How does cortisone (corticosteroid) maintain blood glucose levels?

From the Guidelines

Cortisone maintains glucose levels by stimulating gluconeogenesis in the liver and reducing glucose uptake in peripheral tissues, thereby increasing blood glucose levels, as evidenced by a recent study published in 2023 1.

Mechanism of Action

Cortisone, a glucocorticoid hormone, plays a crucial role in maintaining glucose levels by counteracting insulin and promoting gluconeogenesis in the liver. This process involves the conversion of amino acids and other non-carbohydrate substances into glucose, making it available in the bloodstream. Additionally, cortisone reduces glucose uptake and utilization by peripheral tissues like muscle and fat, further increasing blood glucose levels.

Clinical Implications

The use of glucocorticoid therapy, such as prednisone, can induce hyperglycemia in 56-86% of patients, with or without preexisting diabetes 1. This highlights the importance of considering the type and duration of glucocorticoid action when determining appropriate insulin treatments. For example, daily-ingested intermediate-acting glucocorticoids like prednisone require administration of intermediate-acting insulin, such as NPH, to manage hyperglycemia 1.

Treatment Approaches

In patients on morning steroid regimens, administering NPH insulin concomitantly with steroids is a standard approach, as it helps to manage disproportionate hyperglycemia during the day 1. For long-acting glucocorticoids, such as dexamethasone, long-acting basal insulin may be required to control fasting blood glucose levels 1. Furthermore, higher doses of glucocorticoids may necessitate increasing doses of prandial and correctional insulin, sometimes by as much as 40-60% or more, in addition to basal insulin 1.

Key Considerations

When managing patients on glucocorticoid therapy, it is essential to consider the potential impact on glucose levels and adjust treatment regimens accordingly. This includes monitoring blood glucose levels, adjusting insulin doses, and considering the use of oral glucose-lowering medications or other therapies as needed 1. By prioritizing glucose control and adjusting treatment regimens based on individual patient needs, healthcare providers can help minimize the risk of morbidity and mortality associated with hyperglycemia.

From the FDA Drug Label

ACTIONS Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body’s immune responses to diverse stimuli. The answer to how cortisone maintains glucose levels is not directly stated in the provided text. However, it can be inferred that glucocorticoids, such as cortisone, have metabolic effects that may impact glucose levels.

• The exact mechanism by which cortisone maintains glucose levels is not explicitly described in the label.
• It is known that glucocorticoids can affect glucose metabolism, but the specific details of this process are not provided in the given text 2.

From the Research

Cortisone and Glucose Levels

• Cortisone, a type of glucocorticoid, can induce hyperglycemia and diabetes in some individuals 3, 4, 5, 6, 7.
• The development of insulin resistance and impaired insulin secretion are key elements in the pathophysiology of corticosteroid-induced diabetes 3.
• Glucocorticoids can reduce insulin sensitivity and increase endogenous glucose production, leading to hyperglycemia 5, 6, 7.

Mechanisms of Cortisone-Induced Hyperglycemia

• Corticosteroids can induce insulin resistance in the liver, adipocytes, and skeletal muscle, making it harder for glucose to enter cells 3.
• The use of glucocorticoids can also lead to an increase in gluconeogenesis, further contributing to hyperglycemia 7.
• The timing of glucocorticoid administration can affect glucose levels, with morning administration leading to hyperglycemic excursions in the afternoon 5.

Management of Cortisone-Induced Hyperglycemia

• Early diagnosis and monitoring of glucose levels are crucial in managing corticosteroid-induced hyperglycemia 4, 6, 7.
• Treatment should be personalized based on the severity of hyperglycemia, type of steroid used, and patient comorbidities 6.
• Insulin therapy may be necessary for patients with severe hyperglycemia or those with pre-existing diabetes 3, 4, 6.
• Oral hypoglycemic agents can also be used, but insulin is often the preferred treatment for hospitalized patients 4, 7.