The Ups and Downs of Meds and Diabetes (Part 1): Steroids

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Jun 16, 2008

The Ups and Downs of Meds and Diabetes (Part 1): Steroids

Amy Campbell

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 fact, sometimes people find out that they have diabetes after being prescribed steroids for a certain condition because their health-care provider notices an increase in blood glucose levels. Others may develop what is called "steroid-induced diabetes," which goes away after they stop taking these meds.

Why do steroids jack up glucose levels? First, they increase insulin resistance, causing your insulin (your own or injected insulin) to work less effectively in the body. This means that glucose levels build up in the blood. Second, steroids can trigger your liver to release extra glucose, again, leading to high blood glucose levels.

So, what do you do if your health-care provider prescribes steroids? Talk to the provider who is prescribing steroids to let him know that you have diabetes. He may be able to prescribe something else. But if that's not an option, develop a plan of action with your diabetes team. Here's what you'll need to do:

You'll probably need to check your blood glucose levels more often than you usually do—four or more times a day isn't uncommon.
If you take insulin, you'll likely need to increase your dose, for example, by up to 20% (often called a sick-day booster), depending on your glucose levels.
If you take pills, you may need to increase the dose, add another type of pill, or possibly even take insulin, temporarily. Again, this all is dependent upon the level of your blood glucose.
Call your health-care provider or diabetes educator if your blood glucose levels increase while you're on steroids and your medication dose isn't enough to bring them down.
Carry treatment for hypoglycemia (glucose tablets, juice, candy) with you in case your glucose levels drop suddenly.

Eventually, your steroid dose will be tapered down (steroids shouldn't be stopped all of a sudden). At that point, your diabetes drug doses will likely need to be tapered, too. Checking your blood glucose levels will let you know what's going on.

By the way, if you receive a steroid injection, expect the effect on your blood glucose to last up to several weeks. Steroid inhalers and creams usually don't raise blood glucose levels.

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I dont know if this is the forum, but I have a question I'd like to have addressed. I have type 2 diabetes (uncontrolled) and I'm presently using insulin. as a result of painful arthritis, I was given a cortisone injection and prescribed the drug, Celebrex. What is your opinion on this drug as it relates to persons with diabetes?

Posted by: elofford | Jun 18, 2008 03:50 PM

I have had Type 1 diabetes for 33 years. For 4 or 5 years up to about a year ago, I had persistent bursitis in both my hips that made sitting for long periods and sleeping painful. Several times a year I would have steroid shots in both hips and within a day my blood glucose would shoot up and I would increase my basal insulin by 25 to 30%. This would last 2 to 3 weeks. Anyone who with diabetes who needs steroids should carefully monitor their glucose and make the appropriate adjustments. Then they need to carefully watch for the end of the side effects because it will change quickly.

Posted by: gbtaylor | Jun 18, 2008 06:46 PM

I am one of those unfortunate ones who has to take steroids for asthma, and have type 2 diabetes. My glucose goes sky high, and I don't know how to handle it. I take an amaryl to try to counteract it, but I'm afraid of amaryl because almost always I have such a low that it is frightening. What are the consequences if you don't take something to make it go down, does your other organs get affected? And is that worse? I just can't seem to grasp diabetes...I know about it but I don't know about it....My gp doctor says I must take the amaryl if it gets higher than 150, but when I do the Prednisone...it goes into the 2 and 300.....range, it is scarey....if I take a whole one mg of amaryl it seems to be too much, but at the same time, it doesn't seem to be enough. I can't win for losing, but I have to be able to breathe, so I have to take the Prednisone....and I can't see the harm that the high glucose numbers are doing to me....what are they doing to me? Tell me how I can win this game....it is a game of one med against another trying to beat your body down......gasp!!!!!

Posted by: sue | Jun 18, 2008 08:16 PM

I am not a doctor, but from experience know that once you know your BG is low, TREAT IT and keep checking it.Ask your doctor to give you written instructions for the lows and the highs when s/he prescribes the steroids.

Due to a brain tumor, I had to take a very potent steroid for months. I had BG's in the 700's and had Diabetic Ketoacidosis. I was very sick, but learned that being forewarned is being forearmed. I was put in the hospital and am now well. I asked the same question, and learned that it was a matter of treating the brain swelling (No choice) and treating the side effects (No choice). It is tough but with medical guidance one gets through this stuff. Conditions have to be treated. Don't add to the problem with anxiety. The meds to treat both conditions are there to help you. Help yourself too. Keep learning about diabetes and how to take care of yourself. You can do it. Good luck.

Posted by: Millie | Jun 19, 2008 12:24 PM

Hi sue,
I can imagine how frustrated and worried you must feel. However, as Millie wisely put it, both of your medications are there to help you. The challenge is figuring out how to balance your diabetes with your asthma. You definitely don't want to let your blood glucose levels run high (above 180 or so) for any length of time. Have you talked with your doctor about trying a medication like metformin (perhaps in place of or along with amaryl)? Metformin doesn't cause hypoglycemia, so maybe it's an option. In the meantime, check your glucose levels frequently so that you can stay ahead of any lows. If you see your glucose levels dropping too much, then treat them before they get too low. Also, I'd recommend you make an appointment with a diabetes educator who can help you work out a more refined diabetes treatment plan that works for you. Ask your doctor for a referral. Keep at it!

Posted by: acampbell | Jun 19, 2008 01:01 PM

Hi elofford,
Not being a pharmacist, I asked a pharmacist that I work with for some info on Celebrex. Here's what she told me: Celebrex is known as a COX-2 inhibitor. This class of drugs is linked with an increased risk of cardiovascular events due to the incidence of edema and slight increases in blood pressure. People with diabetes are already at higher risk for cardiovascular problems because of their diabetes. Hopefully your provider has taken your diabetes into consideration while prescribing Celebrex. But if you're not sure, talk with him/her about whether Celebrex is the best choice for you. Weigh the pros and cons. Also, I'm not aware that Celebrex has a direct effect on glucose levels; if you're seeing high glucose levels, it's likely, in part, due to the cortisone injection you received.

Posted by: acampbell | Jun 19, 2008 01:09 PM

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