Steroids As Risk of Diabetes
First of all, the good news: topically applied steroids generally do not affect blood glucose. However, if a patient inhales the medication, for example for asthma or chronic obstructive bronchitis (COPD), the blood sugar should be checked. If diabetes politician needs an oral steroid just take a look at this https://swfas.org/anabolics-com-review/ because of another illness, the blood sugar increase is preprogrammed.
“In people with manifest diabetes mellitus, oral steroids always increase blood sugar,” said Professor Dr. Wolfgang Sippel from the Munich-Bogenhausen Clinic at the “Diabetology Limitless” congress in Munich in early March. However, 10 to 40 percent of patients who have not yet had diabetes also develop steroid or type 3e diabetes under long-term therapy. The higher the dose and the longer the duration of therapy, the greater the risk. Patients who are obese, have a family history or have a long-term blood sugar level HbA1C of more than 5.7 percent are particularly at risk.
Glucocorticoids interfere with sugar metabolism in a variety of ways. They reduce insulin secretion from the pancreatic beta cells, reduce insulin sensitivity in muscles and tissues and increase hepatic gluconeogenesis. The increase in blood sugar begins about two to four hours after taking the corticoid. “The effect on blood sugar can last up to 16 hours, which is significantly longer than the half-life of the corticoids,” said Sippel.
Fasting Glucose is Often Normal
The measurement of fasting values is unsuitable for the diagnosis of steroid-induced diabetes, since fasting blood glucose is usually normal if the patient only takes his corticoid preparation once a day in the morning. Fasting glucose only increases with high doses or twice a day. On the other hand, the postprandial measurement offers itself, since the blood sugar increases significantly during the morning with corticoid intake in the morning. A value over 200 mg/dl one to two hours after a meal indicates diabetes, according to Sippel.
Metformin is suitable for OAD because it inhibits hepatic gluconeogenesis, said Sippel. DPP4 inhibitors (gliptins) are also cheap because they can lower postprandial blood sugar peaks. Blinds are suitable for prandial administration, but have a short duration of action and may be too weakly effective. Sulfonylureas are only suitable to a limited extent because they can trigger nighttime hypoglycemia.
If an insulin dose is indicated due to high blood sugar levels, the – previously non-diabetic – the patient can inject normal insulin three times a day. Analog insulins are not suitable because they act too short. An alternative is to inject mixed insulin once a day in the morning, or in the evening if the fasting levels are high. The initial dose of insulin should be based on body weight, the doctor said and recommended 0.2 IU at the start. per kg body weight per day. The patient should inject more units in the morning and at noon than in the evening. In any case, he has to check his blood sugar. The insulin dose may be titrated up using the measured values.
Adapt Diabetes Therapy
If diabetes patients are already being treated with medication and the blood sugar rises with glucocorticoid intake, the previous therapy regimen must be adjusted. Sippel also recommended insulin for people who have previously taken OAD. The starting dose is similar to that of non-diabetics.