If you have diabetes and your healthcare provider wants you to take a steroid drug for another condition, should you? Learn about the benefits, risks and alternatives to drugs like prednisone and cortisone, then decide with the help of your doctor.
According to diabetes.co.uk, steroid drugs (also called corticosteroids) mimic the action of cortisol, a stress hormone produced by the adrenal glands (which sit on top of the kidneys). Like cortisol, they reduce the body’s immune response, especially inflammation, (for example, the red, swollen, painful, itchy, feeling you get from an insect bite).
Inflammation on the skin is annoying, but in our internal organs, it can cause serious problems. So, doctors prescribe steroids for asthma and lung disease; for bowel diseases like Crohn’s and colitis; for autoimmune diseases such as lupus and rheumatoid arthritis; for allergies and for many other inflammatory conditions.
Steroids can be oral pills like prednisone, injections into inflamed joints such as cortisone, or topical creams and lotions applied to the skin such as betamethasone. They are usually effective in reducing the symptoms of inflammation, but they rarely help the underlying causes of the illness. Although some inflammatory symptoms are disabling or dangerous and need to be suppressed, steroids can mask the causes, and they raise blood sugars.
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Corticosteroids tend to drive blood sugars higher, sometimes much higher. Wil Dubois, a diabetes expert and blogger with type 1 diabetes, reports taking prednisone for muscle spasms: “I took my first pill at a blood sugar of 96 mg/dL. An hour later I was at 552 mg/dL. I ran my insulin pump dry fighting the blood sugar. My insulin might as well have been water.”
According to Medtronic’s Diabetes Clinical Manager Beth Spencer Kline, MSN NP-C, CDE, “steroids increase the liver’s release of glucose and cause insulin resistance, which lead to insulin (either injected or made by your own pancreas) working less efficiently.”
According to diabetes.co.uk, high blood sugars usually go back down when steroids are stopped, but long-term use (over three months) can cause permanent problems and even drive a person with prediabetes into type 2. This is true of oral, injectable, and topical steroids.
Medtronic gives several strategies for people considering steroids. “First,” says Beth Kline, “let your prescribing doctor know you have diabetes, because they may be able to prescribe an alternative medication that will not affect your glucose levels.”
1. If the doctor knows no alternatives, inform your diabetes care team. They will want to adjust your treatment plan to keep glucose levels in your target range. They will quite likely want to increase insulin doses. Some oral medicines for type 2 can also be safely increased, while some can’t. Check with your prescriber or pharmacist.
2. Steroids don’t elevate glucose levels continuously; there are ups and downs, so you may need more frequent glucose checks or a continuous glucose monitor (CGM).
3. Test your urine for ketones as directed and notify your healthcare team immediately if your ketone levels are moderate to high, or your glucose levels remain high, or if you’re experiencing nausea, vomiting or shortness of breath.
4. Even on steroids, hypos blood (low blood sugars) are possible if you’re taking insulin. Carry fast-acting carbs, such as glucose tablets or gels, in case your glucose levels drop.
5. Don’t stop steroids suddenly. They have to be tapered off, because your body will have stopped making its own steroids in response to the medication.
6. Dubois says steroids can “wipe out” the immune system and leave users open to infection, so people using steroids should, “Stay away from places full of sick people like hospitals, doctor’s offices and daycare centers.”
7. Dubois also says, “Short-term high blood sugars caused by steroids won’t kill you. They will make you a bear to live with, and you will be at risk of dehydration, so drink lots of water.” Perhaps be even stricter than usual about avoiding concentrated carbohydrate foods.
8. Remember that the effects of steroid use will take a while to wear off. Registered Dietitian and Certified Diabetes Educator Amy Campbell says that after receiving a steroid injection, “expect the effect on your blood glucose to last up to several weeks.”
Even if your doctor doesn’t know of an alternative to prednisone or cortisone for you, there may well be non-medical ways to control inflammation. Alternative medicine pages have dozens of ideas:
• The most frequently recommended spice is turmeric, the main ingredient in curry powder. Another widely used remedy is ginger. Other anti-inflammatory foods are garlic, blueberries, green tea and oregano.
• An anti-inflammatory diet might help turn down the fires within that are making you sick. Fortunately, an anti-inflammatory diet can also be good for diabetes, with lots of fruits and vegetables, and little or no refined carbohydrates. Fish, nuts, seeds, omega-3 fatty acids and onions are often recommended, while saturated fats and processed foods are discouraged.
• There are also alternatives to steroid injections for joints. One, called “prolotherapy,” involves watery injections into damaged joints and connective tissue. More information about prolotherapy can be found on the Mayo Clinic website.
• Most alternative practitioners seem to recommend getting more sleep to help treat inflammatory disease. This make sense to me, as sleep is when the immune system comes to life and the body heals.
• Chinese medicine such as herbs and acupuncture are standard treatments for inflammation in Asia, although they’re considered “alternative or complementary” here. After consulting with their doctors, people with diabetes might consider these alternatives before committing to a long course of steroids.
So, people with diabetes can take steroids. But they should use other options whenever possible, be very aware of their glucose control while taking the drugs, and stay in close touch with their diabetes care team.
Want to learn more about diabetes and steroids? Read “The Link Between Prednisone and Diabetes.”
A nurse for 25 years at University of California San Francisco and Kaiser hospitals, and one of the first professional health coaches. Nurse Spero is author of Diabetes: Sugar-Coated Crisis and The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, as well as co-author of Diabetes Heroes and the diabetes chapter in Where There is No Doctor. He writes for Diabetes Self-Management, Pain-Free Living, and Everyday Health.
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