Topical steroid creams, such as hydrocortisone and betamethasone, are widely used in dermatology to manage inflammatory skin conditions like eczema, psoriasis, and dermatitis. They reduce inflammation, redness, and itching. A common question is whether these creams can influence blood sugar levels.
How Topical Steroids Affect Blood Sugar
Topical steroid creams can be absorbed into the bloodstream, a process known as systemic absorption. Once in the circulation, these corticosteroids can influence the body’s glucose regulation.
Corticosteroids stimulate gluconeogenesis, a process where the liver produces new glucose from non-carbohydrate sources. This increased glucose production contributes to higher blood sugar levels.
Beyond increasing glucose production, these absorbed steroids can also reduce insulin sensitivity in peripheral tissues like skeletal muscle and white adipose tissue. Insulin is a hormone that helps cells absorb glucose from the blood; when sensitivity is reduced, cells become less responsive, leading to more glucose remaining in the bloodstream. The combined effect of increased glucose production by the liver and decreased glucose uptake by cells can lead to elevated blood sugar levels, a condition known as hyperglycemia.
While systemic side effects are less common with topical steroids than with oral corticosteroids, they can occur, especially with prolonged use or specific application methods. Research has indicated a potential association between topical corticosteroid use and an increased risk of developing type 2 diabetes mellitus. For instance, one study involving diabetic patients showed statistically significant increases in fasting blood glucose levels and hemoglobin A1c after using topical steroids.
Factors That Increase Blood Sugar Risk
Several factors can increase the likelihood of topical steroids affecting blood sugar levels through enhanced systemic absorption. The potency of the steroid plays a role, with stronger formulations having a higher potential for systemic effects. However, some research suggests that the cumulative dose and duration of use may be more significant than potency alone in relation to diabetes risk.
The area of the body where the cream is applied also influences absorption; large body surface areas or areas with thinner skin, such as the face, genitals, and skin folds, allow for greater absorption. For example, absorption is significantly higher on the scrotum. The duration and frequency of use are important considerations, as prolonged or chronic application increases systemic exposure and the risk of adverse effects. Even short-term use of high-potency steroids, particularly with occlusive techniques, can lead to clinically significant changes.
The integrity of the skin barrier is another factor; damaged, inflamed, or diseased skin, such as in severe atopic dermatitis or psoriasis, can have impaired barrier function, leading to enhanced absorption. Occlusion, which involves covering the treated area with bandages or dressings, can dramatically increase absorption by up to 10 times by increasing skin hydration and temperature.
Individual susceptibility also plays a part, particularly for people with pre-existing conditions like type 1 or type 2 diabetes, or pre-diabetes. These individuals are more vulnerable to blood sugar fluctuations. Children are especially susceptible to systemic adverse effects due to their higher body surface area to weight ratio and thinner skin, which leads to greater absorption.
Monitoring and Managing Blood Sugar While Using Topical Steroids
Individuals using topical steroid creams should be aware of potential signs of elevated blood sugar. Common symptoms include increased thirst, frequent urination, fatigue, and blurred vision. Other indicators might include dry mouth, increased hunger, or slow-healing wounds.
For those with diabetes, it is advisable to monitor blood sugar levels more frequently when using these creams. Keeping a detailed log of blood glucose readings can help identify any trends or unexpected increases. Prompt recognition of these symptoms allows for timely intervention.
Communication with a healthcare provider is paramount. It is important to inform your doctor about any topical steroid use, especially if you have diabetes or notice any changes in your blood sugar control. Your doctor can then assess the risk, adjust your diabetes medication if necessary, or modify the steroid treatment plan.
Proper application techniques can help minimize systemic absorption. Always use the smallest effective amount of cream to the affected area. Avoid applying the cream to large body areas or for prolonged periods unless specifically instructed by a medical professional. It is also beneficial to use the cream only for the prescribed duration, as chronic use increases the risk of systemic side effects. Never self-adjust or discontinue diabetes medication or the prescribed steroid cream without consulting a doctor, as abrupt changes can have negative health consequences.