Steroid Induced Diabetes Early Detection Treatment and Management
Posted By Rupa Jaiswal
Posted on Aug 14, 2021
What is Steroid Induced Diabetes?
Steroid Induced Diabetes -A Wake-Up Call! Picture this world from 200 years ago when a simple gash on the leg
seemed life-threatening, for it might develop gangrene or sepsis.
The terror of many diseases has now been erased from the memory
of humanity due to the advent and development of
Steroids medications, and treatments. What earlier
The other side used to be a battle of life and death, today is
of the Wonder only a pill away from cure. We happily take
Drugs medicines sighing in the relief that they bring us
without little thought into what we are actually
consuming. Before a drug is brought into public use, it
undergoes rigorous clinical trials to prove its safety for human
consumption. However, these drugs prove to be potent when
used during necessity, but can also be double-edged.
Steroids, a class of drugs, are commonly used for
suppressing inflammatory reactions in the disorders
of immune system. They ease painful symptoms
and make otherwise incurable disease more
manageable. In spite of steroids being
highly effective in treatment of some
diseases, their long-term high dosage
have long corticosteroids, lasting negative effects on the
body, including development of type 1 diabetes.
What are the uses of steroids?
Most of the sex ovarian hormones in our body such as
androgen, progesterone and estrogen, as well as
corticosteroids (mineralocorticoids and glucocorticoids) released by
adrenal glands are Steroid Hormones. These hormones are derived from cholesterol
and are synthesized in the body as needed since
they cannot be stored in the cells for long. The
steroid based medications, that are commonly
prescribed, are synthetic forms of these hormones and are
given to manage inflammatory reaction that occurs in
autoimmune disorders and others. These drugs are
corticosteroids, of which glucocorticoids are most commonly
Corticosteroids are different from the anabolic steroids that are used for
building up muscle mass. Generally, glucocorticoids are used for managing
a large number of disorders like Asthma, Gout, Allergy, Rheumatoid Arthritis,
Inflammatory Bowel Disease, Multiple Sclerosis and in pregnancy for Fetal
Lung Maturation. Corticosteroids act by switching off genes involved in the
inflammatory reaction, thus, suppressing the effects.
At higher concentrations, they can even activate the
expression of anti-inflammatory genes.
However, the many benefits of corticosteroids are offset by several adverse
effects if glucocorticoids are taken in high doses for a long period of time.
What are the side effects of steroids?
2. Abdominal obesity
3. Growth retardation in children
9. Development of drug resistance
How does steroid induced diabetes happen?
Diabetes Mellitus (DM) is a complication of glucocorticoid use and
is associated with an abnormal increase in blood glucose level.
This includes both the exacerbation of hyperglycemia in diabetic
patients, as well as causing DM in patients without hyperglycemia
before initiation of glucocorticoid therapy. Hyperglycemia may be transient in most
cases but some patients may develop other symptoms associated
with diabetes like polydipsia and polyuria, as well as
glucose levels do not normalize after discontinuation. The end effect
of this may be serious leading to elevated risk of cardiovascular disease
and even coma in elderly patients. Patients who have received transplantation
are given corticosteroids for immune suppression to prevent graft rejection.
In such patients new onset diabetes after transplant is a strong predictor
of graft failure. Currently, there is a paucity of data on the exact prevalence
of steroid induced diabetes making it a challenge for medical practitioners.
What is the mechanism of action of glucocorticoids?
After long term use of glucocorticoids, there is development of insulin resistance and
dysfunction of beta cells of pancreas which gives rise to Hyperglycemia.
They act on the adipose (fat) tissue and liver cells to control the pathways
involved in fatty acid release and uptake from the blood. Their net effect is
to increase the amount of fatty acids in the bloodstream, which interferes
with the uptake of glucose by cells in the body. This leads to the development
of insulin resistance in tissues, particularly in the skeletal muscle Insulin resistance
in turn increases production of glucose (gluconeogenesis) by the liver while
simultaneously lowering uptake of glucose by tissues from the bloodstream.
Corticosteroids also increase glucose production directly by activating genes
involved in the metabolism of carbohydrates in liver, leading to increased
What are the risk factors for development
of Steroid induced Diabetes Mellitus?
Impaired glucose tolerance prior to initiation of therapy
Dosage of the medication
Duration of medication course
However, glucose tolerance is normally seen
to decline with age and obesity, decreased physical activity, and common
use of medications is also more often seen in elderly patients. This makes
older age the only apparent independent risk factor for SDM. In addition to
these, other suspected risk factors include concurrent use of other
immune-suppressive agents, low serum magnesium levels, liverdisease
such as Hepatitis C virus infection.
The symptoms common to diabetes such
as increased thirst and increased urination after taking corticosteroids can
be indicative of SDM and should prompt an assessment of blood glucose,
ideally after 4 to 6 hours of taking the medication. Diabetic ketoacidosis which
is a common complication of type 1 DM has also been reported in patients with
diabetes who receive glucocorticoids and they should hence be monitored carefully.
Steroids can precipitate diabetic ketoacidosis and this may occur in absence of any
other triggering factor, and even in patients with type 2 DM that is well under control.
How do you know if you have steroid induced diabetes?
Considering that corticosteroids are some of the most commonly
used medications in the world, it is no surprise that Steroid induced Diabetes Mellitus is a rather common
occurrence and glucocorticoid induced diabetes is the most common cause of
Steroid induced Diabetes Mellitus, in more serious cases, can lead to hyperglycemia
that may require hospitalization or become a medical emergency. Further,
high glucose level in blood increases the risk of infections and leads to other
complications and comorbidities. Anticipating and detecting SDM early is hence
essential to improve patient outcome.
The diagnostic procedure for Steroid induced Diabetes Mellitus is
similar to that of other types of diabetes. Prior to beginning the glucocorticoid
treatment, patients should be warned to look out for the common symptoms of
diabetes and to seek blood sugar test if symptoms are seen. A glucose level
higher than 200 mg/ml one to two hours after lunch (as glucocorticoids do not
affect fasting glucose levels) should be further investigated.
In the absence of symptoms, HbA1c, fasting plasma glucose or oral glucose
tolerance test may be used, and the results confirmed with repeat testing.
Blood glucose should also be monitored for non-diabetic patients but who at
high risk for developing Steroid induced Diabetes Mellitus. Oral glucose tolerance test can allow early
detection diabetes in highrisk patients. In patients where HbA1c levels could
be unreliable, fructosamine level testing can be done.
How is steroid induced diabetes treated and managed?
Management of Steroid induced Diabetes Mellitus is based on controlling
hyperglycemic episodes in patients who have taken
glucocorticoids. Frequent fluctuations in blood sugar levels are associated with
increased risk of mortality. The therapeutic measures should be progressive and
additive with emphasis on selection of those hypoglycemia drugs that work with
the pathophysiology of Steroid induced Diabetes Mellitus and with the patient's hyperglycemia profile. Since,
these patients are already on medications for treatment of other diseases,
or have recently undergone transplantation, drug interactions between these
medications should be taken into consideration.
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Oral hypoglycemic drugs are prescribed for treatment of milder forms of Steroid induced Diabetes Mellitus.
The oral hypoglycemic drugs which can be given for Steroid induced Diabetes Mellitus should have a rapid
action onset, with preference given to those that can reduce postprandial glucose.
insulin sensitizers as well as insulin itself may also be prescribed for treatment of Steroid induced Diabetes Mellitus.
The main focus of managing Steroid induced Diabetes Mellitus is controlling blood glucose level.
In addition to the hypoglycemic drugs, healthylifestyle measures may also be
implemented. However, these should be done under guidance from a medical counselor because
of the condition for which the glucocorticoid was prescribed.
Despite Steroid induced Diabetes Mellitus being a frequent unwanted effect of corticosteroid usage, its exact mechanisms
are not well known. The diagnostic and treatment procedures are not standardized,
but are rather tailored based on the dosage of the drug given and the patient's profile.
Better understanding of Steroid induced Diabetes Mellitus and an increased awareness about its existence in
patients taking steroid medications are essential to recognize Steroid induced Diabetes Mellitus early and initiate
glucose regulating treatment at the earliest.