD IT!). I am finally ready to do whatever I have to do to find relief and improvements. As you've probably read, I've ordered the Enterolab test (which I fought for years) and I'm intrigued and cautiously optimistic that magesium deficiency might be part of my problem.
I should probably know what my current magnesium level is before I start dosing, right? I have bugged my doctor for so many blood tests lately and I was just looking through pages and pages of results from the past few months but I don't see "Magnesium" as one of them. Is that normally part of a series or do I specifically have to ask for a magnesium test? She's going to think I'm nuts asking for yet another test but it's worth a try.
So what do you two think: oral or topical? I am your blank canvas so fix me, will ya?
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
If you are having WD 10-20 times per day topical magnesium would probably be best as well as Epsom salt foot baths. (I use a bucket)
If you are out of the WD phase and moving into pencil stool I'd transition to mag glycinate.
My experience was I could not stop WD until I eliminated oral and switched to topical for awhile.
If you are out of the WD phase and moving into pencil stool I'd transition to mag glycinate.
My experience was I could not stop WD until I eliminated oral and switched to topical for awhile.