Thursday, August 11, 2022

Can Steroid Injections Cause High Blood Sugar

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How High Will My Blood Sugar Levels Get

Steroid Induced Diabetes

It varies from person to person. It can be common to see blood sugar levels between 13 to 20+ mmol/L. Some peoples blood sugar level can rise so high it reads as Hi on the blood sugar machine.

A common pattern of sugar levels with diabetes if you are taking steroids is:

  • Normal blood sugar level in the morning when you first get up.
  • Blood sugar levels starts to rise by mid-morning to lunch. Between mid-afternoon to early evening blood sugar levels are at their highest levels.
  • Blood sugar levels then start to drop by 10pm-11pm and you wake up with a normal blood sugar level in the morning.
  • However, blood sugar levels remain high overnight and in the morning in some patients.

What Would A Doctor Prescribe Steroids For

Doctors prescribe steroids for many issues, including but not limited to treating the inflammation and pain associated with rheumatoid arthritis, lupus, asthma, and common allergies.

In more serious cases, steroids help treat Addisons disease, when the body lacks the ability to produce corticosteroid, that the body needs for proper functioning.

Steroids are also used to suppress the immune system to prevent organ rejection in transplant recipients.

Taking Steroids With Diabetes

Sometimes, taking steroids is necessary and theres no other option.

If you have diabetes and need to take steroids, talk with your doctor first. Let them know about your diabetes diagnosis. This might change their decision about which drug to prescribe. If its not possible to avoid a steroid, your doctor may need to change the dosage.

When taking steroids while you have diabetes, there are things you can do to manage your diabetes:

  • Check your blood glucose levels more often ideally four or more times a day and talk with your doctor about whether continuous blood glucose monitoring is an option.
  • Increase your insulin or medication dosage based on your blood sugar levels and your doctors recommendation.
  • Carry glucose tablets, candy, or juice in case your blood sugars drop unexpectedly.

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Knee Steroid Injection And Blood Sugar Signatur

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Recruitment Status : Enrolling by invitationFirst Posted : March 23, 2020Last Update Posted : December 29, 2021
  • Study Details
Condition or disease

Who Can Have Steroid Injections

How To Blood Sugar Diabetes: how to lower blood sugar after cortisone ...

Most people can have steroid injections.

Tell the doctor before having treatment if you:

  • have had a steroid injection in the last few weeks you usually need to wait at least 6 weeks between injections
  • you’ve had 3 steroid injections in the last year doctors usually recommend no more than 3 injections in the same area in the space of 12 months
  • have had an allergic reaction to steroids in the past
  • have an infection
  • have recently had, or are about to have, any vaccinations
  • are pregnant, breastfeeding or trying for a baby
  • have any other conditions, such as diabetes, epilepsy, high blood pressure, or problems with your liver, heart or kidneys
  • are taking other medicines, such as anticoagulants

Steroid injections may not always be suitable in these cases, although the doctor may recommend them if they think the benefits outweigh any risks.

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Effects Of Steroids On Diabetes

Corticosteroids tend to drive blood sugars higher, sometimes much higher. Wil Dubois, a diabetes expert and blogger with type 1 diabetes, reports taking prednisone for muscle spasms: I took my first pill at a blood sugar of 96 mg/dL. An hour later I was at 552 mg/dL. I ran my insulin pump dry fighting the blood sugar. My insulin might as well have been water.

According to Medtronics Diabetes Clinical Manager Beth Spencer Kline, MSN NP-C, CDE, steroids increase the livers release of glucose and cause insulin resistance, which lead to insulin working less efficiently.

According to diabetes.co.uk, high blood sugars usually go back down when steroids are stopped, but long-term use can cause permanent problems and even drive a person with prediabetes into type 2. This is true of oral, injectable, and topical steroids.

Where To Find Support

If youre feeling worried, or if youve got more questions about steroid-induced diabetes, were here to help.

You can give our confidential helpline a call and talk to one of our highly trained advisors. Or you can hear from other people with the condition in our online support forum. You dont need to sign up to read about their experiences, but you will need to become a member if youd like to reach out and speak to them.

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How Do Steroids Impact Blood Glucose Levels

In general, treatment with corticosteroids can have considerable side effects, including high blood glucose levels.

The main side effects may include:

  • Acne
  • Weight gain and obesity

When it comes to hyperglycemia after steroid administration, experts note that:

Steroids are the main cause of drug-induced hyperglycemia. They not only exacerbate hyperglycemia in patients with known diabetes mellitus , but also cause DM in patients without documented hyperglycemia before the initiation of glucocorticoids therapy, with an incidence that can reach up to 46% of patients, and increases in glucose levels up to 68% compared to baseline. Furthermore, in some populations they can precipitate acute complications such as nonketotic hyperosmolar state, and diabetic ketoacidosis and in a few instances death, especially in patients with pre-existing DM.

Why does this occur? Experts explain that glucocorticosteroids can cause or exacerbate hyperglycemia by several mechanisms, including stimulation of increased glucose output by the liver and also by causing insulin resistance.

In healthy, insulin-sensitive individuals, the pancreas is often able to compensate for these factors by adequately increasing insulin secretion to maintain normal blood glucose levels. However, for individuals with pre-diabetes, diabetes, or even impaired insulin sensitivity, steroid-induced hyperglycemia can be a serious concern.

How Is An Epidural Steroid Injection Performed

Treating steroid induced diabetes

The epidural steroid injection procedure is quick and simple. While it is common for people to be concerned prior to the procedure, it is actually frequent to hear from patients afterwards: “Is that all?”

The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra . The cord is protected by cerebrospinal fluid , which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the dura, from the Greek for tough . The Greek word “epi” means “outside of.” So, the epidural space is outside of this tough membrane. During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the locally inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

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When Do Steroids Start To Affect Blood Sugar

Steroids may start to affect your blood sugar pretty quickly after starting treatment, although it depends on what course of treatment youre on.

For oral steroids, blood sugars may begin to rise within a few days of treatment. The effects will depend on the dose and type of steroid you are taking.

Steroid injections start to affect blood sugars soon after the injection and can remain high for 3-10 days afterward.

If youre taking topical steroid creams or gels or inhaled steroids, they do not typically affect blood sugar levels.

Risk Factors Of Steroid

There are some factors that may mean you are more likely to develop diabetes if you are taking steroids. These include if you:

  • are over 40 and white, or over 25 and African-Caribbean, Black African or South Asian
  • have a close family member with type 2 diabetes
  • are of African-Caribbean, Black African or South Asian descent
  • have had high blood pressure
  • are living with obesity.

Weve got lots more information about the different diabetes risk factors. If you are taking steroids as part of your treatment for a health condition, or if you are about to start, use our Know Your Risk tool to find out your risk of developing diabetes.

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Drugs That Can Affect Blood Glucose Levels

Knowing the drugs that can affect blood glucose levels is essential in properly caring for your diabetes patients. Some medicines raise blood sugar in patients while others might lower their levels. However, not all drugs affect patients the same way. 390 Drugs that Can Affect Blood Glucose Levels is also available for purchase in ebook format. 390 Drugs that can affect blood glucose Level Table of Contents: Drugs that May Cause Hyper- or Hypoglycemia Drugs That May Cause Hyperglycemia Abacavir | Abacavir + lamivudine,zidovudine | Abacavir + dolutegravir + lamivudine | Abiraterone | Acetazolamide | Acitretin | Aletinib | Albuterol | Albuterol + ipratropium | Aliskiren + amlodipine + hydrochlorothiazide | Aliskiren + amlodipine | Ammonium chloride Amphotericin B | Amphotericin B lipid formulations IV | Amprenavir | Anidulafungin | Aripiprazole | Arsenic trioxide | Asparaginase | Atazanavir | Atazanavir + cobistat | Atenolol + chlorthalidone | Atorvastatin | Atovaquone | Baclofen | Belatacept | Benazepril + hydrochlorothiazide | Drugs That May Cause Hyperglycemia â Continued Betamethasone topical | Betamethasone +clotrimazole | Betaxolol Betoptic® eyedrops, | Bexarotene | (TargContinue reading > >

Risk Factors For Steroid

What are the Most Common Cortisone Injection Reactions?

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 . The association with family history of diabetes is not well defined. Simmons et al. compared the demographics and clinical characteristics of patients with new onset SIDM with those with type 2 diabetes with and without steroid treatment. Those individuals who developed new onset SIDM had significantly less family history of diabetes when compared with individuals with type 2 diabetes mellitus and glucocorticoid treatment .

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What To Know Before You Take A Steroid Injection

Steroid injections may not be the best option for everyone. It is important to inform your doctor, or the medical personnel administering the injection if

  • You recently had a steroid injection.
  • You recently had a vaccine or are planning on getting vaccinated soon.
  • You are pregnant, breastfeeding, or in the process of trying to have a baby.
  • You have heart, liver, or kidney problems.
  • You are currently taking other medications.
  • You have or recently had any kind of infection.
  • You have had allergic reactions to steroids before.

How Do Steroid Medications Affect Blood Glucose Levels

If you have diabetes and are taking steroid medication, your blood glucose levels are likely to increase. Steroid medications can raise blood glucose levels by reducing the action of insulin and making the liver release stored glucose into the bloodstream.

The timeframe in which these medications begin to affect your blood glucose levels can vary depending on how you are taking them.

  • Oral steroids: Blood glucose levels may begin to rise within a few days of starting oral steroids. Their effect on blood glucose levels will depend on the time, dose and type of steroid you are taking.
  • Steroid injections: Blood glucose levels may rise soon after the injection and may remain high for 3-10 days afterwards.

Creams used for skin conditions, and inhaled steroids used for asthma and ear and eye drops are unlikely to affect blood glucose levels.

If you need to take steroid medication, talk to your doctor about how it may affect your blood glucose levels and ask for advice on how to manage this. Ask your doctor or pharmacist for an information sheet about this medication.

High blood glucose levels can make you feel unwell, tired or lacking in energy, and thirsty. It can also make you pass urine more often.

Seek advice from your doctor or a credentialled diabetes educator on monitoring your blood glucose levels while taking steroid medication.

If you are taking steroid medication, talk to your doctor about how this may affect your blood glucose levels.

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Factors Affecting Blood Glucose Elevation

Blood glucose level was significantly elevated 1 day after steroid injection compared to baseline blood glucose, but not 2 days after injection, so we analyzed the relationships between the degree of blood glucose increase 1 day after steroid injection and the various factors.

Both HbA1c > 7% and HbA1c 7% groups had a statistically significant increase in blood glucose 1 day after steroid injection. There was also a significant difference in the increase in blood glucose level between the two groups . In the HbA1c > 7% group, blood glucose level was increased by 99.4±30.7 mg/dL with respect to baseline. In the HbA1c 7% group, blood glucose was increased by 47.6±10.1 mg/dL with respect to baseline. However, there was no significant difference in the decrease in blood glucose levels between the two groups because blood glucose levels had declined to baseline 2 days after steroid injection .

Change in fasting blood sugar level after injection in the HbA1c > 7% group versus the HbA1c 7% group. This figure show the HbA1c > 7% group had a significantly higher degree of FBS increase 1 day after steroid injection than did the HbA1c 7% group. *p< 0.05.

Change in fasting blood sugar level after injection in the insulin group versus the non-insulin group. This figure shows that the insulin group had a significantly higher degree of FBS increase 1 day after steroid injection than did the non-insulin group. *p< 0.05.

The Role Of Lifestyle

10 Questions about cortisone injections by Dr. Andrea Furlan MD PhD

Lifestyle has an important role in managing diabetes, including steroid-induced diabetes.

Eating a healthy and balanced diet, along with getting regular exercise, can help improve blood sugar management. Working with a dietitian may also help you manage blood sugar spikes after meals.

Although exercise can help you manage your blood sugar, talk with your doctor before starting any exercise program to make sure its safe for you and wont affect any health conditions you might have.

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Tips For Diabetes Management While On Steroids

Both Scheiner and Bell say they find it surprising how few PWDs actually know about these steroid effects on glucose levels and how many healthcare professionals dont explain the likely effects to someone with diabetes before giving a steroid injection or prescription.

The advice that PWDs who might be taking steroids should be getting is pretty clear, per this Medical News Today report:

  • Check blood glucose levels more often than usual. Experts recommend doing this four or more times a day.
  • Work with your doctor to increase the dosage of insulin or oral D-medication, depending on blood sugar levels and other health considerations.
  • Monitor urine or blood ketones to be sure BG levels arent approaching dangerously high.
  • See a doctor immediately if BG levels do rise too high while taking steroids, and increased insulin or oral medication doses do not bring the levels down.
  • As a person gradually reduces their dosage of steroids, they should also reduce the equivalent dosage of insulin or oral medication until it returns to the original dosage. It is important never to stop taking steroids suddenly, as this may cause severe illness.
  • Carry glucose tablets, juice, or candy at all times, in case blood sugar levels drop suddenly from the additional D-medication being taken.

In addition to that textbook advice, Scheiner adds some practical tips:

Bell says dealing with these steroid-related BG rises usually means increasing short-acting insulin and/or insulin pump basal rates.

Epidural Steroids Temporarily Up Blood Glucose In Diabetes

    HealthDay News Epidural steroid injections significantly increase the blood glucose levels in patients with diabetes mellitus, but the effect lasts less than two days, according to a study published in the Jan. 1 issue of Spine.

    Jesse L. Even, MD, of the Vanderbilt University Medical Center in Nashville, Tenn., and colleagues conducted a prospective study in which they enrolled patients with diabetes who were scheduled for an ESI. They collected the patients most recent hemoglobin A1c and asked the participants to track their blood glucose numbers at least twice per day for two weeks prior to and after their ESIs.

    The researchers found a statistically significant increase in blood glucose levels in diabetes patients after ESI. The mean blood glucose level prior to ESI was 160.18 ± 47.46 and, after ESI, it was 286.13 ± 111.11. Using a nonlinear mixed effect model, the estimated half-life of this increase was 1.06 days, indicating that patients were back within their normal standard deviation mean glucose levels within two days of injection. There was no association between observed glucose level change and preinjection HbA1c levels or age.

    ESIs were noted to cause a significant increase in the blood glucose levels in diabetics. There was no correlation between preinjection diabetic control, represented by HbA1c levels, and postinjection response, the authors write.

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    Side Effects Of Steroid Injections

    Possible side effects of steroid injections depend on where the injection is given.

    Side effects of injections into the joints, muscles or spine can include:

    • pain and discomfort for a few days paracetamol may help with this
    • temporary bruising or a collection of blood under the skin
    • flushing of the face for a few hours
    • an infection, causing redness, swelling and pain get medical advice as soon as possible if you have these symptoms
    • a loss of fat where the injection was given this can cause dimples in the skin and may be permanent
    • paler skin around the site of the injection this may be permanent
    • if you have diabetes, your blood sugar level may go up for a few days
    • if you have high blood pressure, your blood pressure may go up for a few days

    Epidural injections can also occasionally give you a very painful headache that’s only relieved by lying down. This should get better on its own, but tell your specialist if you get it.

    Side effects of injections given into the blood tend to be similar to side effects of steroid tablets, such as increased appetite, mood changes and difficulty sleeping.

    You can report any suspected side effect to a UK safety scheme.

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