Q: My 63 years old father is suffering from interstitial lung disease (ILD). Presently, the doctor has prescribed steroids and after taking them, his blood sugar increased and he suffered from joint pains. How can interstitial lung disease be managed? What should be the ideal diet for interstitial lung disease?

A:Interstitial lung diseases (ILD) comprises various types and sub-types. It can be caused by various agents including medications and sometimes the cause of this can be unclear and can rarely lead to pre mature deaths (like in Idiopathic Pulmonary Fibrosis). Without knowing the exact nature of ILD, I will not be in a position to tell if steroids are indicated or not in your father’s case. Not all forms of ILD disorders benefit from steroid therapy. His primary physician will be in a better position to tell you what type of ILD he has and whether he would benefit from steroids.

With regard to the side effects of the medication, I do agree with you that steroids are probably worsening the sugar control. Steroids can cause innumerable side effects, especially if taken in large doses for long periods of time. One way to minimise the problem would be to be vigilant with one's food intake. The mechanism by which steroids increase sugars is that they increase appetite and people eat more, often unhealthy foods. I It is very important to watch one's calorie intake. Eat plenty of vegetables (like cucumbers, carrots, etc.) in between meals (total number of meals including snacks should be 6-8 times a day) and with this, the portion of the main meal would tend to be smaller. This is a sure way for better sugar control and to beat weight gain in patients who take steroids on a long term basis.

It is also important to take bone protective agents like calcium carbonate, Vitamin D, and in some patient’s bisphonates to make sure that the damage to the bones, that can be caused by the use of long term steroids is minimised.