Steroids, High Blood Sugar, and Steroid-Induced Diabetes

Steroids can have a powerful effect on blood sugar levels. In some cases, steroids can even trigger the development of diabetes, a condition known as steroid-induced diabetes.

If you already have diabetes, you should know that using steroids, even if only temporarily, may require you to make significant changes to your blood sugar management strategy.

“Steroids, also known as corticosteroids, are awesome at doing their job, which is reducing inflammation and suppressing your immune system,” says Thomas Grace, MD, a physician with the Blanchard Valley Diabetes Center in Findlay, Ohio, and the head of clinical advocacy and outcomes at Dexcom.

There are multiple types of steroids, but when your doctor calls a medication a “steroid,” they are referring to corticosteroids, says Dr. Grace. (By contrast, anabolic steroids, drugs such as testosterone therapies that are often associated with sports and bodybuilding, belong to a completely different class of medicine, and work much differently in the body.)

• Mimic the effect of hormones such as cortisol, which is known to raise blood sugar levels
• Cause the liver to release stored glucose directly into the bloodstream
• Cause the liver to make new glucose, a process known as gluconeogenesis
• Inhibit the ability of muscle cells to take up sugar from the bloodstream
• Increase insulin resistance, which means your body requires more insulin to maintain a healthy metabolic balance

“People with diabetes need to use steroids with caution and should watch glucose levels closely,” says Grace, “with a blood glucose meter or, ideally, with a continuous glucose monitor (CGM).”

In some people without diabetes, steroids can cause blood sugar levels to rise above the level that indicates diabetes. This condition is known as steroid-induced diabetes.

Steroid-induced diabetes is a possible consequence of steroid treatment, particularly when steroids are used indefinitely for chronic conditions.

“For people with chronic illnesses like rheumatoid arthritis, lupus, multiple sclerosis, or inflammatory bowel disease, to name a few, steroids are necessary to combat the condition and constant inflammation,” says Grace. “Unfortunately, that can lead to persistently elevated blood glucose levels and subsequently to diabetes caused by the steroids.”

Steroid-induced diabetes causes the same warning signs and symptoms as other forms of diabetes, including extreme thirst and frequent urination, blurry vision, and frequent infections. It is diagnosed with one or more blood sugar tests.

• Allergy and lung disorders
• Muscle and joint pain
• Rheumatic conditions, such as rheumatoid arthritis and psoriatic arthritis
• Skin diseases, such eczema, hives, and severe psoriasis
• Eye allergies and inflammation
• Nervous system disorders, such as multiple sclerosis and cerebral edema

“Some people with diabetes may be able to tolerate steroids without needing to adjust treatments or medications, but some people with diabetes may experience high blood glucose levels and will need medication adjustments,” says Grace.

“The steroids that get into your general blood circulation usually have the biggest impact on your blood glucose levels,” says Grace. “Those would be oral steroids, sometimes injectable steroids (if they get outside of where they are injected), and possibly inhaled steroids.” Topical steroids, such as creams and lotions, are less likely to affect blood sugar levels because they do not enter the bloodstream.

Steroid treatment may also bring other changes that affect diabetes management: “Steroids … could cause you to be hungrier and disrupt your sleep,” says Grace. “In addition, most ailments we treat with steroids — knee pain, respiratory problems, etc. — can make physical activity more difficult.” A lack of sleep or exercise can also contribute to rising blood sugar levels, as can a change in your diet.

Because individual responses to steroids can vary so widely, it’s important to collaborate with your healthcare team and monitor your blood sugar. “The key to treating any type of diabetes is knowing what your blood glucose is doing in real time,” says Grace. “The best way to know if you will need to adjust your medications is to monitor your blood glucose levels very closely, preferably with a CGM.”

“The duration for which your blood glucose remains elevated after taking steroids can vary based on the type of steroid, dosage, and individual response,” says Grace.

Grace outlines the typical duration of action for several common steroid treatments:

• Hydrocortisone (oral): About 6 hours
• Prednisone: About 12 hours
• Dexamethasone: Up to 36 hours
• Injected steroids: 3–10 days

Grace emphasizes working closely with your healthcare team to fine-tune your diabetes medication doses as needed. If you don’t have an endocrinologist, contact your primary care team for additional support.

• Steroids can greatly increase blood glucose levels and reduce insulin sensitivity.
• In some cases, steroids can trigger the development of diabetes. Steroid-induced diabetes is treated the same way as type 2 diabetes.
• Steroid-induced diabetes may become a lifelong condition, even after you stop steroid treatment.
• Many people who use steroids require additional medication to manage their blood sugar levels. If you have diabetes, you may need to adjust dosages and monitor your blood sugar more carefully.