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.
More on meds next week!
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 at 3:50 pmI 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 at 6:46 pmI 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 at 8:16 pmI 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 at 12:24 pmHi sue,
Posted by acampbell | Jun 19, 2008 at 1:01 pmI 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!
Hi elofford,
Posted by acampbell | Jun 19, 2008 at 1:09 pmNot 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.
My stepdad is a type 2 diabetic. He just had found out he has a tumor on his voice box and was told he will have to do an MRI and he has to wait until next week. Now, he is having problems with breathing, hoarseness and no appetite. He just went to the Emergency Room and they gave him antibiotics and a steroid shot. He is still having the same symptoms: No appetite, can’t sleep because of shortness of breath and he still tries to smoke a cigarette. Will he be Okay ? i mean, he still has the shortness of breath and he can’t breathe to sleep at night a full 6-8 hours and he is in bad shape. Why the people at the Emergency Room sent him home, I don’t know. Will he be able to get low dose chemo for the tumor to shrink? He may need to have the voice box taken out but not be able to talk but he don’t want to go that route. Has anyone out there survived a tumor on the voice box?
Posted by xena007 | Aug 30, 2008 at 10:38 pmHi xena007,
It sounds like your stepfather is going through a tough time. Has he been referred to a cancer specialist? Your questions are probably best answered by his physician and/or an oncologist. Also, as hard as it probably will be for him, one of his main goals should be to stop smoking. I wish you and your stepfather the best of luck.
Posted by acampbell | Sep 03, 2008 at 7:59 amI know that the following information may sound suspect. However, it is not meant to provide advice as opposed to sharing my particular experience.
Posted by Bruce Garwood | Oct 25, 2009 at 2:08 pmI developed a rash. My Doctor says its poison Ivy. However, the rash more resembles Scabies to me. The Doctor insisted that I needed steroids? for treatment and advised me that I would experience a rise in my blood sugar. As I am a type 2 diabetic, and someone, who at 70, should do a better job of controlling what I eat, etc, I don’t. The Doctor prescribed Prednisone (10mg), two tabs a day for four days,1 tab a day for four days, and 1/2 tab a day for four days.
Well, my waking blood sugar used to be somewhere around 130-140. My daily, somewhere around 125 and after my sometimes loss of self control at dinner with friends, it gets into the 150’s. After two days on Prednisone, my waking blood sugar is about 120, just before lunch it was 92 and I felt like my blood sugar was going down and I had the shakes; however I was fine after a bowl of soup and an apple. Same thing on day three and four. (incidentally my rash has gotten worse) The Doctor also prescribed hydroxine 25mg for itching. It doesn’t do anything for itching but induces, in me, what I imagine a taking of to much cocaine would be like. lethargic, very, very drugged like, can’t concentrate, fall asleep every few minutes. ( I don’t take it anymore)
My question is, is there any data on stroids helping type two diabetes? Incidentally, my feet don’t hurt anymore! Thanks for any input.
Hi Bruce,
I’m not aware of data showing that taking steroids helps diabetes (meaning, that it lowers glucose levels). For most people with diabetes, taking steroids can raise glucose levels. You don’t mention if you take medicine to help control your diabetes; however, it may be that your pancreas is responding to the steroids by releasing more insulin. Generally, taking steroids for a short amount of time isn’t worrisome enough to be concerned about the effects on blood glucose. Hopefully your rash will clear up soon!
Posted by acampbell | Oct 27, 2009 at 8:27 amI have type 2. I have had a couple of steroid shots and a 6 pack of steroids for bronchitis. My blood sugar shot up to 230-250. I am through with the pills for a week now. I take Avandia. I just got a low number of 175 in the morning but the number sometimes goes back up to 230. I never had a problem controlling my numbers. I went back on a strict diet, but things are real slow coming around. Do you think they will start coming back down? How long do the steroids stay with you.
Posted by B. Chiasson | Jan 15, 2010 at 10:35 pmHi,
Steroid injections can sometimes affect glucose levels up to 2–3 weeks later. Also, you’re recovering from bronchitis, plus the oral steroids. So I’d suggest perhaps waiting another week and continuing to check your glucose levels. You don’t mention what your glucose average was prior to the steroids, but if they haven’t come back down to “presteroid” levels after another week, give your physician or diabetes educator a call.
Posted by acampbell | Jan 20, 2010 at 5:08 pmHello,
I have to take steroids for life [5mg daily] for chronic Sarcoidosis. I have been having symptoms such as shaking, feeling sick and hunger especially for something sweet, sometimes my blood shows raised sugar levels, other times its normal. My GP says the steroids are upsetting my sugar levels. How will this affect my body and organs?
Posted by Cheryl | Feb 17, 2010 at 8:48 amHi Cheryl,
Managing diabetes while taking steroids can be a little tricky, but its certainly possible. You don’t mention what kind of medicine you take for your diabetes, and you don’t mention how often your blood glucose is running on the high side. My advice is to ask your physician for a referral to a diabetes specialist (an endocrinologist) to evaluate your diabetes medicine program and maybe even switch your diabetes medicine. Also, don’t forget to focus on your carbohydrate intake. You don’t have to stop eating carbohydrate foods, but it’s helpful to try and eat about the same amount of carbohydrate at your meals on a day-to-day basis. Doing so can help lessen the fluctuations in your blood glucose. Meet with a dietitian if you’re not sure how much carbohydrate to aim for. Again, the overall goal (for most people) for diabetes is an A1C level of less than 7%. If you’re not at this target range (or whatever range you’ve decided upon with your doctor), it’s time to adjust your treatment plan.
Posted by acampbell | Feb 17, 2010 at 5:24 pmBruce Garwood,
You and I are kidred spirits. I too am Type 2 and developed a rash(?). Having had my Grandson the day before, and my doctor not being in, I went to the ER to like you, make sure I didn’t have something contagious. They had no idea what the rash was? Three doctors looked at me and gave me no real diagnosis, except that I had a rash.
Finally scratching there heads they sent me home with a little tube of antibotic cream, (which did nothing) and steriods. I forgot the name but it one that you take 5 the first day, 4 the next, and so on till done.
Not only did I make them aware of my diabeties, I was already shaking because it was high. A few days later this rash (?)grew all over my body and I had welts, even in my hair. Four weeks later and having seen allergists, and dermatoligists, and through biopsy found I had an aggresive case of Psorisis and exama. I had no idea how painful this is. I’d never had any skin conditions and I’m 44.
Riddle me this? How do two doctors send a diabetic home with steriods for an undisclosed condtion? And never did they mention and changes I might need to be aware of, being a diabetic. Not to menation, the fact that they couldn’t figure out or even consider psorisis now that I have learned more about it, it’s pretty common. I’m not a doctor and I wasn’t aware of this disease. What I have become aware of, is if you catch it early you can take steps to minimize the breakout hence pain. I’m considering taking further action.
Just my story…;) Wish you all well
Posted by Heidi | Feb 21, 2010 at 3:20 pm