Dr. Ahmad Shahzad
Founder | Lyallpur Diabetes Foundation
Consultant Diabetologist | Educator | Advocate for Preventive Care
Hyperglycemia induced by steroids is a prevalent but sometimes ignored side effect of corticosteroid treatment. When steroids like prednisone or dexamethasone are used to treat If they have inflammation or autoimmune illnesses, they might upset the body’s glucose balance, resulting in high blood sugar levels. Because this illness can manifest in people with and without diabetes, it’s crucial to raise awareness and keep an eye on it. Knowing the causes, signs, and management of steroid-induced hyperglycemia is essential for avoiding problems and preserving general health during steroid treatment.
What Is Steroid Induced Hyperglycemia?
The transient increase in blood glucose levels caused by the use of glucocorticoid drugs is known as steroid-induced hyperglycemia. Regardless of a person’s prior history of diabetes, this can happen. It may occasionally induce steroid-induced diabetes, a form of diabetes that develops for the first time.
How steroids cause high blood sugar
Steroids affect the body’s glucose metabolism by several mechanisms, which increase blood sugar:
- Steroids cause insulin resistance: It lessens the sensitivity of fat and muscle cells to insulin and thus reduces glucose absorption from the blood.
- Increasing blood sugar: Steroids stimulate the liver to generate more glucose from its stored glucose (a process called gluconeogenesis), hence raising the amount of sugar in the blood.
- Large doses of steroids: It may impede the pancreas from producing and releasing enough insulin to regulate the increased blood glucose levels.
Factors that influence the risk
The likelihood and severity of steroid-induced hyperglycemia depend on several factors, including:
- Steroid dosage: Higher dosages of steroids increase the chance of hyperglycemia.
- Treatment time: Longer-term steroid usage raises the possibility of blood sugar control issues.
- Those at a higher risk of getting steroid-induced hyperglycemia include older individuals, those with a greater body mass index (BMI), those who have Have previously had gestational diabetes or have diabetes running in their family.
Signs and Symptoms to Watch For
Though they may not be apparent in minor cases, typical symptoms and indicators of steroid-induced hyperglycemia are comparable to those of other kinds of diabetes. One important distinction to look for is that these symptoms are usually most severe in the evening and late, when the steroid’s impact on blood sugar peaks.
Key signs and symptoms
These symptoms can begin during steroid treatment and are important to monitor:
- Polydipsia—increased thirst: High blood sugar draws fluids from your tissues, leaving you extremely thirsty.
- Frequent urination (polyuria): As your kidneys work to clear away excess sugar, you will need to urinate more often, especially at night.
- Fatigue or weariness: If you lack sufficient insulin to assist your cells in absorbing glucose for energy, you could feel extraordinarily feeble or weary.
- High blood glucose can cause the lens of your eye to swell, therefore impairing your eyesight.
- Unexplained weight loss: You could lose weight even if you have a greater appetite, as your body cannot properly utilize sugar for fuel.
- Headaches: High blood sugar can trigger headaches in some people.
- Common consequence of excessive thirst and urination is dry mouth.
Diagnosing Steroid Induced Hyperglycemia
Standard diabetes criteria are used to diagnose steroid-induced hyperglycaemia (SIH), but the patient’s steroid use is taken into account. Frequent blood glucose monitoring underpins the diagnosis because a patient’s glycemic profile on steroids might vary greatly from that of normal diabetes.
Key diagnostic considerations
- A distinguishing characteristic of SIH is that it mostly causes high blood sugar following meals, especially in the afternoon and evening. Although a morning fasting glucose test could seem normal, it is a bad screening mechanism for this condition.
- Limitations of Hemoglobin A1c (HbA1c): New-onset SIH’s dependable early diagnostic instrument is hemoglobin A1c (HbA1c). It will not show a recent surge brought on by steroids; rather, it measures average blood glucose over the past two to three months. Still, it can be helpful for long-term surveillance or for differentiating new-onset from pre-existing diabetes.
- Risk factors: High-risk patients should be monitored closely. These factors include:
- High steroid dosage and longer duration of treatment.
- Advanced age.
- Higher body mass index (BMI).
- Pre-existing impaired glucose tolerance, prediabetes, or gestational diabetes.
- Family history of diabetes.
Diagnostic monitoring strategy
The Joint British Diabetes Societies (JBDS) and other guidelines recommend the following monitoring approach for patients on glucocorticoids:
Initial screening
- For patients not diabetic: Daily capillary blood glucose (CBG) testing should be performed. Timing is essential; assess hyperglycemia’s most probable occurrence before or after dinner or meal.
- For patients with pre-existing diabetes: Right after beginning steroid therapy, four times daily (before each meal and at bedtime), CBG testing should be increased.
Confirmation of diagnosis
The following glucose readings indicate significant hyperglycemia:
- Random plasma glucose (any time): ≥11.1mmol/L (≥200mg/dL)
- 2-hour post-75g oral glucose tolerance test (OGTT): ≥11.1mmol/L (≥200mg/dL).
Treatment and Management Strategies
Lifestyle adjustments include diet and exercise are part of management of steroid-induced hyperglycemia; insulin is the main treatment for persistent elevated blood sugar. With a basal-bolus regimen being flexible or a simpler basal insulin for novices to insulin, the insulin regimen should be customized to the person. Adjustments are essential: the insulin dosage must be lowered as the steroid dose falls to avoid hypoglycemia.
Management strategies
- Lifestyle modifications:
Initial steps include diet counseling and exercise to help manage post-meal glucose spikes.
- Particularly levels above 200mg/dL, insulin therapy is the best treatment for persistent hyperglycemia.
- Flexible choice including basal, prandial, and corrective dosages known as basal-bolus insulin.
- For those just starting insulin, using a once-daily basal insulin (such as NPH with morning breakfast for once-daily prednisone) is sometimes helpful.
- The current insulin dose may need to be raised. With a maximum of 0.4, a conventional guideline is to add 0.1 units per kg of body weight for every 10 mg of prednisone equivalent. Units/kg/day, and to lower this extra dosage by the same amount as the steroid dose is decreased.
Oral agents: Oral hypoglycemic agents may be used, but insulin is often preferred due to the unpredictable nature of steroid-induced hyperglycemia. Sulfonylureas have a risk of hypoglycemia if meals are missed.
You may also like to read: ADA Diabetes Guidelines
Preventing Steroid Induced Hyperglycemia
Preventing steroid-induced hyperglycemia (SIH) primarily involves proactive monitoring and management of blood glucose levels, especially in patients starting glucocorticoid therapy.
Key Strategies for Prevention
- Pre-steroid screening of at-risk patients (including HbA1c, random blood glucose, and renal function) and encouragement of frequent glucose monitoring during therapy will help. on postprandial glucose following lunch, as steroids commonly cause major post-meal hyperglycemia.
- Start insulin treatment on the same day as steroid administration for better glycemic results, especially in individuals with high steroid doses or pre-existing conditions. Diabetes. Scheduling insulin kinds to coincide with steroid pharmacokinetics—e.g., NPH insulin with prednisone—helps to include steroid-induced glucose deviations.
- Oral medications: In mild or outpatient situations, some oral antihyperglycemic medicines like metformin or insulin secretagogues may be utilized with care to enhance insulin sensitivity and Although insulin is still the favored option in hospitalized or severe cases, decrease insulin resistance.
- Patients should eat consistent meals including starchy carbohydrates, refrain from skipping meals, and restrict sugary foods to lower glycemic spikes, therefore promoting more stable blood levels.
- Dynamic modification of insulin doses with steroid dose fluctuations—for instance, cut insulin by half the percentage reduction in steroids during tapering to avoid hypoglycemia—
- Highlight self-monitoring of blood glucose, awareness of hyperglycemia symptoms, and knowledge of insulin adjustment procedures to give patients control over SIH.
Bottom Line
Early detection and appropriate treatment of steroid induced hyperglycemia make it a manageable disease. Proper medical treatment, changes in diet, and consistent blood glucose monitoring can help minimize the hazards associated with steroid consumption. Whether temporary or long-term, managing blood glucose levels during steroid treatment is essential for general health and successful therapy. Consulting a medical professional guarantees secure steroid use and correct control of any blood glucose swings.
FAQs
How long does hyperglycemia last after prednisone?
Commonly ordered corticosteroids include dexamethasone, prednisone, and hydrocortisone. While dexamethasone can last from 12 to 36 hours, prednisone can cause hyperglycemia within four hours and might last up to 12 hours.
Is steroid-induced diabetes reversible?
Often used in cancer therapy, Dexamethasone (a steroid drug) might cause this. Usually, a transient state is steroid induced diabetes. Your blood sugar will typically return to normal once you discontinue Dexamethasone.
What foods are good for steroid-induced diabetes?
Select whole-grain or granary varieties of bread, cereal, rice, and pasta whenever you can; these foods are rich in fibre. Keep sugary foods to an occasional treat (including biscuits, sweets, chocolate, jams, cake, ice-cream, and sugary beverages), as these will cause your blood sugar levels to rise fast.
How to flush prednisone out of your system?
Stay hydrated: Drinking plenty of fluids helps your kidneys as they clear prednisone. Exercise improves blood circulation and metabolism. This aids your system to effectively process and removing medicines. Still, pay close attention to your body.