People use steroid medications for several reasons like bone or muscle injury, lung conditions, pain, etc. Steroids can also be used for COVID-19 as it causes shortness of breath.
Glucocorticoid is the more specific medical term for steroids, and they are naturally produced in the adrenal glands (kidney) with anti-inflammatory action. While the body naturally produces steroids, the synthetic versions of steroids act like hormones, and so they are designed to reduce inflammation. In addition, they also regulate glucose metabolism and can lead to higher blood glucose levels when used to treat inflammation, and long-term usage may bring about type 2 diabetes mellitus.
Steroids can be taken,
1. Orally - Such as Prednisolone.
2. Topically - Such as Hydrocortisone skin cream.
3. Inhalers or nasal sprays - Such as Beclometasone.
4. Injections - Such as Methylprednisolone.
But the, systemic glucocorticoids (oral, injection, inhalation) are the most likely to affect glucose levels.
Some of the generic names of oral glucocorticoids are,
They are used for asthma and chronic obstructive pulmonary disease (COPD), a long-term lung condition.
Inhaled glucocorticoids that act on the lungs directly are,
The steroids are prescribed to reduce and control the redness and inflammation of conditions that include,
Crohn's disease (inflammatory bowel disease).
Asthma and COPD.
Hives and eczema.
Multiple sclerosis (MS).
Steroids do not cause side effects until they are taken for a short time, and do not stop the medication by yourself without consulting the doctor if you find some side effects as it can lead to withdrawal symptoms.
People experience some unpleasant side effects such as,
High blood sugar or diabetes.
Difficult to sleep.
High blood pressure.
Increased risk of infections like measles and chickenpox.
So, prior to the treatment, tell the doctor if you have,
Allergic reaction to steroids in the past.
Conditions such as diabetes, epilepsy, high blood pressure, or problems in the liver, heart, or kidneys.
An unhealed open wound.
Infection (also including eye infections).
When you recently had or are about to have vaccinations.
Pregnant, breastfeeding, or trying for a baby.
Adequate usage of a high dosage of steroids can lead to the onset of diabetes, especially in
Previously insulin-resistant people.
For example, Dexamethasone raises blood glucose levels. Before taking the morning Dexamethasone pill, the blood glucose level is the same as usual, but the blood glucose level is much higher after taking the morning Dexamethasone pill. This is because steroids do not allow the body’s own insulin or injected Insulin to work by increasing insulin resistance. This makes people worry about what they eat, thinking the food is causing the unusual high glucose reading, but it is likely from the steroid.
Mainly, systemic steroids elevate blood glucose levels (hyperglycemia), and it is a known side effect. As it is challenging, especially for people with diabetes, Insulin is the best way to counteract the high blood glucose levels caused by steroids.
When steroids are received via intravenous route, the doses are higher than the oral pills. In that case, doctors prescribe different types of Insulin at different times of the day to reduce hyperglycemia. When you take oral steroids, it is not required to start new Insulin, but ask the doctor about the Insulin dose to take for guidance.
The predisposing factors and prevalence of steroid-induced diabetes are estimated to be 20 % to 54 % of people treated with steroids.
The risk factors for steroid-induced diabetes are,
Family history of diabetes.
Previous gestational diabetes.
Duration of the drug.
Glucocorticoids have even more damaging effects on patients who already have diabetes. Mainly elderly patients who are on chronic use of high daily doses of steroids and already have diabetes are at 94 % higher risk of being hospitalized due to diabetes complications.
New guidance on Dexamethasone therapy in COVID-19 patients has been released, and the aim is to manage the blood sugar levels in COVID-19 patients taking Dexamethasone therapy. In response to the recovery trial, Dexamethasone has prevented death,
In around one-eighth of the ventilated patients.
One in 25 patients who are requiring oxygen.
The low dose of Dexamethasone, 6 mg daily for ten days, is five to six times greater than the therapeutic glucocorticoid replacement dose. The high doses of glucocorticoids can worsen,
Hyperglycemia in diabetes patients.
Unmask undiagnosed diabetes.
Precipitate hyperglycemia who are at risk of diabetes.
New-onset of diabetes.
Glucocorticoids are the most important cause of developing potentially life-threatening hyperglycemic hyperosmolar states (HHS) in hospitalized diabetes patients. In order to avoid these harms, the guidelines address inpatient management of steroid-induced hyperglycemia. But, these guidelines are not appropriate for patients with severe COVID-19 infection receiving,
Dexamethasone-induced impaired glucose metabolism.
COVID-19 impaired Insulin production.
COVID-19-induced Insulin resistance.
So a new guideline was addressed for people with severe COVID-19 infection commencing Dexamethasone therapy. The aim is to make sure that patients who commenced on Dexamethasone with or without diabetes should receive appropriate glucose surveillance and management for hyperglycemia. The recommendations include:
Correct the doses of rapid-acting Insulin when capillary blood glucose is greater than 12.0 mmol/l. The dose is to be calculated based on the patient's weight or calculated with the already given total daily insulin dose.
It does not include the Insulin correction ratios that some people with type 1 diabetes usually use.
In order to maintain glycemic control, NPH (neutral protamine Hagedorn) Insulin is needed. This is because the duration of action is intermediate when compared to longer-acting insulin, even though the metabolic effects of Dexamethasone can persist for up to 36 hours.
NPH Insulin is given twice a day with flexibility in dose adjustment. The starting dose is based on weight, but a reduced dose should be used in elderly patients and those with an eGFR of less than 30 ml/min.
Hence, careful monitoring is needed with Insulin dose adjustment to avoid hypoglycemia. This is because Insulin resistance will fall when Dexamethasone is stopped.
Dexamethasone is safe, and it has a benefit-risk profile in patients with severe forms of pneumonia and less prominent benefit in patients with non-severe pneumonia. There are no serious side effects even on high doses of steroids as the treatment is short, except for experiencing high blood glucose levels (hyperglycemia), and it is also temporary.
The prolonged use for more than two weeks leads to adverse effects such as,
Increased risk of infections.
Increased blood sugar levels and high Insulin resistance affects the mental health of the patient with diabetes. This happens when they decide to use steroids without the supervision of physicians or even when prescribed by physicians and are not aware of how to handle the situation. These effects are dose-dependent, and when it is without medical supervision, they could turn into serious side effects. It is always essential to suspect the risks of adrenal insufficiency after abrupt withdrawal of Dexamethasone on prolonged use. Also, the physicians should predict the damages related to these drugs and should offer guidance on the side effects of self-prescription. So, it is important to add additional knowledge to patients because inexperience in using medications such as Dexamethasone can cause a friendly drug to harm our health.
Last reviewed at:
29 Apr 2022 - 6 min read
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