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A potential cause-and-effect relationship exists between steroids and diabetes, with some steroidal prescriptions triggering the onset or exacerbation of diabetes. Steroids, such as prednisone, dexamethasonehydrocortisone and dexamethasone, can cause the liver to release too much glucose and cause the body to develop insulin-resistance, resulting in high blood sugar levels. Insulin is necessary to change glucose to energy and keep blood sugar balanced.
Depending on the productivity of the pancreas, prescription steroids can make even those not genetically predisposed to diabetes develop the condition. If the pancreas senses the body is not effectively using insulin in the presence of steroids, it may release additional insulin to combat the problem. Without additional insulin or if the body resists the insulin, a medical condition known as steroid-induced diabetes develops. For those that have diabetes already, taking steroids could worsen it.
This link between steroids and diabetes is usually temporary, lasting roughly three days and vanishing when steroid medication is completely discontinued. For people on long-term steroid therapy, diabetes could be chronic, however. To avoid the negative side effect of steroids and diabetes, many doctors prescribe steroids at low dosages or use another type of medication to treat inflammatory issues, such as asthma or arthritis, which are the two most common conditions for which steroids are taken.
Single-shot injections with 35 mg or less of a steroid are unlikely to trigger high blood sugar even in diabetic patients, studies show. Dosages of 50 mg or more, however, do typically elevate blood sugar. If high dosages of steroid medication must be used, some doctors opt to concurrently prescribe high dosages of insulin, particularly for patients at high risk of developing steroid-induced diabetes. Physicians advise daily monitoring of blood glucose levels for steroid users.
The reason for this correlation between steroids and diabetes is not fully understood by scientists. Preliminary studies on mice suggest that steroids interfere with fatty acids in the liver so that they can no longer activate a special protein known as peroxisome proliferator-activated receptor-alpha (PPAR-alpha). Without functioning PPAR-alpha, studies found that blood sugar built up and insulin-resistance ensued. Another simpler theory is that oral and epidural steroids decrease chromium in the body, which is a key nutrient required to control blood sugar.
Certain people are more susceptible to the negative relationship between steroids and diabetes. Children who have Crohn's disease and use steroids regularly are at high risk of developing steroidal diabetes. Aging patients with neurological disorders are also at greater risk.