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Diabetes Linked to Low Dose Steroids

Both high and low dose steroids now correlated with increased risk of diabetes…. 

While anti-inflammatory steroids have been previously found to raise blood sugar levels in high doses, a small study recently from Flinders University, Australia, found that low doses also had a similar effect. Steroid medications are used to treat a wide variety of conditions including: arthritis, asthma, organ transplantation, and auto-immune diseases. Patients with diabetes need to be especially careful while on these medications because steroids oppose insulin action and stimulate glucose production from the liver resulting in a net increase in blood glucose levels.

Dr. Carolyn Petersons studied the effect of anti-inflammatory steroids on the body’s ability to metabolize glucose. The study analyzed nine patients given anti-inflammatory steroids for rheumatoid arthritis for a one-week period and compared the results with 12 long-term steroid users. Even after a week, low dose steroids increased the amount of glucose made in the body when fasting. The study also found that the low dose steroids made patients less sensitive to insulin.

Dr. Petersons said that doctors should rethink prescribing anti-inflammatory steroids in conditions requiring low doses over a prolonged period. She further stated, "Knowing how steroids affect insulin sensitivity in the body means we can find the right kind of treatment to target the underlying cause of the diabetes, but it also means we need to be more vigilant in screening patients so we don’t miss people who have steroid-induced diabetes. Finally, we should be looking at alternative ways to treat these conditions instead of using steroids, particularly in patients who may be at high risk of developing diabetes."

Practice Pearls:
  • Low dose steroids may also be linked to high blood glucose.
  • Steroids increase blood glucose by opposing the action of insulin and increasing the liver’s production of glucose.
  • Alternative treatment may be optimal in patients who are diabetic or at risk for developing diabetes.

Diabetes Care September 2013 36:2822-2829; published ahead of print May 13, 2013, DOI: 10.2337/dc12-2617