Do steroids, such as prednisone (corticosteroid), raise blood sugar levels?

Steroids Significantly Raise Blood Sugar Levels

Yes, steroids such as prednisone definitely raise blood sugar levels through multiple mechanisms including impaired beta cell insulin secretion, increased insulin resistance, and enhanced hepatic gluconeogenesis. 1

Mechanisms of Steroid-Induced Hyperglycemia

Corticosteroids like prednisone affect glucose metabolism through several pathways:

• Impaired insulin secretion: Prednisone has an early inhibitory effect on insulin response to glucose 2
• Increased insulin resistance: Steroids reduce tissue sensitivity to insulin 1
• Enhanced hepatic gluconeogenesis: Steroids stimulate the liver to produce more glucose 1

Timing and Pattern of Hyperglycemia

The blood glucose elevation from steroids follows a predictable pattern:

• Prednisone: When taken in the morning, peak hyperglycemia occurs approximately 8 hours after dosing (late afternoon/evening) 1
• Dexamethasone: Peak hyperglycemia occurs 7-9 hours after administration 1
• Intravenous steroids: Trigger greater degrees of hyperglycemia than oral forms 1

The severity of hyperglycemia correlates directly with the steroid dose - higher doses cause more significant elevations in blood glucose 1.

Clinical Significance

Steroid-induced hyperglycemia occurs in 10-60% of patients receiving glucocorticoid therapy and significantly increases mortality and morbidity risk through:

• Increased susceptibility to infections
• Higher risk of cardiovascular events 3

Diagnostic Criteria

Steroid-induced diabetes is diagnosed when there are:

• Random blood glucose readings ≥11.1 mmol/L (200 mg/dL) on different occasions
• Newly elevated HbA1c ≥6.5%
• Concurrent use of corticosteroids 1, 3

Monitoring Recommendations

For patients on steroid therapy:

• High-risk patients (pre-existing diabetes, newly detected hyperglycemia): Daily self-monitoring of blood glucose 1
• Moderate-risk patients (starting corticosteroids): Check blood glucose 2 hours postprandial or 8 hours after prednisolone dosing 1
• All patients on steroids: Blood glucose monitoring should be performed every 2-4 hours during initial therapy, particularly 4-6 hours after steroid administration 3

Route of Administration Considerations

Even non-oral routes can affect blood glucose:

• Intra-articular injections: Can cause significant hyperglycemia in diabetic patients, with peak values reaching as high as 500 mg/dL, typically occurring 24-72 hours after injection 4

Comparative Effects of Different Steroids

Different corticosteroids have varying impacts on blood glucose:

• Dexamethasone and methylprednisolone: Associated with greater hyperglycemia compared to prednisolone and hydrocortisone 5
• Deflazacort: Shows less diabetogenic effect than prednisone in insulin-treated diabetics 6

Management Approach

For steroid-induced hyperglycemia:

1. Mild cases: Oral agents like gliclazide and metformin are appropriate first-line treatments 1
2. Moderate to severe cases: Insulin therapy matched to the steroid dose and profile is required 1
3. Insulin dosing: NPH insulin at 0.1-0.2 units/kg/day administered with morning steroid dose to synchronize peak insulin action with peak steroid effect 3
4. Steroid tapering: When reducing steroid doses, insulin must be proportionally decreased to prevent hypoglycemia (approximately 0.4-0.5 units of NPH per mg of prednisone) 3

Important Clinical Considerations

• Patients should be educated about symptoms of hyperglycemia and when to seek medical attention 1
• When adjusting steroid doses, the diabetes treatment regimen must be reviewed and modified accordingly 1
• Basal insulin doses may need to be increased by 20-30% from baseline during steroid therapy 3
• Patients should be warned of the risk of hypoglycemia when using glucose-lowering agents 1

Understanding the significant impact of steroids on blood glucose is essential for appropriate monitoring and management to prevent complications in patients requiring corticosteroid therapy.