Northumbria Healthcare NHS Foundation Trust Diabetes & Steroid Therapy Issued by the Diabetes Service
What are Steroids? Steroids (Corticosteroids) are a group of medicines that can be used in the treatment of many conditions such as asthma, inflammatory bowel conditions, arthritis and cancer therapy. Taking steroids can often cause a rise in blood glucose (sugar) levels. However, it is very important that you finish the full course of steroids prescribed to you. If you have any concerns about this please contact the person who prescribes medication for you. Steroids can cause your body to become resistant to either the insulin your body produces or the insulin you inject. The rise in blood glucose levels will usually start one or two days after starting steroids, and this more commonly happens in the afternoon and evening which may require an increase in your day time diabetes treatment. Blood glucose lowering treatment will be based on your glucose level patterns and how long you will be taking the course of steroids. Your blood glucose levels should return to their previous levels one or two days after stopping your steroids. What will happen? Depending on the length of the course of your steroids and whilst your blood glucose levels are high, you may need to start or increase blood glucose lowering medication/treatment. This may include: dietary/lifestyle advice, tablets, insulin or GLP-1. You will be taught how to test your own blood glucose levels, if you are not already doing this,and how to react to high or low readings. 1
If your diabetes is treated by: Diet/lifestyle alone you may need tablets to reduce your blood glucose whilst taking steroids. Tablets you may need to increase your blood glucose lowering tablets or possibly use insulin whilst on steroids Insulin you may need to increase your insulin dose whilst taking steroids and/or use a different type of insulin If your blood glucose levels regularly rise above 15mmol/L, you should contact your GP or diabetes clinic to arrange a review and possible change in diabetes treatment whilst on steroids. Your treatment will be based on your blood glucose levels and how you will be on your steroid course. Steroid Induced Diabetes What is steroid induced diabetes? Steroid induced diabetes is the discovery of higher than normal blood glucose levels after starting steroids in people not previously known to have diabetes. Why does it happen? Blood glucose levels are normally controlled by a substance called insulin which is naturally produced by a gland called your pancreas. Steroids can cause your body to become more resistant to the insulin produced causing blood glucose levels to rise. 2
The facts The rise in blood glucose levels will usually happen between one or two days after starting steroids, and you will probably find that this will happen more commonly in the afternoon and evening. Your blood glucose will return to previous levels one or two days after stopping your steroids. With steroid induced diabetes some people will continue to have high blood glucose levels after the steroid course is finished. This is because the blood glucose levels were raised before taking steroids but they were unaware of it. If this happens, your GP or nurse will discuss this further with you. How will I know if my blood glucose levels have returned to normal after finishing steroids? When/if your steroids are stopped you should be tested for diabetes with a blood test. Please contact your GP to arrange this. What are the benefits of treating my high blood glucose? High blood glucose levels can cause you to feel unwell. In particular you may become thirsty, tired, pass more urine and can sometimes require hospital admission. 3
What problems can treating high blood glucose cause? The main problems arise when people are taking too much treatment for high blood glucose. This only happens on tablet and insulin treatment. This can cause low blood glucoses below 4.0mmol/L (hypos). You will be given specific instructions about how to recognise these and avoid them. Remember If your steroids are reduced or stopped your blood glucose levels may fall, usually after one or two days. You will be advised to continue to check your glucose levels, and if you are taking blood glucose lowering tablets or insulin these may need to be reduced or stopped. Please contact your GP/Diabetes team for advice if any alteration is made to your steroid dose. 4
Useful Contact Numbers GP: Diabetes Nurse/Team: 5
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PIN 035/V4 Review date: August 2017