Let’s talk about the very important topic of glucocorticoids and cortical steroids in the diabetes population.

It is not ok to just expect a patient to “Weather a time of high blood sugars” This is physically damging, makes the patient feel more ill and may directly inhibit their improving.

 

Sudden high blood sugars feel AWFUL! Fatigue, nausea, raging headaches, loss of clear thinking , irritability and more accompany elevated blood sugars.

 

Suddenly having massive blood sugar spikes and a provider who seems to not care about them deeply impacts the relationship between the provider and the patient, patients lose trust in their provider’s judgement and empathy.

 

Patients work HARD for blood sugar management, suddenly having blood sugars throw high for an extended time leads to the patient feeling undermined, and victimized by diabetes and the medical world all over again. This can lead to a big loss in clinical goal efforts. Also, think of the mixed message being sent when we tell patients that they have to exercise, eat right, and take their medications or diabetes could kill them… and then we turn around and tell them not to worry about a couple weeks over 2 or 300!

 

We have already looked at the impact of hyperglycemia on the processes needed for immune response and healing. We are using steroids to reduce inflammation and infection, to speed recovery, and yet we are causing a hyperglycemic state that works directly counter to that aim. Not to mention increased risks of UTI, yeast infections, thrush fungal infections etc that come with hyperglycemia. We need to be helping people get well, not making them sicker somewhere else!

 

So many providers take the path of least interference and simply avoid the use of steroidal medications entirely. I can’t tell you how many times I have heard, “I’d typically start you on a steroid but with the diabetes..”.  That is telling the person with diabetes that they are not deserving of, or eligible for, the best modern medicine has to offer. That is simply unacceptable. We have tools to offset hyperglycemia. We must assess every patient, every illness and every tool at our disposal to make individualized treatment decisions.

 

Steroids may significantly raise blood sugars for a short duration, but not using them can lead to longer moderate blood sugar increases from illness or injury, as well as risking permanent damage such as respiratory scarring, kidney damage, or loss of mobility. Keep the long-term picture in view, don’t substitute a long-term loss to avoid a short-term problem.

 

Be very up front with patients about potential blood sugar impacts, even if you perceive them to be minimal.

Just because someone has an A1C of 8 don’t assume that they won’t be bothered seeing blood sugar elevations! You have no idea what keeps them up at night! They may also have very stable elevated blood sugar and a sudden swing could make them feel horrible physically.

Likewise a patient with tight control might be distressed and unable to perform to their best with a BG elevation at the top end of “in range”. Patients need to know this to prepare medically, psychologically or even to reschedule work, athletic or personal plans around their blood sugar impacts.

 

If you’re unsure what to expect from a steroid or other medication, reach out to your diabetes educators, and if your practice does not partner with a diabetes educator--FIND ONE! These valuable partnerships can help guide your patients through rough times and their experience with these “special topic areas” can be highly beneficial.

 

Finally, make a cooperative plan with your patient. Maybe they are not ok with a BG elevation and would rather steer clear of steroids. Maybe they’d like to temporarily adjust their diet, or increase their exercise to offset blood sugar impacts. Or maybe they’d like to add or increase long-acting insulin for a while to keep blood sugars in a healthy range. Never make assumptions about what lengths your patients are willing and able to go to! Have frank and open discussions about the different options--and pave a path together.

 

Medications and Diabetes

Topical steroids will have little to no impact on blood sugars (some patients will report a rise, but it may actually be from the underlying condition being treated, rather than the treatment itself). ,

But inhaled steroids will see a moderate jump in blood sugars for the 2-4 hour duration of the medication action.

But oral steroids like prednisone, or Medrol dose packs (as an example), can have MASSIVE impacts on blood sugars (we are talking the potential 3x normal insulin needs)!

Blood sugar impacts typically step down as steroid doses step down as well.

Injected steroids are variable. We often see a moderate bump in blood sugars a day following injection that tapers down, but it will depend on where the injection is, the steroid being used, and the individual’s activity in the joint or area.