Case Study: A 60-year-old Woman With Type 2 Diabetes And Copd: Worsening Hyperglycemia Due To Prednisone
CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 Presentation A 60-year-old woman with a 3-year history of diabetes is seen for worsening dyspnea and cough. She has had chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated hemoglobin measured 1 month ago was 6.8% (normal 4–6%). Physical exam reveals an anxious woman with blood pressure 130/70 mmHg, pulse 120, respiratory rate 24, and weight 180 lb. Lungs are clear to percussion, but wheezing is present bilaterally. No accessory muscles are being used. No cyanosis is present. Lab evaluation: ABG: 7.46; pO2: 60; pCO2: 40; O2 Sat: 88%. Chest X-ray: flat diaphragms hyperinflated, no infiltrates. Spirometry: forced vitality capacity (FVC): 3.2; forced expiratory time in 1 second (FeV1): 1.4. She is started on albuterol and begun on a course of prednisone at 40 mg/day for 3 days, tapering over 2 weeks. On day 3, she calls to report that her blood glucose level is 350 mg/dl at 4:00 p.m. Questions What is the typical pattern of steroid-induced hyperglycemia? What are reasonable treatment strategies? How can the patient's worsening COPD adversely affect her diabetes? Commentary This patient has had type 2 diabetes adequately controlled with diet for the past few years. Her blood glucose levels increased markedly with the addition of prednisone. The typical characteristics of hyperglycemia induced by corticosteroids include minimal effect on fasting blood glucose levels and an exaggeration in postprandial blood glucose elevations. The degree of elevation is correlated with previous glucose tolerance. Patients with pre-existing diabetes can have profound increases in blo Continue reading >>
Expert Answers: Do Asthma Steroids Cause Diabetes?
Community Question: I’ve read a lot of people say that they got diabetes because they used asthma steroids. Is this true? I am so worried as I need to use steroids for my asthma. Response from Leon Lebowitz, RRT: The medical treatment of asthma focuses on a step-wise approach, as recommended by the National Heart, Lung, and Blood Institute. Medications can include rescue inhalers, inhaled corticosteroids (ICS), long acting beta agonists (LABAs), and oral corticosteroids, to name a few. The medical literature reports that ICS are the most effective medications for the reliable control of long-term asthma. Inhaled corticosteroids are the very backbone of asthma treatment for most adults and children with persistent asthma. Oral corticosteroids tend be used in the treatment of severe acute asthma and may be used at the beginning or end of an attack, usually on a short-term basis. They are only used on a long-term basis to treat patients with the most severe asthma. Corticosteroids carry a risk of side effects, some of which can cause serious health problems. Because oral corticosteroids affect the entire body (instead of just a particular area, as with aerosols), this route of administration is the most likely to cause serious side effects. When these are used over a long period of time, you may experience high blood sugar. High blood sugar can trigger or worsen diabetes, which is the main concern you expressed. In order to get the most benefit from corticosteroid medications with the least amount of risk, I would suggest trying lower doses or intermittent dosing, with your physician directing treatment. If it is at all possible, perhaps you can switch to inhaled corticosteroids, again with your physician’s approval. As well, you can make healthy choices during therapy Continue reading >>
Steroid Induced Diabetes
Tweet Corticosteroids are used to reduce harmful inflammation but can lead to diabetes - often referred to as steroid diabetes. People on steroids who are already at a higher risk of type 2 diabetes or those who need to take steroids for longer periods of time are the most susceptible to developing steroid induced diabetes. What is the role of steroids? Steroids are taken to reduce inflammation, brought on by the body’s immune system, and can be taken as treatment for a number of illnesses including: Asthma Lupus Rheumatoid arthritis Crohn’s disease Ulcerative colitis To achieve their purpose, corticosteroids mimic the action of cortisol, a hormone produced by the kidneys and responsible for brining on our body’s classic stress response of higher blood pressure and increased blood glucose levels. Corticosteroids increase insulin resistance thus allowing blood glucose levels to rise and remain higher. Read more on steroids and their side effects. What are the symptoms of steroid induced diabetes? People taking steroids may notice the following symptoms of diabetes: Dry mouth Blurred vision Increased thirst Increased need to urinate Tiredness and lethargy However, symptoms may not be present unless blood sugar levels are significantly higher than normal. Is steroid induced diabetes permanent? High blood glucose levels whilst taking steroids may subside after you stop taking steroids, however, some people may develop type 2 diabetes which will need to be managed for life. Type 2 diabetes is more likely to develop following longer term usage of steroids, such as usage of oral corticosteroids for longer than 3 months. Am I at risk of developing steroid induced type 2 diabetes? People at a higher risk of developing type 2 diabetes include: Those that are overweight If y Continue reading >>
About 1 in every 10 hospitalized patients is treated with a steroid-containing drug such as hydrocortisone or prednisone. These drugs are excellent at reducing inflammation and suppressing the immune system, but they can also result in high blood glucose levels or, eventually, diabetes in those at high-risk. Because diabetes often (but not always) goes away after the steroids are completed, doctors refers to this condition as “steroid-induced diabetes.” I’m taking steroids – what should I watch for? Urinating often Feeling hungrier than usual Excessive thirst Feeling tired, even after a full night’s sleep Infections that don’t seem to heal Who’s at risk? About half of all hospitalized patients who take high doses of steroids and have other risk factors for diabetes will develop high blood glucose levels Persons who already have diabetes often find it difficult to control their blood glucose when they take steroids Persons in the intensive care (ICU) are five times more likely to develop high blood glucose levels compared with other hospitalized patients. If this condition is temporary, why should I notify my health care provider? Patients with normal blood glucoses levels often have a shorter hospital stay, develop fewer infections, and heal more quickly than patients with uncontrolled or high blood glucose levels A history of steroid-induced diabetes usually indicates the presence of other risk factors for developing diabetes What treatments are available? Insulin (particularly in the hospital) and sometimes pills. When should I call my doctor for an update? Make sure your health care provider knows as soon as you stop taking steroids or change the dose. It’s very important that the provider adjusts your diabetes medications to prevent dangerous drops o Continue reading >>
Steroid Medication & Diabetes Whats The Link?
myDC > Blogs > DC Blog > October 2017 > Steroid medication & diabetes whats the link? Steroid medication & diabetes whats the link? October 30, 2017 ByNancy Cardinez, Andrea Miller Many people have or may know someone who has used steroid medications, such as prednisone, for the treatment of conditions, such as asthma, rheumatoid arthritis, cancers, or an organ transplant. But did you know that steroids (if taken as pills, an injection or IV fluids) can increase blood sugar levels also known as hyperglycemia ? For a person who doesnt already have diabetes, hyperglycemia can hinder your bodys ability to use insulin properly, which can lead to diabetes. Symptoms of hyperglycemia include increased thirst, frequent urination, fatigue and drowsiness these signs are common to all types of diabetes. In the case of someone who takes steroid medication, also known as corticosteroids, and does not have diabetes, the diagnosis would be steroid-induced diabetes. Steroid-induced diabetes occurs more frequently than you might think. People who take high doses of steroid medications (for example, more than 5 mg of prednisone) or use them for long periods, such as the cancer and transplant patients weve worked with, are likely to see an increase in their blood sugar levels. These medications are incredibly effective, and the benefits of using them make them difficult to avoid. As nurses and certified diabetes educators, we believe its important to know about potential side effects, such as hyperglycemia. That way, you can be aware and be your own advocate with your health-care team, who can help you identify and treat steroid-induced diabetes early on to decrease the risk of other serious health problems. How do steroid medications increase blood sugar levels? Steroids increase the am Continue reading >>
Prednisone And Diabetes: What Is The Connection?
Prednisone is a steroid that works in a similar way to cortisol, which is the hormone normally made by the body's adrenal glands. Steroids are used to treat a wide range of conditions from autoimmune disorders to problems related to inflammation, such as arthritis. They work by reducing the activity of the body's immune system and reducing inflammation and so are useful in preventing tissue damage. However, steroids may also affect how the body reacts to insulin, a hormone that controls the level of sugar in the blood. Contents of this article: How do steroids affect blood sugar levels? Steroids can cause blood sugar levels to rise by making the liver resistant to the insulin produced by the pancreas. When blood sugar levels are high, insulin is secreted from the pancreas and delivered to the liver. When insulin is delivered to the liver, it signals it to reduce the amount of sugar it normally releases to fuel cells. Instead, sugar is transported straight from the bloodstream to the cells. This process reduces the overall blood sugar concentration. Steroids can make the liver less sensitive to insulin. They can make the liver carry on releasing sugar even if the pancreas is releasing insulin, signalling it to stop. If this continues, it causes insulin resistance, where the cells no longer respond to the insulin produced by the body or injected to control diabetes. This condition is called steroid-induced diabetes. Steroid-induced diabetes Diabetes is a condition that causes a person's blood sugar level to become too high. There are two main types of diabetes: Type 1 diabetes: in which the pancreas fails to produce any insulin. Type 2 diabetes: in which the pancreas fails to produce enough insulin, or the body's cells fail to react to the insulin produced. Steroid-induce Continue reading >>
How Steroids Could Give You Diabetes
When Tony Martin was prescribed new drugs for his asthma and nasal polyps, he hoped they’d help him manage the respiratory problems he’d suffered for years. In fact, as a result of the treatment he developed type 2 diabetes. The drugs he’d been prescribed, glucocorticoids, are a type of steroid. Six million prescriptions for these powerful anti-inflammatory drugs are given out annually in the UK for conditions such as asthma, rheumatoid arthritis and irritable bowel syndrome. And many people will take glucocorticoids not knowing a common side-effect is type 2 diabetes. Tony had developed asthma in 2000; he was then diagnosed with bronchiectasis, a condition where some of the air passages become permanently widened, meaning extra mucus builds up and the patient is more prone to chest infections. He was given inhalers to keep the conditions under control, but these weren’t enough. ‘I ended up in hospital four times with severe attacks,’ recalls Tony, 65, a semi-retired communications consultant from Wandsworth, South London. In hospital he was given oral steroids in the form of prednisone, to reduce the inflammation in his airways. He then developed nasal polyps and so started taking prednisone more regularly. Polyps are swellings in the nasal cavity which can cause a runny nose and, in Tony’s case, loss of sense of smell. ‘Doctors told me the steroids could help to shrink the polyps,’ he recalls. ‘I took them only if my chest was troubling me, or when I travelled overseas for business meetings, to spare myself the embarrassment of a dripping nose.’ Tony’s doctors warned him not to take them too often because of serious side-effects such as a hormone disorder called Cushing’s syndrome, so he kept to no more than once every three months. But his d Continue reading >>
How Prednisone Affects Blood Sugar
It isn’t unusual for people with diabetes to sometimes require corticosteroid treatment. Corticosteroids, or steroids for short, are used to reduce inflammation and suppress the immune system. They are often a last resort for a wide variety of conditions, in everything from asthma to allergy attacks to arthritis and ulcerative colitis. Steroids are also prescribed to prevent the immune system from seeing donated organs as foreign bodies and rejecting them after an organ transplant. One of the most commonly used steroids is prednisone. “Among all medications available to treat different medical conditions, prednisone and similar steroids have the most profound effect on glucose metabolism. Medications such as prednisone can significantly increase glucose levels in patients with diabetes as well as individuals with impaired glucose tolerance or pre-diabetes,” says William Sullivan, M.D., a senior staff physician at Joslin Clinic in Boston and the Medical Director at the Joslin Clinic at Beth Israel Deaconess Hospital, Needham. Prednisone is amazingly effective at calming inflamed tissue and reducing pain, but that comfort sometimes comes at a high price. Prednisone’s list of side effects is long and scary. The longer you are on the drug and the higher the dose, the more likely it is that you will experience side effects. When you have diabetes, even a short course of prednisone at a low dose is likely to wreak havoc with your blood glucose levels. In fact, another name for corticosteroids is glucocorticoids in honor of the powerful effect they have on glucose metabolism. Prednisone induces elevated glucose levels by stimulating glucose secretion by the liver as well as reducing glucose transport into adipose and muscle cells. The overall effect is a reduction in g Continue reading >>
Steroid Induced Diabetes Mellitus In Patients Receiving Prednisolone For Haematological Disorders
Steroid induced diabetes mellitus in patients receiving prednisolone for haematological disorders 1 Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria 2 Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria *Corresponding author: Dr Taiwo R Kotila Department of Haematology University College Hospital PMB 5116, Ibadan Nigeria [email protected] Copyright Makerere Medical School, Uganda 2013 This article has been cited by other articles in PMC. Steroids are a useful component of combination chemotherapy or as a single agent in the treatment of haematological disorders even though there are adverse effects associated with its use. We report four patients who developed diabetes mellitus (DM) during treatment with steroids for haematological disorders despite a negative history of DM. The mean age of the patients was 55yrs and DM was diagnosed by fasting plasma glucose (FPG) after a cumulative steroid dose of 5001800mg. It is necessary to have a baseline and frequent FPG in patients who are considered for combination chemotherapy which include steroid since the development of DM does not appear to be dose dependent or related to history of DM in the patient or family. Keywords: Steroid, Diabetes Mellitus, Haematological malignancy, Chemotherapy, Adverse effect Combination chemotherapy is useful in the management of haematological malignancies and this evolved from the use of single agents in order to overcome drug resistance. Attention was drawn to the benefit of steroids in the treatment of lymphoid malignancy by the observation that it induces regression of lymphoid tumours in man 1 . Subsequently, massive doses of steroids were used in the management of haematological malignancies but the associated side e Continue reading >>
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 (no medications). 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 >>
New Here - Prednisone-induced Diabetes
Hi! I'm newly diagnosed and learning the ropes of diabetes. A month ago my vision started getting blurry. I was on prednisone, advair and singulair, and all of them said that they could cause blurry vision, cataracts and/or glaucoma. Dr. told me to stop them and get my eyes checked. Eye dr. asked if I was diabetic. Mid-January my fasting blood sugar at my physical was 100, so no, unless something had changed. He told me there were some signs in my eyes that my blood sugar might be off, and recommended getting checked. I was leaving the next day for a cruise, but made an appt. for 2 days after my return. During the cruise, my vision worsened, there wasn't enough water on the ship for me to satisfy my thirst and I was in the bathroom constantly, including 3x during the night. I knew then that I was diabetic. Doctor called me 2 days after my test with results: fasting was 334! The day I came home from the cruise I made an immediate and drastic change in my diet and within 3 days my vision was normal, and no more thirst/frequent urination. My numbers are frighteningly high though. In the past 6 days since I started testing, I have ranged from 261 (fasting) to the upper 500s (once it even registered as HI, which is over 600). What's truly frightening though is wondering how high the #s were on the cruise and before, if I'm no longer having the adverse symptoms. Ironically, I feel better than I have in 10 years. Yes, my dr. is aware of the high #s and started me on Metformin XR (500mg/1xday) and asked me to start doubling it tomorrow. (She wanted to ramp me up slowly to minimize any GI complaints) She said that if at any point I start to feel unwell, to get to the ER. Today was day 4 on Metformin, so she's hoping that #s will start coming down soon. She's not too terribly co Continue reading >>
Steroid diabetes (also "steroid-induced diabetes") is a medical term referring to prolonged hyperglycemia due to glucocorticoid therapy for another medical condition. It is usually, but not always, a transient condition. Medical conditions The most common glucocorticoids which cause steroid diabetes are prednisolone and dexamethasone given systemically in "pharmacologic doses" for days or weeks. Typical medical conditions in which steroid diabetes arises during high-dose glucocorticoid treatment include severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and induction chemotherapy for leukemia or other cancers. Insulin Glucocorticoids oppose insulin action and stimulate gluconeogenesis, especially in the liver, resulting in a net increase in hepatic glucose output. Most people can produce enough extra insulin to compensate for this effect and maintain normal glucose levels, but those who cannot develop steroid diabetes. Criteria The diagnostic criteria for steroid diabetes are those of diabetes (fasting glucoses persistently above 125 mg/dl (7 mM) or random levels above 200 mg/dl (11 mM)) occurring in the context of high-dose glucocorticoid therapy. Insulin levels are usually detectable, and sometimes elevated, but inadequate to control the glucose. In extreme cases the hyperglycemia may be severe enough to cause nonketotic hyperosmolar coma. Treatment Treatment depends on the severity of the hyperglycemia and the estimated duration of the steroid treatment. Mild hyperglycemia in an immunocompetent patient may not require treatment if the steroids will be discontinued in a week or two. Moderate hyperglycemia carries an increased risk of infection, especially fungal, and especially in people with other risk factors s Continue reading >>
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Steroids And Diabetes: The Effect On Your Glucose Levels
Autumn is approaching with its beautiful fall foliage, hayrides at the pumpkin patch, and harvest festivals, as well as its sniffles and running noses. Cold and flu season is a drab for everyone, but can be particularly worrisome for people with diabetes. In addition to worrying about how being sick will affect their glucose levels and whether or not cold and flu medications are sugar free, being prescribed corticosteroid (steroids) adds a whole other layer of concern. Medtronic Diabetes Clinical Manager, Beth Spencer Kline, MSN, RN, NP-C, CD is back to discuss an important aspect of diabetes management, steroid effects on blood glucose. What are steroids? Steroids are medications used to reduce inflammation and suppress the immune system. Steroid treatment is commonly prescribed for short periods of time to treat conditions such as rashes, musculoskeletal pain, injury, and respiratory ailments. However, steroids can also be prescribed for longer periods of time to treat certain inflammatory disorders, autoimmune disorders, and organ transplants. While steroids can help reduce inflammation and reduce pain, they can also significantly increase blood glucose levels in people with diabetes, as well as individuals with impaired glucose tolerance or pre-diabetes. Why is this? Steroids increase the liver’s release of glucose, and cause insulin resistance, which leads to insulin (either injected or made by one’s own pancreas) working less efficiently. What if I’m prescribed steroids and have diabetes? First, let your prescribing doctor know you have diabetes, because they may be able to prescribe an alternative medication that will not affect your glucose levels. If alternative medication is not an option, inform your diabetes healthcare team immediately so they can dete Continue reading >>
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Glucocorticoid-induced Diabetes Mellitus: An Important But Overlooked Problem
Go to: Glucocorticoids are widely used as potent anti-inflammatory and immunosuppressive drugs to treat a wide range of diseases. However, they are also associated with a number of side effects, including new-onset hyperglycemia in patients without a history of diabetes mellitus (DM) or severely uncontrolled hyperglycemia in patients with known DM. Glucocorticoid-induced diabetes mellitus (GIDM) is a common and potentially harmful problem in clinical practice, affecting almost all medical specialties, but is often difficult to detect in clinical settings. However, scientific evidence is lacking regarding the effects of GIDM, as well as strategies for prevention and treatment. Similarly to nonsteroid-related DM, the principles of early detection and risk factor modification apply. Screening for GIDM should be considered in all patients treated with medium to high doses of glucocorticoids. Challenges in the management of GIDM stem from wide fluctuations in postprandial hyperglycemia and the lack of clearly defined treatment protocols. Together with lifestyle measures, hypoglycemic drugs with insulin-sensitizing effects are indicated. However, insulin therapy is often unavoidable, to the point that insulin can be considered the drug of choice. The treatment of GIDM should take into account the degree and pattern of hyperglycemia, as well as the type, dose, and schedule of glucocorticoid used. Moreover, it is essential to instruct the patient and/or the patient's family about how to perform the necessary adjustments. Prospective studies are needed to answer the remaining questions regarding GIDM. Keywords: Glucocorticoids, Hyperglycemia, Diabetes mellitus Go to: INTRODUCTION Glucocorticoids have been shown to be potent anti-inflammatory and immunosuppressive drugs; they sta Continue reading >>
Prednisone And Other Corticosteroids
Corticosteroid drugs including cortisone, hydrocortisone and prednisone are useful in treating many conditions, such as rashes, lupus and asthma. But these drugs also carry a risk of serious side effects. Working with your doctor, you can take steps to reduce these side effects so that the benefits of corticosteroid treatment outweigh the risks. Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which sit on top of your kidneys. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis and asthma. Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues. Corticosteroid drugs are used to treat rheumatoid arthritis, lupus, asthma, allergies and many other conditions. They also treat Addison's disease, a condition where the adrenal glands aren't able to produce even the minimum amount of corticosteroid that the body needs. And these drugs also help suppress the immune system in order to prevent organ rejection in transplant recipients. By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as rheumatoid arthritis and lupus. By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies. Topically. Creams and ointments can help heal many skin conditions. By injection. This form is often used to treat muscle and joint signs and symptoms, such as the pain and inflammation of tendinitis. What side effects can corticosteroids cause? Corticosteroids carry a risk of side effects, some of which can c Continue reading >>
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