Recently a middle aged gentleman , Mr Omprakash ji visited my clinic with some questions . He had to be hospitalized few days back due to breathing difficulty . He told me that he was not a diabetic , but at the hospital his blood sugar levels were quite high ( around 400mg/dl ). The doctors then started him on insulin injections 3-4 times a day. He was very surprised and scared , but after few days post his discharge from hospital his sugars have now normalized. I asked him straightway that whether he was on steroids , for which he nodded in a yes. Then , he asked me a long list of questions related to the use of steroids and the most important one that can steroid therapy lead to diabetes in a previously healthy (non-diabetic ) patient, which I am presenting to you in detail below. But, before that lets go through his case study.
Case Summary: Managing COPD Exacerbation and Steroid-Induced Hyperglycemia
Mr. Omprakash, a 55-year-old male with a history of Chronic Obstructive Pulmonary Disease (COPD), presented to the hospital with an acute exacerbation and type 2 respiratory failure. His symptoms included severe shortness of breath, cough, and increased sputum production. The medical team there initiated a comprehensive treatment plan, including immediate oxygen therapy, bronchodilators, and steroid therapy (both inhaled and intravenous) to address airway inflammation.
During the course of treatment, Mr. Omprakash was surprised to see that his blood sugar levels were sky rocketing . Regular monitoring of blood glucose levels was initiated to detect any changes promptly. He was advised multiple insulin injections to control his blood sugars. He expressed concerns about the potential impact of steroids on his blood sugar levels. The healthcare team acknowledged the known side effect of steroid-induced hyperglycemia and reassured him that this elevation in blood sugar is often temporary, dependent on the duration and dosage of steroid therapy.
As Mr. Omprakash responded positively to the treatment and his respiratory status improved, the steroid dosage was gradually tapered. Subsequent blood glucose monitoring showed a gradual return to baseline levels. So, now he was at my clinic wanting to learn more about what had happened to him. I will go through his questions later , but first read this article on Steroid induced Diabetes. This will answer most of your queries related to can steroids cause diabetes.
Steroid-induced diabetes, also known as steroid-induced hyperglycemia or steroid-induced diabetes mellitus, refers to elevated blood sugar levels caused by the use of certain steroids, particularly glucocorticoids like prednisone. The impact of steroid-induced diabetes can vary among individuals, and in some cases, blood sugar levels may return to a healthy range after discontinuing steroid treatment, while for others, the condition may persist.
Steroid-induced diabetes mellitus is characterized by elevated blood glucose levels due to glucocorticoid use, with or without a history of diabetes.
Mechanisms of Steroid-Induced Diabetes:
1. Insulin Resistance:
Glucocorticoids induce insulin resistance by reducing the sensitivity of cells to insulin, the hormone responsible for glucose uptake. This leads to an impaired ability of cells to utilize glucose efficiently.
2. Increased Gluconeogenesis:
Glucocorticoids stimulate the liver to produce more glucose through a process called gluconeogenesis. This results in elevated levels of glucose in the bloodstream.
3. Reduced Insulin Secretion:
Steroids may also affect the pancreatic beta cells responsible for insulin secretion. This can lead to decreased insulin production, further contributing to hyperglycemia.
Symptoms of steroid-induced diabetes
Symptoms of steroid-induced diabetes may include:
Increased thirst
Frequent urination
Fatigue
Blurred vision
Weight loss despite increased appetite
Slow-healing wounds
Recurrent infections
Tingling or numbness in hands or feet
Monitoring blood sugar levels regularly is crucial for individuals on steroids to detect and manage steroid-induced diabetes early to prevent complications.
Reversibility of Steroid-Induced Diabetes:
1. Individual Variability:
The resolution of steroid-induced diabetes can vary among individuals. Some people may experience a return to normal blood sugar levels shortly after discontinuing steroid treatment, while others may face prolonged effects.
2. Risk Factors:
Risk factors for steroid-induced diabetes include:
Old age
High BMI (>25 kg/m²)
Abdominal obesity
Hypertriglyceridemia
Impaired glucose tolerance
Family history of type 2 diabetes
Long duration of steroid therapy
High cumulative dose of steroids
Inhaled corticosteroids used at high doses (e.g., fluticasone at ≥1,000 µg per day)
3. Duration and Dosage of Steroid Use:
The likelihood of reversible steroid-induced diabetes is often influenced by the duration and dosage of steroid treatment. Short-term and lower-dose regimens may have a lower risk of persistent effects.
4. Reversibility After Discontinuation:
For many individuals, blood sugar levels return to normal after discontinuing steroid treatment. This is particularly true for short-term or low-dose courses.
5. Delayed Resolution in Some Cases:
In some cases, especially with longer or higher-dose steroid regimens, it may take time for blood sugar levels to normalize after discontinuation. The body needs time to readjust its glucose metabolism.
Management and Prevention:
1. Importance of Monitoring:
Regular monitoring of blood glucose levels is crucial during and after steroid treatment. This helps in detecting any persisting abnormalities and guides appropriate management.
2. Lifestyle Modification:
Adopting a healthy lifestyle with a balanced diet, regular exercise, and weight management can play a significant role in managing and potentially reversing steroid-induced diabetes.
3. Medical Intervention:
Insulin Therapy: Insulin is the preferred treatment for individuals with steroid-induced hyperglycemia, especially when blood glucose levels remain high persistently.
Oral Medications: Sulfonylureas are the first-choice oral treatments for steroid-induced hyperglycemia due to their immediate impact on lowering blood glucose levels.
4. Long-Term Risks:
Persistent hyperglycemia, if not properly managed, can contribute to the development of long-term complications associated with diabetes, such as cardiovascular disease, kidney problems, and nerve damage.
Abruptly stopping steroid treatment can lead to adverse effects, such as risk of Adrenal Insufficiency therefore, gradual tapering is a standard practice in managing and preventing potential complications.
Abrupt cessation of steroid treatment can suppress the adrenal glands' natural production of cortisol. This can lead to adrenal insufficiency, characterized by symptoms such as fatigue, weakness, and low blood pressure.- Dr Anirban Biswas MDIt's essential for individuals who have undergone steroid treatment and are concerned about their blood sugar levels to communicate openly with healthcare professionals. Healthcare providers can assess individual risk factors, monitor blood glucose levels, and tailor appropriate interventions to manage steroid-induced diabetes effectively.
Steroid induced Diabetes vs Type 1 DM vs T2DM
The relationship between steroid use and diabetes is a complex and multifaceted topic that requires a nuanced understanding of the mechanisms involved.
Differences | Steroid-Induced Diabetes | Type 1 Diabetes | Type 2 Diabetes |
Cause | Caused by taking steroids, leading to insulin resistance and elevated blood sugar levels. | Pancreas fails to produce insulin. | Body does not respond appropriately to insulin or does not produce enough insulin. |
Duration | Typically resolves after stopping steroid treatment, but may progress to type 2 diabetes in some cases. | Lifelong condition : as the pancreas does not produce insulin. | Lifelong condition : due to insulin resistance or inadequate insulin production. |
Management | Requires monitoring blood sugar levels during steroid use and may necessitate oral medication or insulin. | Involves lifelong management with insulin therapy and lifestyle adjustments. | Involves continuous management with medication, lifestyle changes, and sometimes insulin therapy . |
TABLE 1. Steroid induced Diabetes vs T1DM vs T2DM
Types of Steroids
Steroids can be broadly classified into two main types: corticosteroids and anabolic steroids. Each type serves different purposes and has distinct mechanisms of action. Here's a table outlining the types of steroids, examples, and some brand names:
Type of Steroid | Examples | Indian Brand Names |
Corticosteroids | - Prednisone | - Wysolone |
- Prednisolone | - Omnacortil | |
- Dexamethasone | - Dexona, Decdan | |
- Hydrocortisone | - Hydrocortil, Hisone | |
- Methylprednisolone | -Medrol | |
- Triamcinolone | - Kenacort, Tricort | |
Anabolic Steroids | - Testosterone | - Testoviron, Andriol |
- Nandrolone | - Deca-Durabolin | |
- Oxandrolone | - Oxanabol, Oxandrin | |
- Methandrostenolone (Dianabol) | - Dianabol | |
- Stanozolol (Winstrol) | - Rexobol, Stanabol | |
- Boldenone | - Equipoise |
TABLE 2. Types of Steroids. Corticosteroids vs Anabolic Steroids
Notes:
Corticosteroids: These medications are commonly used in India for their anti-inflammatory and immunosuppressive properties to treat conditions such as asthma, allergies, and autoimmune disorders.
Anabolic Steroids: While some anabolic steroids are used for legitimate medical purposes in India, they are also known to be misused for non-medical purposes, and their availability is regulated.
Frequently Asked Questions:
Can steroids directly cause diabetes?
Steroids can indirectly contribute to diabetes by inducing insulin resistance and affecting glucose metabolism.
2. Do all steroids have the same impact on blood sugar levels?
No, different steroids have varying effects. Synthetic glucocorticoids are more likely to cause hyperglycemia.
3. Is there a link between steroid injections and diabetes?
Localized steroid injections may have fewer systemic effects on glucose metabolism compared to oral or intravenous administration.
4. Can steroid-induced diabetes be reversed?
In some cases, discontinuation of steroid use and lifestyle changes may help manage steroid-induced diabetes.
5. Is the risk of diabetes higher with short-term or long-term steroid use?
Prolonged or high-dose steroid use is associated with a higher risk, but even short-term use may affect glucose metabolism.
6. How can steroid users monitor their blood glucose levels?
Regular blood glucose monitoring and consultation with healthcare professionals are essential for users at risk.
7 . Do anabolic steroids have the same impact as corticosteroids on diabetes risk?
Anabolic steroids may indirectly affect glucose metabolism through changes in body composition and insulin sensitivity.
8 . Can steroids worsen diabetes in individuals already diagnosed?
Steroids can exacerbate diabetes in individuals with pre-existing conditions, necessitating careful management.
9 . Are there alternatives to steroids that do not impact blood sugar levels?
Alternative medications or therapies may be considered under the guidance of healthcare professionals, depending on the medical condition being treated.
10. How long does steroid-induced diabetes last?
Some studies suggest that the effects may persist even after discontinuation, emphasizing the importance of long-term monitoring and management.
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