Steroids, while highly effective in reducing inflammation and suppressing immune responses, can significantly elevate blood sugar levels. In some cases, prolonged use of steroids may lead to the onset of diabetes, a condition known as steroid-induced diabetes.
For individuals with pre-existing diabetes, even temporary steroid use can necessitate substantial changes to blood sugar management strategies.
How Steroids Affect Blood Sugar
Corticosteroids—distinct from anabolic steroids used in bodybuilding—alter blood sugar levels through several mechanisms. Dr. Thomas Grace, a physician at the Blanchard Valley Diabetes Center, explains that corticosteroids:
- Mimic cortisol, a hormone that raises blood sugar levels.
- Stimulate the liver to release stored glucose into the bloodstream.
- Trigger gluconeogenesis, the production of new glucose by the liver.
- Inhibit muscles from absorbing sugar.
- Increase insulin resistance, necessitating higher insulin levels to maintain glucose control.
For some, the pancreas compensates by producing more insulin. However, individuals with prediabetes, diabetes, or insulin sensitivity issues may experience hyperglycemia. Additional side effects of steroids, such as weight gain and sleep disturbances, can exacerbate blood sugar spikes, and in rare cases, lead to diabetic ketoacidosis (DKA).
Steroid-Induced Diabetes
Steroid-induced diabetes is a potential outcome of long-term steroid use, particularly in managing chronic conditions like rheumatoid arthritis or lupus. Symptoms mimic those of type 2 diabetes, including excessive thirst, frequent urination, blurry vision, and recurrent infections.
Management typically involves lifestyle adjustments, including dietary changes and exercise, along with medications such as metformin or insulin. While some cases resolve after discontinuing steroids, others may persist, particularly if the individual was already at risk of developing diabetes.
Adjusting Diabetes Management
Steroid use is common in treating various conditions, including allergies, joint pain, and autoimmune disorders. However, these medications can complicate diabetes management, especially when administered orally or via injection, as they directly enter the bloodstream.
According to Dr. Grace, adjustments to glucose-lowering medications may be necessary, including increasing insulin doses. Continuous glucose monitoring (CGM) is strongly recommended to track real-time blood sugar levels and guide medication adjustments.
Steroids may also affect sleep, appetite, and physical activity, further influencing blood sugar levels. Patients are advised to work closely with their healthcare team to navigate these changes.
Duration of Steroid Effects
The impact of steroids on blood sugar varies depending on the type, dosage, and individual response:
- Hydrocortisone (oral): 6 hours.
- Prednisone: 12 hours.
- Dexamethasone: Up to 36 hours.
- Injected steroids: 3–10 days.
As steroid treatment tapers off, close monitoring is critical to avoid hypoglycemia, especially if medication dosages were increased during treatment.
Questions for Your Doctor
- How should I adjust my diabetes management while using steroids?
- Am I eligible for a CGM, or should I monitor with test strips?
- Are there alternative treatments with less impact on blood sugar?
- What symptoms should prompt concern about high blood sugar?
Key Takeaways
Steroids can significantly elevate blood glucose levels and, in some cases, cause steroid-induced diabetes.
Steroid-induced diabetes is managed similarly to type 2 diabetes, with lifestyle changes and medication.
Close collaboration with healthcare professionals is essential for monitoring and adjusting diabetes management during and after steroid treatment.
By understanding the risks and working closely with your healthcare team, you can navigate the challenges posed by steroid treatment and maintain better blood sugar control.
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