Steroid induced diabetes


Have been on pred for about 16 months, never getting below 20mg and due to frequent hospital admissions have had a fair amount of iv hydrocortisone. I randomly check my urine (as you do) and yesterday for the first time I had 2 plus glucose. Am off to docs on Monday but as I have no other classic signs of diabetes, could this be something else (she asks with fingers, toes etc crossed). Have only just got to grips with being brittle asthmatic, don't know if I could manage diabetes too!

Thanks for any info


3 Replies

  • Hi Sarah,

    Sorry to hear that you're struggling and can't get off the dreaded pred.

    I've been more on pred than off it for about 12 years, and on it continuously for the last three. I've had steroid induced diabetes for about two and a half years, I think, but it's not been too problematic until very recently and I've been able to control it with diet. I've recently had to start taking metformin tablets as it has been harder to control and my numbers are good at the moment. I guess the first thing I want to say is, don't panic - even if you do have steroid induced diabetes, it may well not be as bad as you think.

    A one off episode of glycosuria (sugar in the urine) without symptoms is absolutely not enough to make the diagnosis of diabetes. It could well have just been a one off high sugar - a lot of people get them occasionally, especially if on steroids, without necessarily being diabetic. It does need keeping an eye on, but it doesn't necessarily mean that you have a problem. You could also have a low renal threshold for glucose - these means that your kidneys will spill sugar into your urine at a relatively lower blood sugar level compared to others. Urine testing is a relatively inaccurate way of monitoring blood sugar in any case; blood tests are a lot more accurate.

    I'm guessing that your doctor will probably want to do bloods for fasting glucose and HbA1C (measure of sugar levels over the last 2-3 months) and take it from there. They might also advise you to get a glucose meter and monitor your sugars at home, or they may suggest that you go for an Oral Glucose Tolerance test, where you drink a measured amount of glucose and then have a blood test 2 hours later to see what it's done to your sugar. This test is less often done these days, but can be useful when there is doubt about the diagnosis.

    Hopefully the results will show that you don't have anything to worry about, but please try not to worry too much, anyway. I am sure you will cope with it, whatever it turns out to be.

    Take care,

    Em H

  • PS - the other thing to think about, if you are getting significant complications from the steroids, is whether it would be appropriate to try a steroid sparing agent such as methotrexate, azathioprine or ciclosporin, if you haven't tried them already. Of course, they're not suitable for everyone, but they can be helpful in getting the steroid dose down. There's lots of info on here about them if you use the Search facility.

  • If it's any reassurance, I had a bit of a faff about possible diabetes during a recent admission. Had some urine and blood glucose results that were outside 'normal', so they did a fasting blood glucose and decided all was fine. They carried on sticking me once a day for blood glucose and some of these carried on being a little outside 'normal' but still nothing to worry about.

    hope it turns out to be ok for you too.

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