Prednisone is a commonly prescribed corticosteroid medication used to treat a range of inflammatory and autoimmune conditions. While it is widely recognized for its effectiveness, its impact on blood sugar levels can be complex. Hypoglycemia, defined as abnormally low blood sugar, is typically below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) for most people with diabetes. Although prednisone is more often associated with elevated blood sugar, there are specific circumstances where it can lead to unexpectedly low levels, requiring careful attention and management.
Prednisone and Blood Sugar: The Unexpected Connection
Prednisone primarily influences blood sugar by increasing it, known as steroid-induced hyperglycemia or diabetes. This occurs through several mechanisms, including increased glucose production by the liver (gluconeogenesis) and reduced sensitivity of muscle and fat tissues to insulin, a condition called insulin resistance. This leads to higher blood sugar levels as cells do not absorb glucose efficiently.
Despite this typical effect, prednisone can contribute to hypoglycemia. A primary reason is the rapid withdrawal of the medication. When prednisone is taken for more than a few weeks, the body’s natural production of cortisol, a hormone that helps regulate blood sugar, decreases. Abruptly stopping prednisone can leave the body without sufficient steroid hormones, leading to adrenal insufficiency and a rebound drop in blood sugar.
Interactions with other medications, particularly those used to manage diabetes, can also cause hypoglycemia. Prednisone can reduce the effectiveness of insulin and oral diabetes medications. If diabetes medications are not adjusted appropriately as prednisone doses are lowered, or if a person is also taking medications like sulfonylureas or insulin that actively lower blood sugar, the combined effect can lead to dangerously low blood glucose.
Identifying Hypoglycemia
Recognizing the signs and symptoms of hypoglycemia is important for intervention. Symptoms can appear suddenly and vary. Common indicators include shakiness, nervousness, anxiety, sweating, chills, and clamminess.
A fast heartbeat, dizziness, lightheadedness, and hunger can also signal low blood sugar. Some may experience tingling or numbness in the lips, tongue, or cheek. As blood sugar drops further, cognitive symptoms like confusion, difficulty concentrating, irritability, and blurred vision may develop.
Managing and Preventing Hypoglycemia
Managing and preventing hypoglycemia while taking prednisone involves a proactive approach, especially during steroid tapering or when medication effects lessen. One important strategy is to adhere strictly to the prescribed prednisone dosage and schedule, never abruptly stopping the medication without medical guidance. A gradual tapering schedule, often reducing the dose by 5-10% every 1-2 weeks, is recommended to allow the body to adjust and prevent adrenal insufficiency.
Regular blood sugar monitoring is important, particularly before meals and at bedtime, aiming to keep levels above 70 mg/dL. For those with diabetes, working closely with a healthcare provider to adjust insulin or oral hypoglycemic medications during prednisone tapering is advised, as medication needs can change. Consuming regular, balanced meals that include complex carbohydrates, protein, and healthy fats can help stabilize blood sugar levels. Keeping fast-acting carbohydrates, such as glucose tablets, fruit juice, or hard candy, readily available is also helpful for treating sudden drops in blood sugar.
When to Seek Medical Help
Knowing when to seek medical attention for hypoglycemia is important. Seek immediate medical help if severe symptoms like loss of consciousness, seizures, or inability to self-treat occur. If you have diabetes and experience frequent or severe low blood sugar episodes, or do not recognize symptoms when blood sugar is low, consult your healthcare provider.
If you do not have diabetes but experience low blood sugar symptoms like unexplained shaking, confusion, or a fast heartbeat, seek medical evaluation to determine the cause. Persistent or worsening symptoms despite self-management also warrant medical attention. Always ensure that your healthcare providers are aware of all medications you are taking and any symptoms you are experiencing.