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Effects of Dexamethasone on Blood Sugar Levels - Types and Side Effects

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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.

Medically reviewed by

Dr. Syed Raza

Published At April 29, 2022
Reviewed AtDecember 19, 2022

What Are Steroids?

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.

What Are the Types of Steroids?

Steroids can be taken,

1. Orally - Such as Prednisolone.

  • Tablet form.

  • Syrups.

  • Liquids.

2. Topically - Such as Hydrocortisone skin cream.

  • Gels.

  • Lotions.

  • Creams.

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.

Oral Steroids:

Some of the generic names of oral glucocorticoids are,

  • Prednisolone.

  • Hydrocortisone.

  • Dexamethasone.

  • Fludrocortisone.

  • Deflazacort.

  • Betamethasone.

Inhaled Glucocorticoids:

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,

  • Beclomethasone.

  • Budesonide.

  • Fluticasone.

Topical Glucocorticoids:

  • Hydrocortisone.

  • Betamethasone.

When Are These Steroids Prescribed?

The steroids are prescribed to reduce and control the redness and inflammation of conditions that include,

What Are the Side Effects of Steroids?

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.

  • Increased appetite.

  • Mood changes.

  • Difficult to sleep.

  • Heartburn.

  • 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.

What to Do When Steroids Are Prescribed When You Have Diabetes?

Adequate usage of a high dosage of steroids can lead to the onset of diabetes, especially in

  • Previously insulin-resistant people.

  • Obese individuals.

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.

What Are the Predisposing Factors of Steroid-Induced Diabetes?

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,

  • Age.

  • Family history of diabetes.

  • Previous gestational diabetes.

  • Abdominal obesity.

  • Drug use.

  • Duration of the drug.

  • Cumulative dose.

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.

What Are the Effects of Dexamethasone on Blood Sugar Levels of COVID-19 Patients?

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.

  • 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.

What Are the Side Effects of Dexamethasone?

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,

  • Glaucoma.

  • Cataract.

  • Fluid retention.

  • Hypertension.

  • Psychological effects.

  1. Mood swings.

  2. Memory issues.

  3. Confusion.

  4. Irritation.

  • Weight gain.

  • Increased risk of infections.

  • Osteoporosis.

Conclusion:

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.

Frequently Asked Questions

1.

Does Dexamethasone Elevate Glucose?

Dexamethasone is a corticosteroid that is used to treat cerebral edema. It is known to produce elevations in the blood glucose concentration. This affects a single intraoperative dose of Dexamethasone on the blood glucose concentration, which is not known correctly.

2.

Can Steroids Increase Hba1c?

Steroids can increase blood sugar levels in individuals who have diabetes. This can also increase blood sugar levels in individuals who do not have diabetes. This can happen as the liver produces more sugar during steroid treatment.

3.

Can Dexamethasone Cause Diabetes 2?

Corticosteroids treat the inflammation that can lead to higher blood glucose levels. Blood sugar levels return to a healthy range when they stop taking steroids. Steroid-induced diabetes continues even after the treatment is stopped. This is more likely to increase the risk of type 2 diabetes.

4.

What Happens When Diabetics Take Steroids?

Steroids increase blood sugar levels in many ways; they can cause the liver to release more glucose and are absorbed from the blood by fat and muscle cells.

5.

Can Diabetes Caused by Steroids Be Reversed?

In many individuals the blood sugar levels return to normal range when they stop taking steroids, but in some the induced diabetes continues even after the treatment is stopped. This is more likely to occur in cases of Type 2 diabetes.

6.

Can Dexamethasone Cause Diabetes?

Corticosteroids can cause diabetes. Chronic and high doses of corticosteroids can lead to the onset of diabetes, mainly in cases with obesity and insulin-resistant individuals.

7.

How Long Will Dexamethasone Affect Blood Sugar?

Individuals who take around 10 mg of Dexamethasone increase their blood sugar level from + or - 15 to 23 mg/ dL. A dose of 8 mg dexamethasone increases blood glucose, c-peptide, and insulin levels in 24 hours.

8.

Is Dexamethasone Safe for Diabetic Patients?

Dexamethasone increases the risk of high blood sugar levels in diabetic patients. It significantly increases the risk of glycemic complications. This increases postoperative blood glucose levels but is not associated with significant risk on PJIs and hospital returns.

9.

How Long After Steroids Does Blood Sugar Return to Normal?

After stopping the steroid treatment, blood sugar usually takes one to two days to return to normal. Some individuals may develop type 2 diabetes and need proper follow-up treatment with normal oral medication and insulin therapy.

10.

What Are the Dangers of Taking Dexamethasone?

Dexamethasone administration for a longer duration can lead to eye issues like glaucoma and cataracts. Other common problems faced are aggression, agitation, headache, anxiety, mood changes, mental depression, decreased amount of urine, and irregular heart rate.

11.

Does Dexamethasone Affect Insulin?

Yes, Dexamethasone does affect insulin. It impairs insulin signaling and glucose transport by depletion of insulin receptor substrate-1. A single dose of Dexamethasone increases blood glucose, c-peptide, and insulin levels.

12.

How Long Does Hyperglycemia Last After Dexamethasone?

Dexamethasone is a long-acting glucocorticoid, and the steroid hyperglycemia caused by it lasts for more than 24 hours. This is slightly declined during an overnight fast. This hyperglycemia starts within three hours, peaks within nine to ten hours =, and remits after 48 hours.

13.

How To Lower My Blood Sugar After a Steroid Shot?

Taking cortisone injections may elevate blood sugar levels. The best way to deal with this is by taking insulin doses monitored by the health care provider, and steps like food changes and exercise can help counter the steroid and lower the blood sugar.

14.

How Long Does Blood Sugar Stay High After Steroid Injection?

The blood sugar levels increase within three hours of steroid administration and can stay high up to one day after the steroid injection. These blood glucose should be monitored and managed during transient elevation.

15.

What Is the Effect of Dexamethasone on Diabetes?

A single dose of dexamethasone injection increases blood glucose levels, and prolonged administration causes optic nerve damage and conditions like glaucoma, cataracts, anxiety, headache, decreased urine output, and conditions that affect diabetic symptoms.

16.

How to Control My Blood Sugar While on Steroids?

Steroid injections are proven to increase steroid-induced diabetes, and this can be actively managed by administration of insulin monitored by a healthcare provider, following a healthy nutritious diet, lifestyle changes, exercises, and being more active and walking.
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Dr. Syed Raza
Dr. Syed Raza

Family Physician

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