Healthy Living
October 30, 2017 By Nancy Cardinez, Andrea Miller
Steroid medication & diabetes – what’s the link?

Many people have or may know someone who has used steroid medications, such as prednisone, for the treatment of conditions, such as asthma, rheumatoid arthritis, cancers, or an organ transplant. But did you know that steroids (if taken as pills, an injection or IV fluids) can increase blood sugar levels – also known as hyperglycemia?

For a person who doesn’t already have diabetes, hyperglycemia can hinder your body’s ability to use insulin properly, which can lead to diabetes. Symptoms of hyperglycemia include increased thirst, frequent urination, fatigue and drowsiness – these signs are common to all types of diabetes. In the case of someone who takes steroid medication, also known as corticosteroids, and does not have diabetes, the diagnosis would be steroid-induced diabetes.

Steroid-induced diabetes occurs more frequently than you might think. People who take high doses of steroid medications (for example, more than 5 mg of prednisone) or use them for long periods, such as the cancer and transplant patients we’ve worked with, are likely to see an increase in their blood sugar levels.

These medications are incredibly effective, and the benefits of using them make them difficult to avoid. As nurses and certified diabetes educators, we believe it’s important to know about potential side effects, such as hyperglycemia. That way, you can be aware and be your own advocate with your health-care team, who can help you identify and treat steroid-induced diabetes early on to decrease the risk of other serious health problems.

How do steroid medications increase blood sugar levels?
Steroids increase the amount of sugar produced by the liver and reduce the effectiveness of the body’s own insulin causing a ‘spike’ in blood sugar levels. Research shows that steroid medications can decrease the body’s ability to respond to blood sugar spikes by as much as 60%.

Who is at risk?
Anyone taking high-dose steroid medications or using them for long periods of time is at risk. For individuals without a previous history of diabetes, additional risk factors for developing steroid-induced diabetes are similar to those for type 2 diabetes: age, ethnicity and family history.

How do you treat steroid-induced diabetes?
The use of insulin injections is widely accepted as the treatment of choice, although some diabetes pills can be useful. While insulin comes with its own challenges, such as daily injections, frequent glucose testing or the possibility of low blood sugar (hypoglycemia), it provides immediate action compared to most diabetes pills that may often take days to be effective. Insulin has the ability to lower blood sugar levels to a target range in a relatively short time.

If you are diagnosed with steroid-induced diabetes and prescribed insulin, it is important to understand that this does not necessarily mean you’ll need to take insulin for the rest of your life. As your steroid medication dose is decreased or stopped, your health-care team will monitor your blood sugar levels closely to determine whether you will continue to need insulin or diabetes pills. Some people’s blood sugar levels return to the normal range after using steroid medications, and they will no longer need insulin or pills to manage their blood sugar levels.

Steroid medications are very effective for treating various illnesses and are at times essential for maintaining health. Being aware of the possible effect on blood sugar levels and recognizing symptoms of hyperglycemia early on can help to effectively manage steroid-induced diabetes.

Nancy Cardinez is a nurse practitioner and certified diabetes educator who works as a clinical research nurse specialist at Mount Sinai Hospital – Lunenfeld Tanenbaum Research Institute, and who specializes in type 1 diabetes clinical management and research. Nancy has previously worked with the diabetes team at University Health Network as a nurse practitioner in the Transitional Diabetes Clinic, which specializes in diabetes care for transplant patients in Toronto and the GTA. Nancy can be reached at ncardinez@lunenfeld.ca.

Andrea Miller is a nurse practitioner and certified diabetes educator, who works closely with patients who have organ transplants. This group of patients is very prone to steroid-induced diabetes.

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