From the FDA Drug Label
Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.
The use of intra-articular steroid injections, such as triamcinolone, may increase blood sugar levels in individuals with diabetes. As a result, dosage adjustments of antidiabetic agents may be necessary to manage blood glucose concentrations.
From the Research
Yes, intra-articular steroid injections can increase blood sugar levels in individuals with diabetes mellitus, with the most recent and highest quality study 2 showing a significant elevation in blood glucose levels 1 day after injection. This effect typically begins within 1-2 days after the injection and may persist for up to 1-2 weeks. Patients with diabetes should monitor their blood glucose more frequently after receiving these injections, particularly during the first week. The magnitude of the effect varies based on the specific steroid used, the dose administered, and individual patient factors, such as the level of diabetes control, with higher HbA1c levels associated with greater elevation in blood glucose 2. Common steroids used for these injections include methylprednisolone (40-80mg), triamcinolone (20-40mg), and betamethasone (6-12mg). The blood sugar elevation occurs because corticosteroids promote gluconeogenesis in the liver, increase insulin resistance in peripheral tissues, and reduce glucose uptake by cells. While these injections are not contraindicated in diabetic patients, healthcare providers should consider using lower doses when possible and warn patients about the potential need to temporarily adjust their diabetes medications. Some key points to consider:
- The increase in blood glucose levels can be significant, with peak values reaching as high as 500 mg/dL 3.
- The timing of the peak increase in blood glucose levels can vary, but it often occurs within 24-72 hours after injection 3, 4.
- Patients with poorly controlled diabetes (HbA1c >7%) may experience a greater increase in blood glucose levels compared to those with well-controlled diabetes 2, 5.
- Insulin-dependent diabetic patients may also experience a greater increase in blood glucose levels compared to non-insulin-dependent diabetic patients 5. Patients should contact their healthcare provider if they experience persistent hyperglycemia that doesn't respond to their usual management strategies.