What is the incidence of patients having both MS and Type 1 DM?

Here is My Question:
What is the incidence of patients having both MS and Type 1 DM?

If MS flares develop in a person in this circumstance- how do you go about treatment- as IV steroid use is very difficult to manage. I have had multiple consults with MS Specialists over the years and there does not seem to be an understanding of how to manage with steroids. I have been told if you have an insulin pump/cgm- we would just administer the IV steroid in the office. An insulin pump cannot handle controlling glucose levels on IV steroids.

The lack of understanding on treatment of T1DM with MS is frightening. 

Answer:
There is not an increased world-wide co-occurrence of Type I diabetes and MS despite similarities in environmental and genetic risk factors and immune pathogenesis. Perhaps one reason is that common genetic susceptibility risk factors differ between the two disorders.

It is true that management of MS relapses can be difficult in people with both type I and type II diabetes because of the effect of steroids on glycemic control. The best approach is to use high active DMTs to dramatically lower the risk of relapses, make sure worsening function is not caused by an infection and, if so, treat appropriately, use only short courses (3 days) of high dose corticosteroids (500 to 1000 mg per day equivalent methylprednisolone dose), avoid tapering prednisone courses following the high dose treatment, and frequent blood sugar checks with sliding scale insulin coverage. In practice we usually admit people for 3 days during their steroid treatment to monitor and control blood sugars.

Hope this helps.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
#multiplesclerosis #diabetes #diabetesandmultiplesclerosis