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Steroid Joint Injection And Diabetes

The Right Way To Use Cortisone Injections

The Right Way To Use Cortisone Injections

On a daily basis, I am asked what the downsides of cortisone injections are. The answer depends on location of the injection, medical history, type of steroid used, and technique. Steroid injections have received mixed reviews in the media lately, but when used judiciously, they can cure joint swelling, restore motion, and significantly reduce pain. The term “steroid” represents a broad class of medications that can be taken by mouth or injected. With regards to steroid injections they take one of two forms: corticosteroids or anabolic steroids. Corticosteroids (also known as glucocorticoids) defines the chemical class of steroids used to reduce inflammation and pain. Corticosteroid medications mimic naturally produced cortisol, produced by the adrenal glands, which have immune system effects. These are prescribed and injected into joints, tendons, and muscle tissue to reduce inflammation, swelling, and pain. Corticosteroids are also prescribed by mouth to help with autoimmune and arthritic conditions, skin conditions, nerve disorders and some cancers. They are used in inhaled form for asthma and airway diseases. Anabolic steroids (also known as androgens or male sex hormones) act as hormones in the body and are known for being abused by bodybuilders and illegally by high performance athletes. Anabolic steroids when used appropriately have a therapeutic role in medicine to treat growth disturbances, certain tumors, muscle wasting diseases, and low testosterone. When abused, anabolic steroids can cause cancer, stroke and heart disease along with serious mood disturbances. Corticosteroid injections usually contain 1 of the 3 most commonly used types of steroid (methylprednisolone (depo-medrol), triamcinolone (kenalog), or betamethasone (celestone) mixed with one or bo Continue reading >>

Cortisone Injections Safe For Diabetics

Cortisone Injections Safe For Diabetics

Dear Dr. Roach • My mom is nearing 90 and recently developed an arthritic hip, which is curtailing her activities. She has Type 2 (no insulin) diabetes. The orthopedic doctor we saw gave her the choices of hip replacement surgery (no!), therapy or a cortisone injection. We almost proceeded with the cortisone injection, until I found out that it can elevate one’s sugar levels. I’m getting conflicting reports of how high the levels can go and for how long. She is not overweight (132 pounds and 5 feet, 1 inch tall) and is allergic to sulfur and penicillin. She also takes medicine for high blood pressure. She is doing her own home therapy (keeping active including stair climbing). Any suggestions on the cortisone or other treatments to help her? — D.C. Answer • Injection of steroids into an arthritic joint is both safe and effective for most people with arthritis. Her surgeon likely will choose a steroid that tends to stay in the joint longer, leading to more improvement and less systemic effects. The effect on blood sugar in people with diabetes usually is minimal and lasts two to three days. Her allergies and other medications should not interfere with the injection. Although exercise is a great way of treating the arthritis, she should take it easy the day after the injection to allow the medicine to stay in the joint as long as possible. Hip injections usually are done with an X-ray to make sure the injection goes in the right spot. Dear Dr. Roach • Both of my parents died with Alzheimer’s disease, and I have great fear of getting it myself. (I’m 70, with worsening memory.) Recent news has suggested that copper intake may worsen or even cause the disease. I’ve been looking for foods low in copper, but most of the ones I eat (beans, greens, nuts, whole Continue reading >>

The Ups And Downs Of Meds And Diabetes (part 1): Steroids

The Ups And Downs Of Meds And Diabetes (part 1): Steroids

If you take any kind of medication for your diabetes management, whether that be metformin, sulfonylureas, exenatide (brand name Byetta), or insulin, for example, hopefully you’re familiar with how that drug works and what the effect is on your blood glucose control. But, just like people who don’t have diabetes, you’re going to come down with a cold or the flu every now and then. You may need to take steroids for a while. Maybe you take medicine for controlling your blood pressure or your cholesterol. How familiar are you with these drugs, particularly in terms of your blood glucose levels? Most of us are prescribed medicines for various reasons at one time or another. Unfortunately, we aren’t always told by our physician or pharmacist how they work and how they might interact with other medicines. And in the case of diabetes, chances are you’re not always given information on how a drug may affect your blood glucose level or how a it may interact with your diabetes medication—and many of them do. Your pharmacist should be your number one source for any questions you have about any drug that you take. But we can scratch the surface and take a look at this important area of diabetes management. We’ll look at steroids this week. Steroids Steroids (corticosteroids, glucocorticoids) are a potent class of medications (meds for short) that are known to raise blood glucose levels, often quite significantly. Steroids are given to help reduce inflammation that may occur with arthritis or asthma. People with certain immune disorders, such as lupus, rheumatoid arthritis, or sarcoidosis, usually need to take steroids as well. While steroids are very effective at doing what they’re supposed to do, one of the side effects is an increase in blood glucose levels. In fa Continue reading >>

Blood Glucose Levels Following Intra-articular Steroid Injections In Patients With Diabetes: A Systematic Review.

Blood Glucose Levels Following Intra-articular Steroid Injections In Patients With Diabetes: A Systematic Review.

Abstract BACKGROUND: Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabetic patients. These abnormal blood glucose levels in diabetic patients raise concerns that intra-articular steroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus. METHODS: A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed. RESULTS: All studies showed a rise in blood glucose levels following intra-articular steroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articular steroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours. CONCLUSION: Intra-articular steroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabetic patients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Continue reading >>

Detail-document: Prescriber's Letter

Detail-document: Prescriber's Letter

Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Corticosteroids are used for a wide array ofindications and are given by many different routes (oral, topical, intra-articular,inhaled, epidural, etc). Hyperglycemiais a well known complication of systemic (oral, intramuscular, intravenous)corticosteroid therapy, but less well recognized with other routes ofadministration. This document reviewshyperglycemia associated with corticosteroids given by topical, intra-articular,inhaled, and epidural routes of administration. Hyperglycemia is a well-known adverse effect ofcorticosteroid therapy. Orallyadministered corticosteroids have been shown to worsen glucose control inpatients who already have diabetes and to cause hyperglycemia in patientswithout preexisting diabetes.1 The incidence of corticosteroid-inducedhyperglycemia is difficult to quantify because it is dependent on manypatient-specific (type of diabetes, body mass index, age, family history) andtreatment-specific (drug, dose, route of administration, duration) factors.1 There are a number of mechanisms by whichhyperglycemia occurs. Corticosteroidsreduce glucose utilization, increase glucose production, inhibit the effects ofinsulin on myocytes and adipocytes, and increase hepatic glucose release.2The effects can be seen as early as 12hours after beginning therapy.3 In patients taking oral prednisone, the mostpronounced hyperglycemic effect occurs one to two hours after a meal.3 Certain corticosteroids have a more pronouncedeffect on blood glucose than others. Forexample, the synthetic corticosteroids prednisone and dexamethasone are fourand 30 times more potent, respectively, than natural corticosteroids such ashydrocortisone at reducing carbohydrate metabolism.3 There appears to be an as Continue reading >>

Steroids And Diabetes: The Effect On Your Glucose Levels

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 >>

Cortisone Injections In Diabetics

Cortisone Injections In Diabetics

Cortisone injections are commonly used for the treatment of a variety of orthopedic conditions. Cortisone is a powerful anti-inflammatory medication that can be injected around tendons or joints where inflammation is present. Cortisone injections are often used in the treatment of conditions including tendonitis, bursitis, and arthritis. There are several common, and many uncommon, side-effects of a cortisone shot, and before having this treatment you should discuss these possible complications with your doctor. While most cortisone side-effects are mild and temporary, it is worthwhile to discuss these possible problems so that you know what to expect after your injection. Diabetes and Cortisone Diabetics are especially prone to side-effects from cortisone injections. It is very common for patients with diabetes to experience a temporary rise in their blood sugar in the hours and days following a cortisone injection. If not expecting this likely side-effect, the unanticipated rise in blood sugar can be alarming for patients working hard to keep their blood sugar levels under control. A recent study investigated the use of cortisone injections in diabetic patients. The patients all had injections for hand problems (including trigger finger and carpal tunnel syndrome). The patients were then surveyed daily until their symptoms resolved. The findings of the study included the following: The rise in blood sugar corresponded to the severity of diabetes as measured by hemoglobin A1c (HbA1c). When a patient's HbA1c was greater than 7%, they had higher elevations in blood sugar following the injection, and the elevated blood sugar lasted longer. Most diabetic patients experienced temporary elevations in blood sugar. In this study, 80% of the patients reported elevated blood sug Continue reading >>

Steroid Injections | Types And Side Effects | Patient

Steroid Injections | Types And Side Effects | Patient

Steroids are chemicals that occur naturally in the body. Steroid medicines can be used to reduce inflammation and are used to treat many different conditions, including arthritis. Steroid injections can be used to reduce inflammation in joints and soft tissues, such as tendons or tennis elbow. A local steroid injection may be given to reduce inflammation and pain in a joint. Steroid injections may be used for people with rheumatoid arthritis or other causes of joint pain and swelling such as osteoarthritis , gout or frozen shoulder . Steroid injections may also be used for inflammation of soft tissues, such as: The main purpose of the steroid injection is to decrease pain and increase movement and use of the affected area. Steroid injections are usually well tolerated and much less likely than steroid tablets to cause serious side-effects. See the separate leaflet called Oral Steroids . How do I have local steroid injections and how long do they take to work? Steroid injections can be given by your doctor (GP or specialist). Most injections are quick and easy to perform but the injection must be given in a very clean (sterile) environment to prevent infection. You should rest the injected joint for 1-2 days after the injection and avoid strenuous activity for five days. The steroid injection can be repeated if the first injection is effective. However, you should not have more than four steroid injections into the same place in any 12-month period. How long do local steroid injections take to work? Short-acting steroid injections can give relief within hours and the benefit should last for at least a week. Longer-acting steroid injections may take about a week to become effective but can then be effective for two months or even longer. A local anaesthetic may be combin Continue reading >>

Blood Glucose Levels In Diabetic Patients Following Corticosteroid Injections Into The Hand And Wrist

Blood Glucose Levels In Diabetic Patients Following Corticosteroid Injections Into The Hand And Wrist

Go to: Abstract To quantify diabetic patients’ change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2 receiving a corticosteroid injection recorded their morning fasting blood glucose levels for 14 days after their injection. Fasting glucose levels on days 1–7 after injection qualified as “case” data with levels on days 10–14 providing control data. A mixed model with a priori contrasts were used to compare post-injection blood glucose levels to baseline levels. A linear regression model was used to determine patient predictors of a post-injection rise in blood glucose levels. Forty of 67 patients (60%) recruited for the study returned completed blood glucose logs. There was a significant increase in fasting blood glucose levels following injection limited to post-injection days 1 and 2. Among patient risk factors in our linear regression model, type 1 diabetes and use of insulin each predicted a post-injection increase in blood glucose levels from baseline while higher HbA1c levels did not predict increases. Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. Keywords: Blood Glucose, Corticosteroid, Diabetes, Methylprednisolone Go to: Introduction Corticosteroid injections are commonly used to treat a variety of common hand and wrist conditions such as trigger finger, De Quervai Continue reading >>

Sacroiliac-joint Steroid Injections

Sacroiliac-joint Steroid Injections

Sacroiliac-joint steroid injections help to diagnose and relieve lower-back pain caused by problems with one or both of the sacroiliac joints, which connect the spine's base (sacrum) to the pelvis's ilium bones. If one or both of the sacroiliac joints is inflamed (sacroiliac-joint dysfunction), a patient can experience pain in the buttocks and lower back that worsens when running or standing. Sacroiliac-joint dysfunction can be caused by osteoarthritis, traumatic injury, pregnancy, inflammatory joint disease, or underlying structural abnormalities. Reasons for Sacroiliac-Joint Steroid Injections A sacroiliac-joint steroid injection is used to confirm a diagnosis of sacroiliac-joint dysfunction. If the injection provides pain relief, it establishes the joint as the pain's source, and, at the same time, acts as a treatment. Corticosteroids, along with a local anesthetic and saline solution, are injected directly into the sacroiliac joint, reducing swelling and pain for, possibly, several months. As with other spinal blocks, a sacroiliac-joint injection can be repeated up to 3 times a year. Spinal injections only provide temporary relief from pain; they are not a cure. For that, surgery may be necessary. The Sacroiliac-Joint-Steroid-Injection Procedure To make sure the injection is placed in the correct spot, the procedure, which takes less than half an hour, is performed using imaging guidance and a contrast dye. The patient lies facedown on a surgical table, and the skin on the lower back is cleansed with an antiseptic solution. A local anesthetic is given to reduce discomfort from the injection, which contains steroid medication, saline solution and anesthetic. When the procedure is complete, the injection site is covered with a small bandage. The anesthetic in the inj Continue reading >>

Sacroiliac Joint Injections

Sacroiliac Joint Injections

A sacroiliac joint injection is an injection of local anesthetic and a steroid medication into the sacroiliac joint. Due to the numbing medicine used during this procedure, you may experience temporary pain relief afterwards that may last several hours. Once the numbing medicine wears off, however, your pain will most likely return. The steroid medication may give longer lasting pain relief and usually begins working after 24-48 hours. Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety! As with most procedures, there is a remote risk of bleeding, infection, or allergic reaction to the medications used. Additional short-term effects may occur. You may have some temporary numbness or weakness in your legs caused by the local anesthetic (numbing medicine). If this interferes with your ability to walk safely, you will have to remain in the Pain Management Center until it resolves, usually several hours. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars as a result of the steroid medication. Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure (this lasts only a few seconds); however, every persons response to any procedure will differ. No solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before coming Continue reading >>

Steroid Injection For Shoulder Pain Causes Prolonged Increased Glucose Level In Type 1 Diabetics

Steroid Injection For Shoulder Pain Causes Prolonged Increased Glucose Level In Type 1 Diabetics

Title: Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics The proof of your manuscript appears on the following page(s). It is the responsibility of the corresponding author to check against the original manuscript and approve or Please read the proofs carefully, checking for accuracy, verifying the reference order and checking gures and tables. When reviewing your page proof please keep in mind that a professional copyeditor edited your manuscript to comply with the style requirements of the journal. This is not an opportunity to alter, amend or revise your paper; it is intended to be for correction purposes only. The journal reserves the right to charge for excessive author alterations or for changes requested after the During the preparation of your manuscript for publication, the questions listed below have arisen (the query number can also be found in the gutter close to the text it refers to). Please attend to these matters and return the answers to these questions when you return your corrections. Please note, we will not be able to proceed with your article if these queries have not been addressed. Q1 IMPORTANT: Corrections at this stage should be limited to those that are essential. Extensive corrections will delay the time to publication and may also have to be approved Q2 Please note that alterations cannot be made after you have approved for publication, irrespective of whether it is Online First. Q3 Author SURNAMES (family names) have been highlighted - please check that these are Q4 Please check all names are spelt correctly, and check afliation and correspondence details, Q5 Please note that you cannot add or delete author names, or change the order of the names without permission from ALL authors. If you are Continue reading >>

Diabetic Ketoacidosis Following Administration Of Cervical Epidural Steroid Injection In A Non-diabetic

Diabetic Ketoacidosis Following Administration Of Cervical Epidural Steroid Injection In A Non-diabetic

f, Warren L. Reuther, IIIg aKansas City University of Medicine and Biosciences, Kansas City, MO, USA bDepartment of Internal Medicine, University of South Florida, Tampa, FL, USA cDepartment of Internal Medicine, Banner Good Samaritan Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA dDepartment of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL, USA eDepartment of Internal Medicine, Palm Beach Centre for Graduate Medical Education, West Palm Beach, FL, USA fThe Ohio State University, Columbus, OH, USA gDepartment of Radiology, West Palm Hospital, West Palm Beach, FL, USA hCorresponding Author: Andrew C. Berry, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO 64106, USA Manuscript accepted for publication July 4, 2014 Short title: Diabetic Ketoacidosis doi: Our case describes a 56-year-old African-American female who underwent fluoroscopy-guided epidural steroid injection for recurrent neck and arm pain. The administration of steroid injections has been shown to diminish peripheral glucose metabolism and to stimulate gluconeogenesis, thus elevating blood glucose concentration and worsening insulin resistance. Though uncommon, diabetic ketoacidosis (DKA) can arise following both epidural steroid treatments in diagnosed diabetics or in cases of coinciding infection. At the time of the epidural injection, the patient showed no signs of acute infection, concomitant drug use or any documented diabetes, all potential causes of DKA. Our case is unique because it describes a documented non-diabetic patient who went into DKA following cervical epidural steroid injection. Keywords: Diabetic ketoacidosis; Diabetes; Epidural steroid injection; Degenerative disc disease Degenerative d Continue reading >>

Beware Cortisone!

Beware Cortisone!

Today's e-mailbag brought a letter from someone who reported that their blood sugar deteriorated significantly after a single shot of cortisone administered by an orthopedic doctor and that, even two months later, it has not returned to the level it was before the shot. I wish this were an isolated, oddball occurrence, but sadly, it is not. Years ago when I posted a question on the old alt.support.diabetes newsgroup about the events leading up to a Type 2 diabetes diagnosis, I heard from several people who said that their blood sugars, which had been marginal before a cortisone treatment, became fully diabetic afterwards. It was only then that I connected my own diabetes diagnosis with the ten day long course of prednisone I'd been given the previous year and and realized that it was only after that treatment that I'd developed the raging hunger and uncontrollable weight gain that seems to have signaled that my blood sugars had crossed over some disastrous boundary. Every doctor I've mentioned this too has pooh-poohed it. Yes, they say, cortisone temporarily raises blood sugars, but they should go back to normal afterwards. But my doctor said the same thing, even when faced with the evidence that I'd suddenly developed much stronger symptoms of diabetes. So it is possible that doctors believe that cortisone will not worsen diabetes and because of that belief attribute the worsening when it occurs to something else! Alternatively, because cortisone is often given by orthopedic doctors who don't monitor a patients' blood sugar, it is possible that they don't ever learn of the effect of their shots on the patients. My belief, after dealing with several rheumatologists and orthopedic doctors, is that these doctors often administer a shot of cortisone so that the patient--wh Continue reading >>

Can Steroids Have A Lasting Effect On Blood Glucose?

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 >>

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