From the Research
Steroid injections can temporarily increase blood glucose levels in patients with diabetes rather than ease them. The most recent and highest quality study, 1, found that local corticosteroid injection to the shoulder can create a significant, short-term increase in systemic glucose levels in patients with type 2 diabetes mellitus not treated with insulin. This study used a continuous glucose monitoring device to evaluate the effects of corticosteroid injection on glycemia in patients with type 2 diabetes mellitus. The results showed that the mean glucose level per patient increased from 136 mg/dL in the preinjection period to 159 mg/dL in the first 3 days after the injection, and then returned to normal thereafter.
The mechanism of this increase in blood glucose levels is due to the promotion of gluconeogenesis in the liver, increase in insulin resistance, and reduction in glucose uptake in peripheral tissues by corticosteroids, as mentioned in the example answer. This is consistent with the findings of other studies, such as 2, which found that higher HbA1c levels before injection were significantly associated with the degree of blood glucose increase 1 day after injection.
It is essential for patients with diabetes to monitor their blood glucose levels more frequently for 1-2 days after injection and may need temporary adjustments to their diabetes medications, as suggested in the example answer. Those on insulin might need to increase their dosage by 20-40% during this period, while those on oral medications might require additional short-term coverage. Despite their anti-inflammatory benefits, the metabolic effects of steroids typically worsen glycemic control rather than improve it.
Some studies, such as 3, have found that corticosteroids can improve glucose tolerance in patients with active rheumatoid arthritis, but this is not relevant to the context of patients with diabetes receiving steroid injections. Other studies, such as 4 and 5, have found that corticosteroid use can lead to hyperglycemia and worsen glycemic control in patients with diabetes, which is consistent with the findings of the most recent and highest quality study, 1.
In summary, the most recent and highest quality evidence suggests that steroid injections can temporarily increase blood glucose levels in patients with diabetes, and patients should be aware of this potential effect and take necessary precautions to monitor and manage their blood glucose levels.