Steroids and Diabetes: Safe Use and Alternatives

Steroids are powerful medications often prescribed to manage inflammation and other medical conditions. However, for individuals with diabetes, the use of steroids can complicate blood sugar management, leading to potential health risks. As diabetes patients face the challenge of maintaining stable glucose levels, understanding the impact of steroids is crucial. In this blog post, we will explore safe steroid use for diabetics and discuss effective alternatives that can help manage inflammation without significantly affec ting blood sugar levels. By staying informed, patients can make better decisions for their health while navigating the complexities of treatment options.

Steroids: Types and Their Medical Uses

Steroids are a class of powerful drugs that play a significant role in treating various medical conditions. Broadly, they are categorized into two main types: corticosteroids and anabolic steroids. These substances mimic hormones in the body, with corticosteroids resembling cortisol (a hormone produced by the adrenal glands) and anabolic steroids mimicking testosterone.

• Corticosteroids

Corticosteroids, like prednisone and hydrocortisone, are primarily used to reduce inflammation and suppress the immune system. They are commonly prescribed for autoimmune disorders, asthma, and rheumatoid arthritis, helping manage chronic inflammation and alleviate symptoms in conditions where the immune system attacks healthy tissues.

• Anabolic Steroids

Anabolic steroids, on the other hand, are synthetic versions of testosterone. They promote muscle growth and strength and are primarily used in treating muscle-wasting diseases or aiding recovery after severe injury or surgery. However, their misuse in sports and bodybuilding is prevalent.

How Do Steroids Affect Blood Sugar Levels?

Corticosteroids significantly impact blood sugar levels, potentially causing complications for both diabetic and non-diabetic individuals. They reduce insulin sensitivity, meaning cells become less responsive to insulin, which results in elevated blood sugar levels—a condition known as insulin resistance.

Additionally, corticosteroids promote gluconeogenesis, the production of glucose from non-carbohydrate sources in the liver, leading to excess glucose release into the bloodstream. They also enhance the liver’s ability to produce glucose, worsening hyperglycemia, especially in those managing diabetes.

These metabolic changes can create a hormonal imbalance, making it challenging to regulate blood sugar effectively. In some cases, even non-diabetic individuals on long-term steroid therapy may develop steroid-induced diabetes.

Insulin Sensitivity and Resistance: The Steroid Connection

Corticosteroids significantly affect insulin sensitivity, often leading to insulin resistance and difficulty regulating blood sugar. This resistance stems from disruptions in how the body uses insulin at the cellular level, particularly impacting glucose transport and uptake.

When insulin binds to its receptors on cell surfaces, it activates the PI3K-Akt pathway, facilitating the translocation of glucose transporters like GLUT-4 to the cell membrane, allowing glucose to enter muscle and adipose tissue. However, chronic steroid use can reduce the number of insulin receptors or impair signaling in this pathway, resulting in fewer GLUT-4 transporters being activated. This decreases glucose uptake and raises blood sugar levels.

This reduced sensitivity particularly affects Muscle and fat cells, leading to impaired glucose tolerance after meals. Over time, prolonged corticosteroid use can cause persistent issues with glucose uptake. The pancreas compensates by increasing insulin production, but this can eventually lead to pancreatic exhaustion, contributing to steroid-induced diabetes in non-diabetic individuals or worsening glycemic control in those with diabetes.

Steroids and Type 1 Diabetes

Steroid use in individuals with Type 1 diabetes poses significant challenges for blood glucose management. Type 1 diabetes is characterized by an autoimmune attack on insulin-producing beta cells in the pancreas, resulting in an absolute deficiency of insulin. While corticosteroids can treat inflammation or autoimmune conditions, they can also lead to insulin resistance and increased blood glucose levels.

Corticosteroids impair insulin receptor function and reduce the number of GLUT-4 transporters, decreasing glucose uptake in muscle and fat cells. This leads to heightened blood glucose levels and fluctuations, making glycemic control difficult. Steroids also stimulate glucagon release, further complicating glucose regulation and increasing the risk of both hyperglycemia and hypoglycemia.

As a result, insulin dosage adjustments are often necessary when Type 1 diabetics use steroids, as higher steroid doses require increased insulin to maintain control. Continuous glucose monitoring (CGM) can assist in fine-tuning insulin delivery in response to steroid-induced hyperglycemia.

While steroids possess immunosuppressive properties that may theoretically reduce autoimmune activity, their benefits in managing Type 1 diabetes’s underlying autoimmune processes are unclear. Careful monitoring is essential to balance the treatment of coexisting autoimmune disorders with the risks of exacerbating hyperglycemia.

Steroids and Type 2 Diabetes

Managing blood sugar levels is challenging for individuals with Type 2 diabetes due to insulin resistance, and the introduction of corticosteroids like prednisone and hydrocortisone can further complicate this. These steroids impair insulin effectiveness, increasing glucose production in the liver through gluconeogenesis and reducing insulin sensitivity in muscles and fat cells, leading to hyperglycemia.

When prescribed steroids, patients with Type 2 diabetes require careful blood glucose monitoring, as steroid use typically raises blood sugar levels shortly after administration and can result in persistent hyperglycemia. This often necessitates adjustments to basal insulin or oral medication dosages and close collaboration between patients and healthcare providers to manage diabetes effectively during steroid treatment.

Long-term steroid use can worsen insulin resistance and may contribute to metabolic syndrome, leading to weight gain and complications in managing blood sugar levels. Patients on chronic steroids should be closely monitored for worsening glycemic control, with strategies including lifestyle modifications and adjusting steroid use to mitigate impacts on diabetes management.

Risk Factors for Steroid-Induced Diabetes

Steroid-induced diabetes is a type of diabetes that can develop from prolonged use of corticosteroids like prednisone and hydrocortisone. While these medications are often prescribed for inflammatory and autoimmune conditions, their long-term use can disrupt glucose metabolism and increase diabetes risk. Factors that heighten this risk include:

• Long-Term Steroid Therapy

Chronic use of corticosteroids, especially for conditions like rheumatoid arthritis or lupus, can lead to significant glucose metabolism disturbances.

• High Dosages of Steroids

Higher steroid doses accelerate insulin resistance, making even non-diabetic individuals prone to elevated blood sugar levels.

• Obesity

Obese individuals are already at higher risk for insulin resistance, and corticosteroids can worsen this condition, further complicating glucose regulation.

• Family History of Diabetes

Those with a family history of Type 2 diabetes may have a genetic predisposition that makes them more vulnerable to steroid-induced diabetes.

• Pre-existing Prediabetes or Glucose Intolerance

Individuals with prediabetes or existing glucose intolerance are at increased risk, as corticosteroids can exacerbate these conditions and lead to full-blown diabetes. About 98 million American adults have prediabetes, according to the CDC.

• Pancreatic Dysfunction

A pancreas that struggles to produce enough insulin can further complicate blood sugar control when corticosteroids are introduced, eventually leading to diabetes.

Managing Blood Sugar Levels While on Steroids

Steroid medications like prednisone and hydrocortisone are essential for treating various conditions, but they can lead to hyperglycemia, particularly in individuals with diabetes. Effective blood sugar management is crucial while on steroids. Here are key tips:

• Monitor Blood Sugar Frequently

Regular glucose checks are vital to catch spikes early, especially after meals. Consider using Continuous Glucose Monitoring (CGM) for real-time data.

• Adjust Insulin or Medication Dosage

Steroids can decrease insulin sensitivity, requiring dose adjustments. Consult your healthcare provider before making changes to your regimen.

• Focus on a Low-Glycemic Diet

Eat low-glycemic foods to prevent blood sugar spikes. Practice carb counting, choose high-fiber foods, and monitor portion sizes. Steroid use may necessitate a 20-50% increase in insulin dosages or oral diabetes medications to combat insulin resistance.

• Incorporate Regular Exercise

Physical activity enhances insulin sensitivity. Engage in moderate exercise while monitoring blood sugar levels before and after.

• Stay Hydrated

Drinking plenty of water helps regulate blood sugar levels and prevents dehydration.

• Time Steroid Doses Strategically

Discuss with your doctor the optimal timing for taking steroids to minimize blood sugar levels rise.

• Address Stress and Sleep

Manage stress through techniques like yoga or meditation, as both stress and lack of sleep can worsen hyperglycemia.

• Regular Follow-ups with Your Healthcare Provider

Collaborate with your healthcare provider to adjust your diabetes management plan as needed, especially if steroid dosages change.

Long-Term Health Risks of Steroid Use in Diabetics

Corticosteroids like prednisone and hydrocortisone, commonly prescribed for chronic inflammatory conditions, can pose significant health risks for individuals with diabetes, particularly with prolonged use. Here’s a brief overview of the potential complications:

• Cardiovascular Disease Risk

Long-term steroid use can lead to increased blood sugar levels, contributing to chronic hyperglycemia—a known risk factor for heart disease. This is exacerbated by oxidative stress, which damages blood vessels and promotes atherosclerosis, and by endothelial dysfunction, leading to hypertension.

• Neuropathy (Nerve Damage)

Steroids may accelerate diabetic neuropathy by worsening insulin resistance and raising blood sugar levels, damaging peripheral nerves. Chronic hyperglycemia and altered inflammatory responses further contribute to nerve damage.

• Retinopathy (Eye Damage)

Steroid use can worsen diabetic retinopathy by increasing blood glucose levels, and damaging the small blood vessels in the retina. It also raises the risk of glaucoma and cataracts.

• Nephropathy (Kidney Damage)

Prolonged steroid use can exacerbate kidney damage by increasing blood pressure and worsening blood sugar control. Chronic inflammation and oxidative stress contribute to declining kidney function, potentially leading to kidney failure. Diabetic neuropathy affects 50% of people with diabetes, and steroid use can worsen nerve damage by increasing blood sugar levels and promoting inflammation.

• Exacerbation of Insulin Resistance and Hyperglycemia

Steroids impair insulin sensitivity and interfere with glucose uptake, leading to persistent hyperglycemia. Patients may need a higher insulin dose or oral medications, complicating diabetes management.

Steroids and Cardiovascular Risk in Diabetics

Corticosteroids are commonly used to treat inflammatory conditions, but their prolonged use can significantly increase cardiovascular risks in diabetic patients. Here’s a concise overview of how steroids contribute to cardiovascular issues:

Hypertension (High Blood Pressure)

• Fluid Retention: Steroids cause the kidneys to retain sodium, leading to increased blood volume and elevated blood pressure. This is especially problematic for diabetics, who are already at risk for cardiovascular complications.

• Vascular Inflammation: Steroids promote inflammation in blood vessels, further narrowing arteries and raising hypertension risk, which increases the likelihood of heart attacks.

Cholesterol Imbalances and Dyslipidemia

• LDL Increase: Steroids elevate low-density lipoprotein (LDL) cholesterol, leading to plaque buildup in blood vessels and atherosclerosis, increasing the risk of heart disease.

• HDL Decrease: They lower high-density lipoprotein (HDL) cholesterol, which normally helps remove excess cholesterol, worsening cardiovascular risk. Steroids also raise triglyceride levels, further contributing to heart disease.

Atherosclerosis and Plaque Buildup

• Vascular Inflammation: Steroids exacerbate inflammation in blood vessels, leading to more plaque accumulation. Diabetic patients are particularly vulnerable due to pre-existing high blood sugar.

• Endothelial Dysfunction: Steroids impair blood vessel function, hindering their ability to dilate, which can elevate blood pressure and increase cardiovascular event risk.

Myocardial Infarction (Heart Attack) Risk

• The combined effects of hypertension, dyslipidemia, and atherosclerosis significantly increase the risk of heart attacks in diabetics on steroids. Increased heart strain from hypertension and the potential for atherosclerotic plaque rupture lead to heart attacks.

Alternative Treatments for Steroid Use in Diabetics

For diabetics requiring treatment for inflammatory conditions, steroids are often prescribed but can significantly impact blood glucose levels. Therefore, safer alternatives are sought. This article highlights several options, including:

• Non-steroidal anti-inflammatory Drugs (NSAIDs)

These medications, such as ibuprofen, naproxen, and aspirin, inhibit cyclooxygenases (COX-1 and COX-2) to reduce pain and inflammation without significantly affecting blood sugar. While generally safer, they can have gastrointestinal and cardiovascular side effects with long-term use.

• Biological Therapies

Biologics, including TNF inhibitors (like etanercept and infliximab), target specific immune components to reduce inflammation. They generally pose a lower risk of impacting glucose levels and are often used for chronic conditions like rheumatoid arthritis, chronic obstructive pulmonary disease, and Crohn’s disease.

• Disease-modifying antirheumatic Drugs (DMARDs)

Medications like methotrexate modulate the immune response to manage inflammation without the metabolic disturbances associated with steroids. While side effects exist, DMARDs are generally safe for long-term use in diabetics with proper monitoring.

• Topical Anti-Inflammatory Treatments

These include topical steroids, which minimize systemic absorption, and non-steroidal options like diclofenac gel, providing localized relief without significantly affecting blood glucose.

• Other Immunosuppressive Therapies

Drugs such as azathioprine and cyclosporine can be used for autoimmune conditions and generally have less impact on glucose metabolism than steroids. Careful monitoring is crucial for managing potential side effects.

Conclusion

Steroid use in patients with diabetes poses significant risks, including high blood sugar levels and insulin resistance, which can lead to complications like steroid-induced diabetes. Effective management involves regular blood glucose monitoring and adjusting insulin therapy as needed. Adopting lifestyle changes, such as a low-glycemic diet and regular exercise, can improve insulin sensitivity. Exploring alternatives like non-steroidal anti-inflammatory drugs (NSAIDs) and biological therapies may provide effective inflammation management with fewer impacts on glucose levels. Continuous patient education and risk assessment are crucial for navigating steroid use, and ensuring a balanced approach to diabetes management while prioritizing overall health. 

Frequently Asked Questions

– Disclaimer –
This blog is for informational & educational purposes only, and does not intend to substitute any professional medical advice or consultation. For any health related concerns, please consult with your physician, or call 911.