Steroid-induced Diabetes: Is It Just Unmasking Of Type 2 Diabetes?
Steroid-Induced Diabetes: Is It Just Unmasking of Type 2 Diabetes? 1Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Level 6, West Wing, Camperdown, NSW 2050, Australia 2Sydney Medical School, The University of Sydney, D06, Sydney, NSW 2006, Australia Received 6 March 2012; Accepted 29 April 2012 Academic Editors: G.Garruti and G. F.Wagner Copyright 2012 Lisa R. Simmons et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims. We compared the demographic profile and clinical characteristics of individuals with new onset steroid-induced diabetes (NOSID) to Type 2 diabetes (T2DM) patients with and without steroid treatment. Methods. The demographic profile and clinical characteristics of 60 individuals who developed NOSID were examined and matched to 60 type 2 diabetes patients receiving steroid therapy (T2DM+S) and 360 diabetic patients not on steroids (T2DM) for age, duration of diabetes, HbA1c, gender, and ethnicity. Results. Patients who developed NOSID had less family history of diabetes ( ). NOSID was more commonly treated with insulin. Despite a matching duration of diabetes and glycaemic control, significantly less retinopathy was found in the group of patients with NOSID ( ). Conclusions. It appears that steroid treatment primarily precipitated diabetes in a group of individuals otherwise less affected by risk factors of diabetes at that point in time, rather than just opportunistically unmasking preexisting diabetes. Furthermore, the absence of retinopathy suggests that patients with NOSID had not been exposed to long periods of hyperglycaemia. However, the impact of Continue reading >>
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f e b r u a r y 2 0 1 4 , v o l . 7 2 , n o 2 r e V i eW steroid diabetes: from mechanism to treatment? D.H. van Raalte*, M. Diamant Diabetes Centre, VU University Medical Centre, Amsterdam, the Netherlands, *corresponding author: e-mail: [email protected] a B s t r aC t Glucocorticoids (GCs) are frequently prescribed anti-inflammatory and immunosuppressive drugs. In addition to their beneficial effects on disease activity, GCs have an extensive side effect profile, including adverse effects on metabolism resulting in the development of glucose intolerance and overt diabetes. Recent developments have led to renewed interest in the mechanisms underlying these diabetogenic effects of GCs. First, dissociated glucocorticoid receptor (GR) agonists were developed which are designed to segregate the anti-inflammatory and metabolic actions of GCs, potentially rendering compounds with a higher therapeutic index. Second, at present, 11-beta hydroxysteroid dehydrogenase type-1 inhibitors are under development. These compounds may lower tissue GC concentrations by inhibiting cortisone to cortisol conversion and are being evaluated in clinical trials as a novel treatment modality for the metabolic syndrome. Here, we provide an up-to-date overview of the current insights regarding the mechanisms responsible for the adverse metabolic effects of GCs that may lead to steroid diabetes. Particularly, we will focus on GC-related induction of insulin resistance and pancreatic islet-cell dysfunction. Finally, we will discuss how increased knowledge concerning the pathophysiology of steroid diabetes may result in improved treatment strategies. K e Y Wor ds Pancreatic islet-cell dysfunction, glucocorticoids, insulin resistance, steroid diabetes i n t rodUC t i on Glucocorticoid (GC) hormones 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 >>
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 >>
How Glucocorticoids Effect Blood Sugar
Medications known as glucocorticoids, such as prednisone and cortisone, are mainly used as anti-inflammatories or as anti-rejection drugs. They are prescribed, for example, for an arthritis attack or after an organ transplant. One of their side effects is to increase blood glucose (sugar) since these drugs promote glucose production in the liver and reduce the sensitivity of the cells to insulin. Consequently, glucose accumulates in the blood and can cause a rise in blood sugar levels. The side-effects vary from person to person based on the prescribed dose of glucocorticoids, the way it is administered (cream, tablets or injection), and the length of time a person takes the drug. If you are taking glucocorticoids, measure your blood sugar more often than usual in order to monitor the drug’s impact on your diabetes control. It may be necessary to talk to your doctor to adjust your antidiabetes medication or your insulin dosage to maintain normal blood-glucose levels. When glucocorticoids treatment is over, blood glucose levels usually return to normal within a few days. Note: It is essential that the termination of glucocorticoids be supervised by a health professional. Research and text: Amélie Roy-Fleming , Dietitian and Certified Diabetes Educator Scientific review: Louise Tremblay, nurse, M. Ed. September 2014 Continue reading >>
Steroid Induced Diabetes
Steroids are hormonal chemical messengers that are produced naturally in the body by the adrenal glands (which are just above each kidney) and by the reproductive organs. Man-made versions of these hormonal substances are used to treat a wide range of illnesses and medical conditions. They damp down the immune system so that, for instance, it does not fight a transplanted organ. Steroids are also used to treat auto-immune conditions, where the body starts to attack itself after mistakenly recognising its cells as the ‘enemy’. As well as damping down the immune system, very high doses of steroids may have other effects on the body, such as weight gain and thinning of the bones when taken for a long period of time. They may also affect how the body controls insulin. Insulin is a hormone, which controls the concentration of glucose (sugar) in the blood. Insulin is released by beta-cells in the pancreas. Normally, the beta-cells release insulin in response to the concentration of glucose in the blood. Glucose is the body’s energy source and the insulin transports the glucose into the cells where it is needed. When there is a high concentration of blood glucose, the beta-cells release more insulin to allow the glucose to be absorbed from the blood. If there is a low concentration of glucose, the betacells release a much smaller amount of insulin or even switch off insulin production. This keeps the blood glucose concentration balanced and at the right level for the rest of the body to function normally. How do steroids induce or bring on diabetes? Normally, the liver reduces the amount of glucose it releases in response to insulin. Steroids make the liver less sensitive to insulin so it carries on releasing glucose even if the pancreas is releasing insulin. Steroids al 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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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 >>
Cortisone (now mainly referred to as cortisol) is the main hormone produced by the adrenal gland, and belongs to a group of hormones called glucocorticoids, which is a class of steroids. Glucocorticoids antagonize or counter the effects of insulin and increase gluconeogenesis--basically they have an overall blood sugar raising effect. All of us produce extra cortisol daily; it's done shortly before we awaken. The body prepares itself to go into "wake mode" and releases cortisol to ready itself for wake up. In non-diabetics, it happens virtually unnoticed, as the properly working pancreas produces more insulin to handle the cortisol release. Persons without diabetes are unlikely to be checking their blood glucose values on a regular basis, so any temporary increases would not be measured. But with diabetes, it can become a problem known as Dawn phenomenon; the rise in cortisol levels brings with it a corresponding rise in blood glucose, meaning high morning testing values--even before eating. Everyone with diabetes does not have this occurrence, just as all cats aren't white or all dogs brown. Cortisol is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. Note that this is why stress is known to raise blood sugar levels and cause hyperglycemia in diabetic pets. Pets with Cushing's disease are self-administering extra cortisol from the adrenal glands, all the time, leading to hyperglycemia and secondary diabetes. There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosterone. Their main uses are for medically supervised weight gain, inappetance, (most commonly Winstrol/Stanozolol),, in treatment of some for Continue reading >>
Steroid-induced Diabetes: A Clinical And Molecular Approach To Understanding And Treatment
Go to: Glucocorticoids are extensively used in almost every subspecialty of medicine. Indications for short-term acute steroid therapy can be seen in exacerbation of chronic obstructive pulmonary disease, acute gout, chemotherapy protocols, bacterial meningitis and in pregnant women for fetal lung maturation, to name a few. Disease processes benefiting from chronic glucocorticoid use include the following: pulmonary diseases such as idiopathic interstitial pneumonia, hypersensitivity pneumonitis and sarcoidosis; autoimmune conditions; neurologic diseases such as myasthenia gravis and multiple sclerosis; and inflammatory bowel diseases. More recently, chronic glucocorticoid therapy plays an important role in modulating the immune system following solid organ transplantation. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have various common metabolic side effects including hypertension, osteoporosis and diabetes. Steroid-induced diabetes mellitus (SIDM) has been recognized as a complication of glucocorticoid use for over 50 years . Definition Steroid-induced diabetes mellitus is defined as an abnormal increase in blood glucose associated with the use of glucocorticoids in a patient with or without a prior history of diabetes mellitus. The criteria for diagnosing diabetes by the American Diabetes Association  is an 8 h fasting blood glucose ≥ 7.0 mmol/L (126 mg/dL), 2 h post 75 g oral glucose tolerance test (OGTT) ≥ 11.1 mmol/L (200 mg/dL), HbA1c ≥ 6.5% or in patients with symptoms of hyperglycemic, a random plasma glucose of ≥ 11.1 mmol/L (200 mg/dL). Prevalence Given the widespread use of glucocorticoids in both the inpatient and ambulatory care setting, it is not surprising that at our 550-bed teac Continue reading >>
Steroids Make Blood Glucose Levels Rise
Certified diabetes educator Becky Wells recently retired from working with a diabetes self-management education program at Hendrick Medical Center in Abilene, Texas. She has shared her “Ask the Diabetes Educator” advice columns from that program with Insulin Nation. Question: Sometimes my doctor prescribes steroids or gives me a steroid injection when I’m sick. This always makes my blood sugar levels go up, and nothing I do seems to get them down. What should I do? Answer: The use of steroids (glucocorticoids) can cause significantly high blood sugar levels. These hormones decrease the effectiveness of insulin and make your liver dump more glucose into your bloodstream. Some people can have blood sugars as high as 400 mg/dL to 500 mg/dL while taking steroids. These kinds of levels can lead to the need for hospitalization, IV fluids, and/or extra insulin in people with Type 1 or Type 2 diabetes. sponsor Remind your doctor about your diabetes when he prescribes steroids and ask if it’s necessary for you to take them. If steroids are necessary, ask how often you should check your blood sugar and whether your diabetes medications should be adjusted. If the steroids are prescribed for a short time (less than a month), your doctor may decide not to change your medication. If steroids are used over a longer period of time, it’s important to note that the dosage levels are slowly tapered off. Insulin amounts will need to be decreased as steroid levels decrease. Do you have an idea you would like to write about for Insulin Nation? Send your pitch to [email protected] Continue reading >>
Growth Hormone, Steroids And Diabetes
If you check the medical literature for side effects of growth hormone use, you’ll note that diabetes often makes the list. A common effect of GH use is insulin resistance, which is considered a harbinger of full-blown diabetes. In fact, insulin resistance is often called “pre-diabetes.” Estimates are that as many as 50 million Americans fit the criteria for insulin resistance. GH enters the picture because it triggers the release of large amounts of free fatty acids into the blood. The free fatty acids, in turn, interfere with the uptake of glucose, or blood sugar, into cells, and the body attempts to compensate by producing more insulin. Insulin aides glucose uptake into cells, but as the body continues to release large amounts of insulin, the cells become resistant to it. Hence the insulin resistance. Bodybuilders and other athletes are aware of this GH side effect. They often counter it by adding insulin injections to their drug stacks, which serves two purposes: 1) It counters the hyperglycemia, or elevated blood glucose, brought on by GH-induced insulin resistance; 2) it has anticatabolic effects in muscle, and when used with GH and anabolic steroids, it appears to add a layer of anabolic efficiency. Insulin also favors amino acid uptake into muscle and triggers the enzyme that produces muscle glycogen, an effect that creates a fuller-appearing muscle. Of course, using insulin is not without its dangers. Injecting it without taking in carbohydrate can lead to a disastrous drop in blood glucose. That, in turn, can cause a person to pass out suddenly or, depending on the dose used, lapse into a coma. The coma effect has actually happened to several well-known professional bodybuilders. Luckily, they all survived. Then there are the aesthetic side effects of us Continue reading >>
Prednisone Induced Diabetes
Prednisone is a corticosteroid, which means that it is used to treat certain conditions in the body that are caused by low steroid production. The areas requiring this medication include lupus, allergic reactions, arthritis, etc. But sometimes taking Prednisone for long periods of time can result in steroid-induced diabetes. Prednisone works by actually counteracting the natural effects of insulin. When it is present, it causes the pancreas to over-produce insulin just to sustain normal blood sugar levels. The steroid doesn't seem to cause damage to the pancreas: it just puts a much higher demand on insulin production. The severity of the reaction is intensified if the individual has a family history of type 2 diabetes or if they are taking large quantities of the medicine. If they have a personal history of high blood sugar, this will also cause the reaction to be magnified. The symptoms of Prednisone-induced diabetes are the same as normal diabetes: frequent thirst, excessive urination and unexplained weight loss. The only difference between the two is the source of the diabetes. There is good news for those diagnosed with steroid-induced diabetes. A large majority of cases will go away once the steroid use has been reduced or stopped entirely. The important thing to remember is that this should be a warning flag for the individual that their pancreas is sensitive. However, in a few cases, the pancreas might have become permanently altered in which case the individual will have diabetes for life. Type 2 diabetes is different from type 1 diabetes in many ways. As its alternate name of adult-onset diabetes implies, it is usually only found in adults. However, the rate of children acquiring the disease is going up. Type 2 diabetes is also known as non-insulin dependent d Continue reading >>
Prednisone And Diabetes
Cortisone and its analogues are "stress hormones" that prime the body for times of challenge. Thus, the rise in sugar in the body is a natural byproduct of a preparation for stress in tissues of the muscles, brain, and heart for example. This is why an increase in the stress hormone results in an increase of the body's stores of glucose. Long-term prednisone use can cause diabetes in someone who has a tendency to be diabetic. Moreover, the higher the dose of prednisone, the greater the likelihood that the blood glucose (sugar) level will rise. Obesity and a genetic background that includes diabetes also gives a person a greater chance of developing diabetes. 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 >>