What should I monitor with Prednisone?

As a dangerous medication, prednisone must be monitored. The main side effects to monitor include those that affect weight gain, bones, heart, blood sugar, and eyes. With your doctor, be sure that each of these potential side effects are monitored to minimize long-term and irreversible side effects.

It’s like how “a watched pot never boils.” Isn’t that what grandma says? Didn’t she always say, “if you watch what’s going on, it’s never going to happen?”

Or what about how they say, “If you bring an umbrella, it’s not going to rain.” Isn’t that the truth? If you bring that umbrella–if you’re prepared for the worst thing that could happen, then it won’t happen, right?

What do you monitor steroids with?

Prednisone is considered a steroid and to be able to monitor it you need to be more cautious to the side effects that you are currently experiencing. You will also undergo different lab tests as instructed by your doctor to check if your health is improving while taking prednisone. Read the article below to find out specifically what needs to be monitored while on a long-term corticosteroid.

Prednisone Side Effects

We’re going to discuss the common side effects that we need to be watching for and specific things for each of those common side effects that, working with our doctors, we need to check.  Then we’ll end with where to find more help with more answers.

1. Monitoring Weight Gain

• Weight
• BMI

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The #1 complaint of people on prednisone is weight gain. It’s reported that 70% of people on prednisone experience weight gain. So we need to be watching for that. Obviously, the simplest thing that we need to be checking is weight. The weight can be used along with height to calculate a BMI or body mass index.

It’s important to see what your weight was when you started prednisone, compared to where you end up at high doses. Plus to track if it changes when you get to lower doses. I’ve got a whole series of how to cope with the weight gain.  So if you’re wondering about what those are, check out the “The Weight Gain” video series.

• Prednisone Weight Gain 
• Water Weight Gain – How Prednisone Causes It
• Consequences of Prednisone Weight Gain – Not Just the Belly!
• Which Foods Should I Avoid While on Prednisone?
• How to Eat the Nutrients you Need – Stop the Prednisone Weight Gain!
• Ultimate Diet Review for Prednisone

2. Bone Monitoring

• Height
• Fractures
• Bone Mineral Density: Z scores
• DEXA Scan
• FRAX score
• Lateral spine x-ray
• MRI

Next, and to me the very most important one to be checking is bones. Bones are so important that the doctors who prescribe prednisone the most, the rheumatologists who prescribe it for things like rheumatoid arthritis, they say that they are so concerned that they got together and created a guideline.

This list and image, above, shows the guideline of things they wish that people were doing and checking for people on prednisone, especially the doctors who prescribe it.

Height

When you start prednisone, they want to know: What is your height? How tall are you?

The reason they’re checking that is that your spine can get compression fractures. You can actually lose height if your spine is collapsing on itself and that’s from osteoporosis. So we want to make sure that your spine is in good health, so that’s why height.

Fractures

Now those spine fractures, you can’t actually feel them usually. Occasionally you might have back pain but sometimes it’s totally undetectable sometimes even on an x-ray.

Bone Mineral Density

You can see that the second to last thing there, or that often can’t even cap catch these little tiny, tiny cracks that smashed the spine together. And they often have to do an MRI, especially of another type of bone complication called osteonecrosis. That’s when there’s joint bone death especially of the hips.

When that happens the x-rays often can’t detect it either. And so they’ll have to do an MRI of your hip or whatever other joint but you usually can feel the ostial necrosis where you might not be able to feel the osteoporosis.

It’s important if you’re on prednisone for longer than three months to get a bone mineral density test.

The most common one is called a DEXA scan and using that they can calculate a Z score and that just shows how dense your bones are compared to people who have healthy bones because then they can track.

If you’re on prednisone long-term,  you are losing bone density. If you are losing bone density then they need to prescribe medications for you to stop that bone loss!

We don’t want you breaking a hip or breaking your wrist or any other bone and especially not your spine. So it’s important to check these things for good bone health.

3. Heart Monitoring

• Blood pressure
• Lipids/cholesterol
• Framingham Risk Score

Next is your heart. So in other videos in the “Side Effect Series,“ I’ve talked a lot about heart complications.

Prednisone can affect many aspects of heart health. High blood pressure, or hypertension, is a common side effect of prednisone that can lead to other heart problems. Heart palpitations, arrhythmias, or rhythm changes, can be harmless like a racing heart and trembling hands or can be more dangerous and rare.

4. Blood Sugar

• Symptoms: urination, thirst, weight loss
• Glucose
  • Fasting plasma glucose
  • A1c
  • 2-hour Oral Glucose Tolerance Test

Some of the things that we also need to include to check are blood pressure, lipids, or cholesterol. There are lots of blood tests that your doctor can run. Then using that and some other information like your family history of heart disease, they can calculate what’s called a Framingham risk score. This can help decide whether you need certain things like aspirin or statin drugs for high cholesterol or high blood pressure medication diabetes.

So this goes back to that weight gain. Often the weight gain is from high glucose or hyperglycemia but when hyperglycemia is out of control too long, and the insulin isn’t doing its job in the right way anymore, then it can turn into diabetes. And when it becomes frank diabetes, when glucose is high, there will be really, really strong urination, thirst, and weight loss. It feels like you can’t drink enough water. You’re always thirsty.

And you’re going to the bathroom all night long, just lots of urination and weight loss.  That’s a really big sign because on prednisone, you’re usually gaining weight. If you’re suddenly losing weight and you’re thirsty, and you’re going to the bathroom all the time, you definitely need to get checked by your doctor to make sure that your blood glucose is in a stable range. They can test that in your blood.

Your doctor can order an A1C, which will check the last three months of how your blood glucose is. They can do a test to see how your insulin balance is called a two-hour oral glucose tolerance test. That is what they often do for pregnant women to make sure that they’re not getting gestational diabetes. This is a longer test than just like a little quick blood draw–it takes at least two hours.

5. Eyes

• Annual eye exam
• Cataract symptom: vision loss
• Glaucoma: 
  • Intra-ocular pressure
  • Personal/family history of open angle glaucoma
  • Diabetes
  • Rheumatoid arthritis
  • High myopia

I’ve talked about these complications in the past as well, but if you’re on prednisone, long-term, you need an annual eye exam, period. You just need to be going to the eye doctor every year. If you’re on prednisone, then they’ll know what to look for. When you tell them that you’re taking prednisone, there are classic things that they can be checking and looking for to make sure you’re not having those complications.

The ophthalmologist or optometrist will check your intra-ocular pressure. If you have a personal or a family history of glaucoma, if you have diabetes, if you have rheumatoid arthritis or other connective tissue diseases or high myopia. So these are important to even know that it’s a possibility that prednisone may have complications on your vision.

And so go to the eye doctor, get your eyes checked every year.

How is your Prednisone Monitoring?

How have you been getting your eye exam? Have you been getting your bone scan? Have you begun to get your blood tested for your cholesterol or your sugar? Or how about your blood pressure? How’s it doing? Which thing are you working on? We’d love to know! Let us know in the YouTube video comment section.

Want a Printable Prednisone Checklist?

Phew! What a lot of things to check while on prednisone, right?

I tried to make it as easy for you to take care of yourself and get this monitoring done, so I made a Prednisone Checklist.

If you want a list of what these things are that you need to get checked, plus what you can do aside from just getting checked to cope with those side effects, then get your prednisone checklist by signing up below!