Corticosteroids, such as prednisone or cortisone, are common medical treatments for conditions like inflammation, allergies, and autoimmune disorders. These powerful anti-inflammatory and immunosuppressive agents mimic hormones naturally produced by the adrenal glands. For a person with diabetes, systemic steroids significantly interfere with glucose regulation. A diabetic can take steroids when medically necessary, but it demands strict medical oversight and careful management of blood sugar levels. This temporary conflict requires close collaboration between the patient and their healthcare team to prevent severe hyperglycemia.
Steroids’ Impact on Glucose Control
Corticosteroids cause blood sugar levels to rise through a dual mechanism that interferes with the body’s glucose handling processes. The primary effect is increased insulin resistance, making cells in muscle and fat tissue less responsive to insulin. This reduced sensitivity prevents glucose from being absorbed from the bloodstream, causing it to accumulate.
The second mechanism involves the liver, which the steroid triggers to increase its glucose output. This process, known as hepatic gluconeogenesis, results in the liver releasing more sugar into the circulation, even when the pancreas is producing insulin. These two effects create a state of hyperglycemia.
The timing of this glucose elevation depends on the specific steroid. For common oral steroids taken once daily in the morning, the peak blood glucose increase typically occurs several hours after the dose, often between mid-afternoon and early evening. This pattern differs from the usual fasting hyperglycemia, requiring monitoring to account for this delayed effect.
Adjusting Diabetes Management During Steroid Use
Managing diabetes during steroid use requires immediate and significant adjustments to the existing treatment plan. Blood glucose monitoring becomes much more frequent, often suggesting testing four to six times daily to capture the steroid’s peak effect and guide medication dosing. Frequent testing is necessary to accurately track the drug’s impact and prevent dangerous blood sugar spikes.
For individuals managing Type 2 diabetes with oral medications, temporary insulin may be necessary, as steroid-induced insulin resistance can overwhelm oral agents. A short-acting sulfonylurea, like gliclazide, taken once daily may also manage the glucose excursion associated with a morning steroid dose. All medication adjustments, including temporary insulin use, must be prescribed and monitored by a physician or diabetes specialist team.
Diabetics already on insulin therapy will require significantly higher doses to counteract the steroid’s effect. Increases of 10% to 20% in basal (long-acting) insulin are often necessary; some patients, especially those with Type 1 diabetes, may require increases of 40% or more. Bolus (mealtime) insulin doses will also need to be increased to cover higher glucose levels following food intake.
Timing the steroid dose is a helpful strategy to manage the glucose peak during waking hours. Taking the entire daily dose early in the morning allows the highest glucose level to occur in the afternoon, when the patient is awake and can monitor and correct the rise with extra insulin. Patients must also be rigorous with dietary choices, focusing on stricter carbohydrate control and selecting lower-glycemic index foods to minimize the post-meal glucose burden.
Post-Treatment Glucose Management
The management phase does not end immediately when the last steroid pill is taken, as the body requires time to clear the medication and for glucose levels to normalize. Corticosteroid effects can linger for a few days, meaning blood sugar levels will not immediately revert to pre-treatment ranges. Patients must continue intensified monitoring and their diabetes regimen for several days after discontinuing the steroid.
The primary concern in the post-treatment phase is the risk of hypoglycemia, or dangerously low blood sugar. As the steroid wears off, the high doses of insulin or other diabetes medications used to counteract the drug’s effect may suddenly become excessive. Without the opposing force of the steroid, these increased doses can drive blood sugar too low.
To mitigate this risk, diabetes medications must be gradually reduced, or tapered, back toward baseline levels. This de-escalation should ideally mirror the tapering schedule of the steroid itself, if one was prescribed. For those started on insulin specifically for the steroid course, the dose may be reduced by 50% immediately upon stopping the steroid, with further reduction guided by blood glucose readings.