Steroids are a potent class of anti-inflammatory drugs. They are known to raise blood sugar especially when taken orally or by injection, often quite significantly.
Even strong topical steroids can raise your blood sugar if used for prolonged periods and over large areas of the skin. This is because in such circumstances, topical steroids can get adsorbed into the blood.
This can be a tricky situation for your doctor when you are suffering from diabetes mellitus and steroids become indicated for another condition you may be suffering from.
He has to weigh the pros and the cons of high blood sugar levels and the absolute need to use the steroids in serious indications, because use of steroids in a diabetic patient is not without side effects and complications.
Steroids are also called “corticosteroids” or “glucocorticoids” –
- “corticosteroids” because they are naturally manufactured in the body by the adrenal cortex of the adrenal glands, which are located above the kidneys and
- “glucocorticoids” because of their direct action on glucose metabolism.
Among steroids, prednisolone is the more commonly prescribed steroid and can be the main ingredient in the treatment of many serious conditions. It is one of the more potent steroids.
Taking systemic steroids when diabetic
All steroids, whether prednisolone or dexamethasone or any other, raise blood sugar levels even when taken in low doses in patients of both diabetes type 1 and diabetes type 2. Their use, therefore becomes restricted in a diabetic patient.
But, steroids have a very important and life saving role to play in treating many serious health inflammatory conditions. They include:
- Systemic vasculitis (inflammation of blood vessels)
- Myositis (inflammation of muscle)
- Bronchial asthma and its severe life threatening condition called status asthmaticus
- Rheumatoid arthritis
- Inflammation of the kidneys, which if not treated with steroids, can lead to renal shutdown (kidney failure)
You can, therefore, never ignore steroids when they are indicated for use. At the same time, you cannot ignore your diabetes because that also can be dangerous.
Striking a balance therefore, is essential.
Using steroids and diabetes control
According to Roger Austin, MS, RPh, CDE in diabetesforecast.org:
In most people, steroids don’t have a lasting effect on blood sugar levels. Your steroid induced diabetes will go away and blood sugar levels will return to their original status within a few days after the steroids are stopped. However, as explained below, diabetes may stay in certain conditions.
Therefore, it is during therapy with steroids that your sugar levels should be kept in check with additional precautions.
Your sugar levels can be controlled with stronger and faster acting anti diabetic drugs such as insulin or sulfonylureas when steroid treatment is being given. Your diabetes specialist will take care of that.
Do steroids induce diabetes?
Having said that, there is a risk, however, of steroids inducing diabetes. This can happen when you are associated with risk factors associated with diabetes. These are the risk factors, which make you prone to diabetes mellitus even otherwise. They include:
- High dosage, prolonged and frequent treatment with oral and injectable steroids
- Family history of diabetes
- Sedentary lifestyle with no physical activity
- Wrong lifestyle habits such as bad dietary habits, too much consumption of alcohol and excessive smoking
- Advanced age
How do steroids increase your blood sugar?
- Steroids block the action of insulin (whether your own or injected), which directly affects your blood sugar rise. This is called insulin resistance. Insulin is a hormone that is manufactured by the pancreas in your body and keeps the blood sugar levels within normal limits. It prevents the blood sugar from rising too high or from falling too low.
- Steroids inhibit the uptake of glucose by the body cells. Glucose, therefore, accumulates in the blood causing its levels to rise
- They stimulate the liver to produce more glucose
Using topical steroids when diabetic
It becomes a tricky situation when you have diabetes and an inflammatory skin condition or an inflamed nasal passage or an inflammatory eye condition, which is giving you a lot of discomfort.
Allergy is the most common cause of such inflammatory conditions and topical steroids form the main stay of the treatment along with antihistamines.
What you should do?
You should first try natural remedies for your allergic condition. If they don’t work and the discomfort becomes worse, you should use topical corticosteroids.
You cannot ignore a severe attack of allergic rhinitis, which has blocked your nose and makes your breathing difficult. It can give rise to complications such as infection in the ear, insomnia leading to drowsiness during the day, irritability, difficulty in concentrating, etc.
Neither can you ignore a flare-up of your psoriasis, which is oozing and itching like hell. Psoriasis is known to cause complications such as a debilitating joint damage, metabolic syndrome and more.
There can be other complications as well in almost all indications of topical steroids such as a super added bacterial infection and fever.
Using topical steroids for treating such conditions is therefore, essential even though you may be having diabetic mellitus type 1 or type 2..
Certain precautions should be followed during treatment with topical steroids in order to ensure the least possible effect on your diabetic condition. These include:
- Firstly, consulting your diabetic specialist
- Secondly, monitoring your blood sugar closely
- Thirdly, using mild over the counter topical steroids as far as possible
- Lastly, if these do not give you relief, you may have go in for stronger topical steroids, which should be taken after consulting a skin specialist.
Topical steroids will affect your blood sugar levels if they are absorbed into your blood. This can happen when you use strong topical steroids over an extended period of time as may be necessary in case of a flare up of psoriasis or eczema.
However, the rise in blood glucose levels will not be that much when compared to taking these drugs orally or parenterally (by injection) and as mentioned above, the blood glucose will return to its original level when the topical treatment is stopped.
Use of steroids in a diabetic pregnant woman
Steroids or corticosteroids are sometimes required to be given in pregnant women expecting preterm delivery.
Preterm birth is one that takes place three weeks before the baby is normally due. Since the normal pregnancy lasts for 40 weeks, any birth before the start of the 37th week is considered preterm or premature.
This indication of steroids in pregnancy becomes all the more complicated when the pregnant woman is diabetic. Diabetes during pregnancy is associated with the risk of premature birth of the fetus.
Babies born preterm have a high risk of developing infant respiratory distress syndrome (IRDS), also called neonatal respiratory distress syndrome.
It is associated with structural immaturity in the lungs due to improper development of the baby’s lungs as a result of premature birth.
Antenatal steroids (steroids given during pregnancy) play an important role in such situations. They reduce the risk of respiratory distress syndrome in the newborn and promote pulmonary maturity and growth.
The blood sugar levels are closely monitored and increased doses of anti diabetic drugs are given to keep the blood glucose levels in check.