Diabetes Complications

Steroids and Diabetes: The Effect on Your Glucose Levels

Many things can affect blood sugar levels in people with diabetes, which is an added challenge when it comes to managing this disease.

Some people with diabetes have other health conditions, which may require them to take medications that raise their blood sugar. A common example is steroids.

This article will take a closer look at the relation between diabetes and steroid medication and the effect it can have on blood glucose levels.

What are steroids?

Corticosteroids, more commonly referred to as steroids, are a class of medications used to treat a variety of different health problems.

These include skin rashes, asthma, COPD (chronic obstructive pulmonary disease), arthritis, and other inflammatory conditions.

Steroids can be applied topically, inhaled (or taken via nasal spray) for conditions such as asthma, taken orally in the form of pills, and administered via injection.

Steroids are often taken after transplant surgery, such as a kidney transplant for chronic kidney disease. However, some healthcare facilities are trying out steroid-free medication options due to the harmful side effects steroids have.

Some examples of steroids include:

  • Prednisone

  • Prednisolone

  • Methylprednisolone

  • Dexamethasone

  • Triamcinolone

  • Cortisone

  • Hydrocortisone

Steroids have many side effects, both short- and long-term, including:

  • Increased blood sugar

  • Elevated blood pressure

  • Fluid retention, such as leg swelling

  • Memory/mood problems

  • Weight gain

  • Cataracts

  • Thinning bones

  • Bruising/slow wound healing

Side effects can be reduced by taking the lowest doses of steroids needed, adapting lifestyle habits while on steroids, and having regular follow-ups with your doctor to assess side effects.

How steroids affect blood sugar

Steroids mimic cortisol, which is a stress hormone. Cortisol raises blood sugar and blood pressure.

Steroids can make the body more insulin-resistant over time. This means that cells don’t respond to the hormone insulin the way they should, or the body isn’t making enough insulin.

As a result, insulin resistance can occur, as the liver is releasing too much sugar, making the pancreas release more insulin to compensate. Over time, this can cause the pancreas to stop producing insulin, resulting in high blood sugar.

If steroids aren’t taken for a long time, then blood sugars can return to normal once the steroids are discontinued. However, for people taking steroids long-term, the risk of insulin resistance increases.

For those with diabetes, blood sugars often noticeably increase after steroids are administered. Those without diabetes may be unaware that their blood sugars are elevated since they don’t typically check their blood sugar levels.

Steroid-induced diabetes

Steroid-induced diabetes mellitus (diabetes) is defined as “an abnormal increase in blood glucose associated with the use of glucocorticoids in a patient with or without a prior history of diabetes mellitus.”

This means that a person develops diabetes for the first time as a result of taking steroids. Diagnosis of steroid-induced diabetes is based on the American Diabetes Association’s criteria:

  • Fasting (8 hours minimum) blood sugar higher than/equal to 126 mg/dL

  • Blood sugar higher than/equal to 200 mg/dL two hours after consuming 75 grams of carbohydrate by oral glucose tolerance test

  • Hemoglobin A1c of 6.5 or greater with symptoms of diabetes

  • A random blood sugar of 200 mg/dL or greater

If steroid-induced diabetes is diagnosed, it’s usually treated like type 2 diabetes. It is monitored to assess if blood sugars come down over time, especially once steroids may be discontinued.

One study found an almost 15% prevalence in the diagnosis of steroid-induced diabetes among participants.

Many of these patients had respiratory disorders such as pneumonia. The mean duration of steroid treatment in this study was 193 days, which shows how quickly steroid-induced diabetes can occur.

Another study reported that over half of patients receiving steroids receiving high-dose steroids develop high blood sugar, and 86% of these people have at least one incidence of high blood sugar.

Those using steroids for a short period have a lower risk of developing steroid-induced diabetes. However, those taking steroids long-term, or with a previous history of high blood sugar have a high risk.

Risk factors for steroid-induced diabetes

Whether or not someone develops steroid-induced diabetes is dependent on many factors. The risk factors for steroid-induced diabetes are similar to the risk factors for developing type 2 diabetes, such as:

  • Weight – being at a higher weight in proportion to your height.

  • Waist circumference – a waist circumference greater than 40 inches for women and greater than 35 inches for men.

  • Inactivity – spending a lot of time sedentary without regular physical activity.

  • Family history – having a family history of diabetes, especially immediate family such as parents & siblings.

  • Race – black, Hispanic, American Indian, and Asian-American individuals are at higher risk of developing diabetes.

  • Age – risk increases after age 45, though people younger than 45 are increasingly being diagnosed with diabetes.

  • Prediabetes – being diagnosed with “borderline” or prediabetes is a significant risk factor for it developing into type 2 diabetes.

  • Polycystic ovarian syndrome (PCOS) – a hormonal imbalance in women that can increase diabetes risk if insulin resistance is present.

  • Acanthosis nigricans – darkening of the skin, especially on the neck and armpit, is a sign of insulin resistance.

Symptoms of steroid-induced diabetes

Symptoms of steroid-induced diabetes are similar to the signs and symptoms of diabetes, including:

  • Frequent urination – due to the ineffective use of insulin, blood sugar levels rise, and the body attempts to rid the excess blood sugar through urination.

  • Increased thirst – occurs due to frequent urination, which is dehydrating, thus increasing thirst.

  • Increased hunger – the body’s cells are starved of glucose because insulin isn’t helping to get sugar into the cells, which increases appetite.

  • Unintended weight loss – another result of the cell’s starvation from not being able to uptake glucose.

  • Fatigue – glucose is the body’s preferred fuel source, so when the body isn’t able to use this fuel due to insufficient insulin action, it can cause fatigue.

  • Blurred vision – high blood sugar causes the lens of the eyes to swell, which can blur vision.

  • Slow wound healing – high blood sugar levels over time can worsen circulation, which is needed to encourage healing.

  • Frequent infections – high blood sugar can weaken the immune system, making people more susceptible to infections.

Treatment for steroid-induced diabetes

Depending on how far steroid-induced diabetes has progressed, treatment options will vary.

If blood sugars aren’t at a dangerously high level, many healthcare providers will suggest healthy lifestyle changes as the first line of treatment.

If blood sugars still don’t improve to the desired target, then medications may be used.

Lifestyle changes that are recommended for people with diabetes include:

These are all healthy habits that can help promote healthy blood sugar levels.

Medications that are often used to treat steroid-induced diabetes include:

  • Metformin – metformin is commonly used as the first treatment for new diabetes. It is in a drug class called biguanides, and it helps the liver to release less sugar. One of the benefits of metformin is that it doesn’t cause low blood sugar. It can cause gastrointestinal side effects, but starting with a low dose and increasing slowly can help minimize side effects.

  • Sulfonylureas – this class of diabetes medication helps the pancreas release more insulin, so low blood sugar is a possible side effect.

  • GLP-1 receptor agonists – this type of injectable medication helps the body produce more insulin while also reducing the release of sugar from the liver.

  • DPP-4 inhibitors – these oral diabetes medications help the body release more insulin, which helps lower blood sugar.

  • Insulin – when the body isn’t making enough insulin, injecting insulin is one of the most efficient ways to help lower blood sugar. Still, it does come with the largest risk of low blood sugar out of all diabetes medications, so it should be used carefully and under the supervision of a healthcare provider.

Taking steroids with diabetes

Healthcare providers will inform their patients with diabetes that steroids raise blood sugar. If a doctor prescribes someone with diabetes steroids, it’s likely because the benefits outweigh the risks and cons of taking steroids.

For those people with diabetes who need to take steroids for a health condition, some things can help offset the increase in blood sugar:

1) Monitor blood sugar more often – to be aware of how much steroids are impacting your blood sugar, check blood glucose levels more frequently. You should record the results to share with your healthcare provider.

This information is beneficial in determining how much the steroids are impacting your blood sugar. It can also help your healthcare provider decide if there needs to be an adjustment to your diabetes medications, such as increasing insulin dose to compensate for the increased blood sugar.

Good times to check blood sugar include:

  • After waking up (fasting)

  • Before starting a meal

  • Within 2 hours after meals and at bedtime


2) Be mindful of your lifestyle habits– If your blood sugar is running higher than usual because of steroids, take a look at your diet and activity level. Carbohydrates such as bread, pasta, fruit, milk, and food with added sugar raise blood sugar more than foods like vegetables, protein, and fat.

Choosing sugar-free beverages over-sweetened tea, coffee, and soda can also help bring blood sugar levels down.

Reading food labels for sugar content is a helpful way to identify added sugar you might not be aware of. Examples include ketchup, soups, yogurt, granola bars, etc. Familiarizing yourself with the many names for sugar is an excellent place to start!

3) Increase physical activity – Being active helps reduce blood sugar levels naturally. Aerobic exercise, such as walking and swimming, as well as weight lifting and biking are both beneficial for managing blood sugar levels.

While physical activity is vital for everyone’s health, if you aren’t active, increasing your activity level and monitoring your blood sugar to see how it affects, it could be very motivating.

Drug interactions

Certain drugs interact with other medications negatively, which can lead to life-threatening complications.

Keeping an updated list of all of the medicines you take is essential. This will help your doctor, and/or pharmacist can identify any possible drug interactions to avoid issues.

The insert that comes with your new medications will list known drug interactions. Therefore if you see a medication, you take on that interaction list, inform your doctor or pharmacist as soon as possible.

Prednisone, a common steroid, interacts with certain blood thinners and anti-platelet medications. These include warfarin (Coumadin), diuretics, and certain antibiotics. Steroids aren’t known to interact with any particular diabetes medication.

Conclusion

Steroids are a type of medication used to treat a variety of health conditions.

Depending on the dose and duration of steroid therapy, people without a history of diabetes can develop steroid-induced diabetes. This is treated similarly to type 2 diabetes as far as recommendations for lifestyle changes and medication therapy.

Steroids are usually prescribed because their pros outweigh the cons and risks. If you already have diabetes and are prescribed steroids, being extra diligent about lifestyle modifications and following your diabetes care plan can help.

Working closely with your healthcare provider is essential while taking steroids. In some cases, doses of diabetes medications need to be increased while taking steroids.

Sources

  1. Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6(8):1073–1081. doi:10.4239/wjd.v6.i8.1073
  2. Kim SY, Yoo CG, Lee CT, et al. Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease. J Korean Med Sci. 2011;26(2):264–267. doi:10.3346/jkms.2011.26.2.264
  3. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014;30(2):96–102. doi:10.1002/dmrr.2486
  4. Suh S, Park MK. Glucocorticoid-Induced Diabetes Mellitus: An Important but Overlooked Problem. Endocrinol Metab (Seoul). 2017;32(2):180–189. doi:10.3803/EnM.2017.32.2.180
  5. https://www.diabetes.org.uk/professionals/position-statements-reports/specialist-care-for-children-and-adults-and-complications/management-of-hyperglycaemia-and-steroid-glucocorticoid-therapy-october-2014

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