I also have autoimmune disease (no firm diagnosis, but mixed connective tissue disease is one of the prime suspects. All we know for sure is that my lungs, sinuses, joints, nose cartilage, and skin are being affected).
I've been on periodic courses of prednisone and other steroids (and am using topical steroids for the skin issues) and have a love-hate relationship with the oral and injectible steroids.
For me, fatigue isn't usually a problem on the steroids (unless the lung issues are very severe. It's hard to feel energetic if your lungs aren't working properly). In fact, often when I'm on prednisone or similar steroids, my hubby says I have "energizer bunny syndrome." Hunger however is a HUGE problem (but I have found a few helpful strategies)
My understanding is that prednisone weight is multti-faceted. Prednisone apparently can lower metabolism and increase hunger (so weight gain can be true fat gain). There's some evidence that the reduced metabolism can linger, at least for a while after the prednisone is discontinued. Some of the weight gain is water weight, and that would disappear shortly after the prednisone is discontinued.
Some people find the weight loss comes off fairly easily when the prednisone is discontinued, and some people have more difficulty.
What I've found helpful:
Being very diligent about calorie (or in my case exchange) counting, and food journaling while on the prednisone
Keeping a lot of low-calorie munchies, such as raw veggies on hand.
Cutting back on sodium and being sure to drink water and other non-calorie beverages throughout the day (not going overboard, just making sure to get my 6 to 10 glasses in). This helps keep water retention under control.
Low-carb eating. It seems to me that hunger is much worse if I'm eating higher carb foods. To some degree this is always true for me, but when on prednisone the difference between low-carb hunger and high-carb hunger is far more extreme. If I eat higher-carb foods (even "healthy, whole grain ones) I feel caged-and-starved-animal, ravenously hungry.
During the course of the prednisone, rest is very important, even if I do feel like the "energizer bunny." It's just as important when I'm done with the course of prednisone. The more dedicated I am to resting and good sleep habits, the fewer courses of prednisone I will need during the year.
Exercise is important when you're up to it. Sometimes I'm able to exercise during a course of prednisone, and sometimes I'm not. Because exercise can increase your metabolism, it's one of the ways to counteract the metabolism-slowing effects of prednisone.
In my case, I found that the weight loss during prednisone was virtually impossible (especially on any dosage higher than 20mg daily). If I was dilligent about my calorie level, I found that most of any weight gain disappeared within a couple weeks (probably water-weight gain). In general, I didn't find post-prednisone weight loss to be severely hampered. Slower in the first couple months, but returning to pretty much normal (for me) after that.
That's been my experience, at least.
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