Steroid Medications And Diabetes Fact Sheet
This fact sheet is available in two formats.
You can download and print out the PDF version.
Or you can read it as a website page below.
Some people with diabetes may need to take steroid medications to help manage other conditions, such as asthma, arthritis, autoimmune;diseases and dermatitis, or as part of chemotherapy.
Steroid medications reduce pain and inflammation, and they can also be used to prevent nausea during medical procedures .
Your body produces steroid hormones to help it fight stress, injury and disease. Steroid medications have a similar effect to the hormones produced by the body. There are many different types of steroid medications, including cortisone, hydrocortisone, prednisolone, prednisone and dexamethasone.
Steroid medications can be taken in various ways, including:
- with an inhaler
- as drops for eyes or ears
- as a cream applied to the skin.
When Do Steroids Start To Affect Blood Sugar
Steroids may start to affect your blood sugar pretty quickly after starting treatment, although it depends on what course of treatment youre on.;
For oral steroids, blood sugars may begin to rise within a few days of treatment. The effects will depend on the dose and type of steroid you are taking.;
Steroid injections start to affect blood sugars soon after the injection and can remain high for 3-10 days afterward.;
If youre taking topical steroid creams or gels or inhaled steroids, they do not typically affect blood sugar levels.;
Which Side Effects Are Worse On Prednisone 20 Mg Tablets
If your doctor prescribed a prednisone 20 mg tablet or higher, then youve been given a high dose. So which prednisone side effects get worse the higher the dose? In this article, I will share the side effects to expect at higher doses of prednisone according to the five most comprehensive pharmacy databases.
My High Dose Prednisone Experience
First, I want to share my personal experience taking high doses of prednisone and other steroids. Because my immune system killed off so many of my blood platelets, doctors worried I could bleed to death. In the hospital they started with prednisone 60 mg, given as three prednisone 20 mg tablets. That only worked for a week to boost my platelets until they started to crash again.
So the hematologist prescribed another steroid, dexamethasone. I took #10 of the highest strength dexamethasone tablets each day for three days. The dose of dexamethasone I took equals approximately 267 mg of prednisone. Eventually, that failed as well, so my doctor started me on a slow taper down from prednisone 60 mg.
Tapering Roller Coaster
They pricked my arm each week to check my platelet level and decide whether I could continue tapering or whether I needed to go back up to a higher dose. I rode that roller coaster of blood draws for six months before they eventually resorted to chemotherapy which cured my problem, at least for now. Then I finished tapering off prednisone after nine months of high-to-low doses of prednisone.
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Effects Of Steroid Hyperglycemia
Despite its frequency, little is known about the impact of hyperglycemia associated with steroid use on clinical comorbidities and mortality. It is known that rheumatic diseases per se represent an important cardiovascular risk factor, which makes them the leading cause of premature mortality in these patients. Therefore, it is thought that the coexistence of inflammatory diseases and steroid-induced hyperglycemia may lead to worse cardiovascular consequences. Similarly the diabetic patient possesses a traditional cardiovascular risk factor for microvascular and macrovascular complications.
Fluctuations in serum glucose levels have been associated with increased cardiovascular mortality associated with increased LDL cholesterol, endothelial dysfunction, activation of the coagulation cascade, increased pro-inflammatory cytokine production, and oxidative stress resulting in macrovascular disease progression. Several studies have reported that transient increases in serum glucose are associated with acute inflammatory processes and endothelial dysfunction in both diabetic and non-diabetic patients.
Where Was The Warning About Prednisone And Diabetes
Q. Three years ago, I developed a lung infection. The pulmonologist prescribed a short course of prednisone without any mention of side effects, which I promptly developed. Since I couldnt get any answers from him or my primary care physician, I stopped taking the drug.
Last year the infection came back. The symptoms had me worried about a heart attack. The emergency room and the pulmonologist put me on an aggressive tapered course of prednisone, but didnt talk about side effects. I experienced dry mouth, frequent urination, blurry vision, dizziness, constipation and mouth sores.
After 15 days of this, I went back to the emergency department. They apologized for not telling me that the prednisone would raise my blood sugar, which was at 605 when they checked.
They administered insulin and showed me how to use it for the rest of the prednisone course. Let others know that prednisone can definitely raise blood sugar!
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How Steroids Affect Your Blood Sugar
Corticosteroids, or steroids for short, are a common medication prescribed for a multitude of ailments, but can often cause blood sugar issues for people living with diabetes.
If youve ever been prescribed a steroid, you may know that they spike blood sugars easily and quickly, and can lead to stubborn hyperglycemia for days on end.;
In this article, I will describe exactly how steroids affect blood sugar and what you can do about it.;
At the end of the article, I will also describe the rare situation where steroid therapy may actually cause type 2 diabetes by triggering a complication called steroid-induced diabetes.
Can Steroids Have A Lasting Effect On Blood Glucose
Three years ago, when I was 65, I was prescribed prednisone during a very bad cold. I have type 2 diabetes, which I controlled then with diet and exercise . After I started taking prednisone, my blood sugar shot up to 300 mg/dl, and it took me three weeks on Actos to bring it back down. My blood sugar has never been the same, and now I am on diabetes meds. Could the prednisone have caused a lasting effect?Continue reading >>
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Changing Your Diabetes Treatment
You may need to change the way you control your diabetes:
- If you use your diet to control your diabetes, you may need to start taking tablets to control your blood sugar.
- If you already take tablets, you may need to increase the dose or start using insulin for a short time.
- If you already use insulin, you may need to increase the dose or use a different type of insulin.
Correction doses of insulin can be used to reduce very high blood sugars. These may not work as well when you are taking steroids. Your diabetes team can give you advice. They may suggest you take more insulin.
How Do Steroids Affect Blood Sugar
If youre prescribed steroids and live with diabetes, you will notice that your blood sugars may increase as a result .;
If youre prescribed a steroid treatment, make sure the doctor knows you have diabetes. Doctors may sometimes be able to prescribe a different drug that does not interfere with blood sugar levels.
Steroids suppress the effectiveness of insulin, causing insulin resistance, and make the liver release stored glucose into the bloodstream.;
The combination of these two actions can make blood sugars much harder to manage while taking steroids, resulting in higher blood sugars levels, and much more insulin is required to manage diabetes as a result.;
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Which Blood Tests & Lab Values Does Prednisone Change
If youve already been following me for a while you may have seen the nutrients which are depleted by prednisone as shown below. It shows that prednisone depletes calcium, chromium, and other vitamins. Were going to focus on a few of those and show how prednisone changed my personal lab values.
The Peoples Pharmacy Perspective:
Dozens of other drugs, including statins and diuretics, can also interfere with blood glucose control. You can learn more about these in our eGuide to Preventing & Treating Diabetes.;
We also discuss nondrug approaches such as cinnamon, vinegar, curcumin and coffee or supplements like selenium, bitter melon, fenugreek or nopal cactus. You will find it in the Health eGuides section.
Physicians should alert patients to the possibility that a medication could raise blood glucose when they prescribe it. There is a clear connection between prednisone and diabetes.
No should ever discontinue prednisone suddenly! If it becomes necessary to stop this corticosteroid, it should only be done under medical supervision. A gradual tapering is essential to prevent other serious complications.
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How Do Cortisone Shots Work
Doctors give cortisone shots during an office visit directly into the area or joint involved, or sometimes just into a large muscle to get it into the bloodstream. In other parts of the body, the injection often includes a local anesthetic to start easing pain immediately. In these cases, cortisone is typically injected into three areas:
Upswing: Steroids And Water Pills
People take corticosteroids, such as prednisone, to treat rashes, arthritis, asthma, and many other conditions. But they can boost your blood sugar, and may even trigger diabetes in some people. Diuretics that help high blood pressure, also called water pills, can do the same. Some antidepressants also raise or lower blood sugar.
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Prednisone And Low Blood Pressure
If you are being weaned off of prednisone and are taking medications to help lower your blood pressure, be sure to discuss the effect the changes in prednisone could have on your blood pressure and monitor for the symptoms of low blood pressure.
Symptoms of low blood pressure can include:
- Dizziness or feeling lightheaded
- Blurred vision
If Your Blood Sugar Is High
You should talk to your cancer doctor, diabetes team or your GP as soon as possible if:
- your blood sugar levels are high on more than 2 or 3 occasions
- you feel unwell or develop any of the symptoms of diabetes, such as being really thirsty, having blurred vision, passing a lot of urine or feeling very tired.
If your blood sugar level stays high while you are taking steroids, your cancer doctor or specialist nurse may change the dose. They may also change the time you take the steroids. They may spread the dose out during the day.
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How Does Taking Prednisone Affect My Diabetes
Prednisone is used for a variety of conditions such as asthma and other lung problems. It acts like a hormone that your body makes called “cortisol.” Cortisol and prednisone both cause the body to make glucose when you’re not eating . They can worsen diabetes control. Cortisol is called a “stress hormone” because the body releases it to deal with stresses like accidents, infections, or burns. That’s part of the reason why it takes more insulin to keep blood glucose near normal during an infection. If you have had prednisone prescribed for any reason and you have diabetes, you will need to take more diabetes medication. Prednisone’s effect on your blood glucose will go away a day or two after you stop taking it. Your health care team can help you alter your diabetes treatment until you can stop taking the prednisone.
How Steroids Affect Blood Sugar
Steroids mimic cortisol, which is a stress hormone. Cortisol raises blood sugar and blood pressure.
Steroids can make the body more insulin-resistant over time. This means that cells dont respond to the hormone insulin the way they should, or the body isnt making enough insulin.
As a result, insulin resistance can occur, as the liver is releasing too much sugar, making the pancreas release more insulin to compensate. Over time, this can cause the pancreas to stop producing insulin, resulting in high blood sugar.
If steroids arent taken for a long time, then blood sugars can return to normal once the steroids are discontinued. However, for people taking steroids long-term, the risk of insulin resistance increases.
For those with diabetes, blood sugars often noticeably increase after steroids are administered. Those without diabetes may be unaware that their blood sugars are elevated since they dont typically check their blood sugar levels.
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Healing Steroids And Diabetes
Common steroids, such as prednisone and cortisone, help to reduce inflammation and swelling and are used to treat a variety of ailments ranging from arthritis, allergic reactions, respiratory issues and sinus infections, lupus, some cancers, to muscle spasms.
These steroids, known as glucocorticoids, are different from testosterone-based anabolic steroids that some people use to build muscle. The name is derived from glucose + cortex + steroid and refers to the fact that they play a role in the regulation of glucose metabolism.
These steroids are found in oral pill or tablet form, a liquid or cream solution, nasal inhaler, injections, or even intravenous therapy , depending on the medical treatment in question.
For PWDs who may be experiencing complications like trigger finger or frozen shoulder, these oral and injected steroid medications are often a common treatment option. But they come with serious side effects to your blood glucose control.
Per Scheiner, injections tend to have the most significant impact on BGs, while topical creams are less likely to have a glucose effect, though you can find some scattered anecdotes of that happening around the online community.
We see it all the time. Often, people dont realize theres cortisone or another type of steroid in . Or, healthcare professionals believe there isnt enough to affect blood sugars, says Dr. David S. Bell, a longtime endocrinologist practicing outside of Birmingham, Alabama.
How To Treat Prednisone
People who are using prednisone to treat certain medical conditions should talk to their doctors about alternative treatments that will not spike blood sugar or increase the risk for type 2 diabetes. In some cases, doctors may prescribe different medications or recommend healthy lifestyle changes that could improve their conditions.
Those who must continue using prednisone should monitor their blood sugar levels regularly and work with their doctors to prevent or control diabetes. People who are already diagnosed with type 2 diabetes should check their blood sugar levels at least;four times per day;and use higher doses of insulin as advised by their doctors. These individuals should also keep glucose tablets, juice or candies with them at all times to treat hypoglycemia in the event that blood sugar levels should drop abruptly.
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Low Potassium From Prednisone
Another lab value changed by prednisone is Potassium. Prednisone causes low potassium, also known as hypokalemia.
Because the sodium is going up, prednisone causes your potassium to go down and potassium is really important all over your whole body, from the heart, to inside cells, to muscle contractions. The normal range of potassium in your blood is 3.5 to 5.
You can see my normal is hovering around 4.0 before I took prednisone. And after I took prednisone, it was up in the fours, but right there in November 2017, while I was in the highest doses of prednisone, thats when the potassium levels were the lowest.
So we need potassium-containing foods while on prednisone. .
How Sodium & Potassium Link Leads to Survival
Sodium and potassium are linked. So whenever sodium goes up, potassium goes down. At least thats whats supposed to happen with our kidneys monitoring each of them, causing the potassium drops.
This makes sense because our bodies normally produce cortisol from the adrenal gland, which is right on top of the kidneys . Prednisone is replacing our bodys normal secretion of cortisol. Cortisol normally directly affects the kidneys, causing high sodium and low potassium.
If You Already Have Diabetes
If you have diabetes and you are prescribed steroids, then you may notice a rise in your blood glucose levels, which will usually mean that your diabetes treatment needs to be adjusted. It is important that you check your blood glucose levels regularly. If you are concerned that your diabetes is getting out of control while you are on steroids, contact your diabetes care team.
Your blood glucose level may rise 2448 hours after your first steroid injection or first dose of tablets, although this may be temporary. Inhaled steroids and steroid skin creams are unlikely to increase your blood glucose levels.
If your steroid treatment is intermittent, e.g. if you only take it with an acute recurrence of your illness, you may need to be on a different diabetes treatment while you are taking steroids.
If you have been on large doses of steroids but these doses are reduced as you get better, then treatment for your diabetes will also need to be reduced or you will be at risk of hypoglycaemia .
You may need to take steroids on a permanent basis. If so you will be reviewed by your GP or may be asked to attend the diabetic clinic at the local hospital.
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How Is Steroid Induced Diabetes Treated
The treatment for diabetes you are put on may depend on the extent of insulin resistance and how high your blood glucose levels are. It may be possible to treat your diabetes with diet and physical activity but you may need oral anti-diabetic medication or insulin.
If you have been diagnosed with diabetes, you will need to attend health screenings at least once annually so your health can be monitored and treated appropriately.