Steroids and Diabetes: A Dangerous Combination 2022

Corticosteroids, more commonly known as steroids, are naturally-occurring hormones that are secreted by the adrenal glands and in lesser quantities, the reproductive organs, in the body. The adrenal glands, also known as suprarenal glands are located at the top of either kidney and are responsible for regulating homeostasis in the body. 

Corticosteroids comprise catabolic steroids such as glucocorticoids (cortisol) and mineralocorticoids (aldosterone) that help regulate inflammation and maintain water-salt balance in the body, respectively. 

What is Cortisol? 

Cortisol, a glucocorticoid, is also known as the body’s ‘stress’ hormone and is thus secreted by the immune system in response to a perceived threat. As cortisol is primarily responsible for regulating various metabolic processes in the body, it plays a pivotal role in the maintenance of homeostasis. 

In other words, cortisol functions as an immunoprotective or immunosuppressive agent which protects the body from inflammation.

Steroids are routinely prescribed in both outpatient and inpatient medical care as they prevent inflammatory diseases such as asthma or inflammatory bowel disease from worsening. These also include auto-immune diseases such as Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Nephritic or Nephrotic Syndromes, in which the immune system goes haywire and starts attacking its body’s normal cells unnaturally. 

Synthetic steroids usually mimic cortisol and are thus prescribed in organ transplantation as well in order to prevent the body from eliciting a reactionary inflammatory response.

How Is Cortisol Related to Diabetes? 

Insulin, another hormone, is secreted by the beta-cells of the pancreas in response to elevated levels of blood glucose. Insulin helps to maintain the levels of sugar in the bloodstream by moving the glucose into cells for consumption. Excess levels of glucose are stored in the liver, muscles, adipose tissues (fat cells), and thus released into the bloodstream whenever required.

In order to maintain primary metabolic processes such as glucose metabolism, the liver releases glucose into the bloodstream time and again. However, if insulin is already in the bloodstream, it can either reduce or stop the liver from pumping glucose into the blood. 

In addition to its anti-inflammatory properties and keeping the body’s immune system in check, cortisol also plays a role in regulating the levels of glucose in the blood. High levels of cortisol apparently, reduce the liver’s sensitivity to insulin, or in simpler words, prevent the liver from recognizing the levels of insulin in the blood. Failure to comply with the body’s requirements for glucose, the liver goes into overdrive and continues to pump out glucose into the bloodstream.

Large doses of steroids can lead to abnormally high levels of blood glucose in an otherwise non-diabetic patient causing a phenomenon known as ‘Steroid-Induced Diabetes’. However, it is important to note that high cortisol levels can also exacerbate a predisposing or pre-existing case of diabetes. In patients with diabetes mellitus type 2 (Type 1 is an auto-immune condition and characterized by insulin deficiency rather than resistance), steroid doses require intensive monitoring or alternative treatment options.

Steroid-Induced Diabetes – Symptoms and Signs

The symptoms and signs of Steroid-Induced Diabetes can be mistaken for that of Diabetes Type I or II due to their vague similarities. Usually, steroid-induced diabetes comprises a host of symptoms that might go undiagnosed unless there are extremely high blood glucose levels. 

Some symptoms and signs include :

• Excessive thirst (Polydipsia) 
• Frequent urination (polyuria) might lead to multiple visits to the toilet during the night. Waking up frequently from sleep usually accompanies urgency or urine incontinence.
• Dizziness and nausea
• Tiredness, fatigue, and lethargy
• Inability to concentrate due to drowsiness
• Headaches and impaired vision
• Unintentional yet alarming weight loss 
• Decrease in appetite with severe mouth dryness
• Tingling sensation or numbness in digits
• Itchy skin (pruritus) or slowly healing infections

Risk Factors For Diabetes Type II

Long-term usage of steroids, however, such as those in rheumatoid arthritis or nephrotic syndromes, can further progress into Diabetes Mellitus II. Unregulated and uncontrolled levels of cortisol can cause excessive weight gain and puffy faces. People who are either overweight or obese also have a higher inclination of developing diabetes. 

Other demographics include Caucasians above the age of 40 years old or people pertaining to South Asian, Middle-Eastern, and African-Caribbean descent beyond 25 years of age. Plus, discrimination or unavailability of healthcare can prevent marginalized communities from accessing prompt care for preventable medical conditions. 

Management of Steroid-Induced Diabetes

The most popular synthetically occurring glucocorticoids include Prednisolone, Prednisone, Hydrocortisone (cortisol), Betamethasone, Dexamethasone, and Methylprednisolone. Weaning off steroids typically helps to wane off steroid-induced diabetes. But, there is no one-size-fits-all solution for managing steroid-induced diabetes in everyone. 

Oral Anti-diabetic Medications

As per the intensity or necessity of the condition, endocrinologists might need to prescribe oral anti-diabetic medications (metformin and/or sulfonylureas such as glimepiride) or injectable insulin for combatting steroid-induced diabetes.

It is necessary to assess the risk factors of developing steroid-induced diabetes in each patient (especially those who are already diabetic) before starting them on steroids for disease management. 

Your primary care physician might refer you to an endocrinologist if your body is at a higher risk of developing steroid-induced diabetes. Plus, those with a predisposition to diabetes (such as those with a positive family history) might require regular blood glucose monitoring as well. Diabetics should thus consult an endocrinologist for regular follow-ups so that the doctor can assess the discrepancies in blood glucose levels and evaluate for ketone bodies as well. 

As mentioned earlier, steroid-induced diabetes typically resolves after lowering or discontinuing steroids. In most cases, your endocrinologist might also lower the dosing of oral antidiabetics when discontinuing steroids. 

Lifestyle Modifications

Regular exercise and lifestyle modifications can help patients curb their steroid-induced diabetes where antidiabetic medications do not mandate necessity. Most primary care physicians might also recommend a dietician who can monitor your diet and help prevent you from developing steroid-induced diabetes. As glucose levels will commonly spike after meals, it is necessary to seek a well-detailed dietary plan from a nutritionist. 

The Final TakeAway

Steroid-Induced Diabetes does not have to be life-threatening. Routine vigilance is required when taking steroids, especially if you are going to take them for a long while. To prevent the long-term side effects of steroids, it is necessary to get yourself evaluated, even if there are no risk factors that you should be wary of. 

Getting diagnosed in the ambulatory medical setting might be useful in preventing any dire emergencies as patients with steroid-induced diabetes rarely give a warning before collapsing. 

Manhattan Medical Arts are here to assist you in your journey of well-being. Reach out to our expert primary care physician at MMA by booking an appointment, and get evaluated for steroid-induced diabetes today.

– 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.