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Steroid Induced Diabetes: Causes, risks, signs or symptoms, diagnosis, treatment
Ahead of World Diabetes Day 2022, doctors reveal all you need to know about Steroid Induced Diabetes Mellitus, its causes, risks, signs or symptoms, diagnosis and treatment
When an individual is prescribed steroids for treating them for a particular medical condition like acute exacerbation of asthma, breathlessness, severe skin allergies, skin reactions or other autoimmune conditions, their glucose metabolism gets affected where even in the absence of previous hyper glycaemia they may develop steroid induced hyper glycaemia or steroid induced diabetes. In an interview with HT Lifestyle, Dr Manoj Chawla, Consultant, Diabetology at PD Hinduja Hospital and Medical Research Centre in Khar, shared, “Steroids are counter regulatory hormones that oppose the action of insulin in the body. So use of steroids especially larger dose and longer duration carries the risk of new onset steroid induced diabetes.”
What causes the onset of SID in a person?
Dr Manish Dattatraya Karekar, COO, Pathology at Krsnaa Diagnostics, explained, “Steroid-induced Diabetes Mellitus (SIDM) is defined as an abnormal increase in blood glucose associated with the use of glucocorticoids (steroids) in a patient with or without a prior history of diabetes mellitus. The effect of glucocorticoids (steroids) on glucose metabolism is likely the result of dysfunction of multiple pathways including sensitivity to glucose, ability to release insulin by beta cells of pancreas and insulin resistance in other tissues.”
He elaborated, “The combined effect being elevated blood glucose levels above the recommended levels, resulting in Steroid induced Diabetes Mellitus. There has been increased cases of SID post Covid, due to usage of glucorticoids in treatment of COVID cases.”
Who is at risk of suffering from SID?
According to Dr Manish Dattatraya Karekar, the length of time on steroids, the relative potency (strength of drug) of the glucocorticoid and the absolute dose all play a role in the occurrence of SIDM. He revealed, “Glucocorticoids are extensively used in almost every subspecialty of medicine. Indications for short-term acute steroid therapy can be seen in worsening of chronic obstructive Lung disease, acute gout, chemotherapy protocols, bacterial meningitis and in pregnant women for foetal lung maturation, to name a few.”
He highlighted that the disease processes benefiting from chronic glucocorticoid (steroid) use include lung diseases such as autoimmune conditions; neurologic diseases such as myasthenia gravis and multiple sclerosis; and inflammatory bowel (gut) diseases. He said, “More recently, chronic glucocorticoid therapy plays an important role in modulating the immune system following solid organ transplantation. Proposed risk factors for steroid-induced diabetes beyond cumulative dose and longer duration of steroid course include traditional risk factors for type 2 diabetes: older age, family history, high body mass index and impaired glucose tolerance All the above mentioned groups are at a risk of suffering from SIDM”
What are the major signs and symptoms seen in person suffering from SID?
Dr Manish Dattatraya Karekar revealed, “Some key symptoms include, frequent urge to urinate, feeling thirsty, drying of mouth, blurred vision, tiredness and other symptoms common to DM.”
Which diagnostic tests are prescribed for detecting SID?
Dr Manish Dattatraya Karekar informed, “Diagnosis for steroid induced diabetes, like other types of diabetes, is done by measuring blood glucose levels. By understanding the patient’s history of taking steroids – as part of a treatment plan, and undergoing testing that includes – fasting blood glucose test, oral glucose tolerance test, HbA1C test and random plasma glucose test, one can identify and diagnose SIDM.”
What treatment measures are being followed to treat SIDM? Can SIDM be permanently treated?
Dr Manoj Chawla asserted that the treatment is similar to other forms of diabetes management and includes lifestyle modification, use of oral drugs and occasionally use of insulin to overcome the severe hyper glycaemia caused by impact of steroids. He said, “In such cases, the need to continue use of steroids is evaluated and very often once stopped the hyper glycaemia reverses. Occasionally, when steroids have only unmasked the hidden type 2 Diabetes, it may persist even after stopping use of steroids.”
He concluded, “So SIDM may be completely reversible where patient’s previous blood glucose was absolutely normal and the use of steroids is temporary as we saw during the Covid pandemic where there was indiscriminate use of steroids for fear of pulmonary affection and hypoxia. Once detected with SIDM, getting the Hba1c test would help in differentiating between pre-existing hidden diabetes and new onset steroid induced hyper glycaemia.”
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