Would either Mestinon® (pyridostigmine) or steroids upset control of Type 2 diabetes?
No for Mestinon®, but, alas, yes for steroids. So patients may well need to be even more careful with their diet and take higher doses of their ‘anti-diabetic’ tablets than they otherwise would; some even need insulin injections to control their blood sugar. So that might be a good reason for using one of the ‘second-line’ immuno-suppressants like azathioprine, to help cut the steroid doses right down. • Are there alternatives to steroids? Yes, there are several other immuno-suppressants like azathioprine, methotrexate, cyclosporin A and mycophenolate mofetil. Azathioprine takes many months to kick-in, but it quite clearly helps patients to ‘cruise’ on lower doses of steroids, with fewer side-effects. The others are less well tried-and-tested in MG, and are more powerfully immunosuppressive. So they act sooner, but probably carry greater risks of infections. They all have their own side-effects, and can affect fertility, and developing babies if taken by pregnant mums, whereas steroids
