Steroid-induced diabetes is a condition where blood sugar levels become too high due to the use of corticosteroid medications. These medications, often called steroids, are artificial versions of hormones naturally produced by the body, used to reduce inflammation and suppress the immune system.
How Steroids Elevate Blood Sugar
Corticosteroids, such as prednisone and dexamethasone, influence the body’s glucose metabolism through several pathways. These medications can make the liver produce more glucose from non-carbohydrate sources, a process known as gluconeogenesis. This means the liver continues to release sugar into the bloodstream even when insulin is present.
Steroids also reduce the sensitivity of muscle and fat cells to insulin, leading to insulin resistance. This prevents glucose from moving efficiently out of the bloodstream and into cells for energy. Additionally, corticosteroids can directly impair the pancreas’s beta cells, which are responsible for producing insulin, further contributing to elevated blood sugar levels. The extent of blood sugar elevation is often related to the steroid dose and the duration of treatment, with longer-acting steroids causing more pronounced effects than shorter-acting ones.
Recognizing Risk and Symptoms
Several factors can increase an individual’s likelihood of developing steroid-induced diabetes. Higher doses of corticosteroids are associated with increased risk. The duration of steroid treatment also plays a role, with longer courses increasing the probability. Individuals with pre-existing conditions like a family history of diabetes, obesity, or a history of gestational diabetes are at a higher risk. Older age also contributes to increased susceptibility.
Symptoms of steroid-induced diabetes are similar to other forms of diabetes and can include increased thirst, frequent urination, tiredness, and blurred vision. Unintentional weight loss and dry or itchy skin may also occur. Sometimes, symptoms may not be noticeable until blood sugar levels become significantly high. Diagnosis involves blood glucose tests, such as a fasting blood glucose test, an oral glucose tolerance test (OGTT), or an HbA1c test. For instance, a fasting blood glucose level of 126 mg/dL (7.0 mmol/L) or higher on two separate occasions, or an HbA1c of 6.5% or higher, can indicate diabetes.
Managing and Treating the Condition
Managing steroid-induced diabetes focuses on controlling blood sugar levels and preventing complications. Lifestyle adjustments are a primary step, including dietary changes and regular physical activity. Eating regular meals, choosing whole-grain carbohydrates, and avoiding sugary foods can help stabilize blood sugar.
Medical supervision is necessary for potential adjustments to steroid dosage, as reducing the steroid dose can often improve blood sugar control. If lifestyle changes are insufficient, diabetes medications may be prescribed. Oral medications like metformin, which improves insulin resistance, or sulfonylureas, which stimulate insulin release, might be used. Insulin therapy is often used, particularly for significant blood sugar elevations, and can be adjusted based on the type and duration of the steroid being used. Close monitoring of blood glucose levels is advised to guide treatment decisions and prevent dangerously high or low blood sugar.
Outlook and Resolution
The prognosis for steroid-induced diabetes is favorable, with the condition resolving once the steroid medication is tapered or discontinued. Blood sugar levels may return to a healthy range after stopping steroid treatment. However, several factors can influence recovery.
The duration and dose of steroid use play a role, with longer courses and higher doses leading to more persistent hyperglycemia. Individuals who had underlying risk factors for type 2 diabetes before starting steroid therapy are also more likely to experience continued elevated blood sugar after stopping steroids. Ongoing monitoring of blood glucose levels is recommended to detect any lingering issues. Some individuals may develop long-term type 2 diabetes, requiring lifelong management.