Common steroid can have a big effect on blood sugar

Steroids always make blood sugar go up, but the effect differs among people and by the dose of steroid.

DEAR DR. ROACH »

My son was diagnosed with Type 1 diabetes in March 2020. We recently learned on our own that prednisone greatly affects blood sugar. This needs to be more common knowledge. We found this out when my son’s blood sugar was averaging 250 a day, 100 more than usual. We called his endocrinologist, who temporarily increased his pump dosage.

— K.J.

Prednisone is a synthetic glucocorticoid. It’s a steroid, but it has nothing to do with anabolic steroids, like testosterone. It is very similar to

ANSWER »

cortisone, critical to the body’s response to stress.

One of the effects of cortisone is to oppose the action of insulin by raising blood sugar through several mechanisms, including causing the liver to make more sugar and preventing fat cells from taking up sugar. Steroids always make blood sugar go up, but the effect differs among people and by the dose of steroid.

When used at low doses (the equivalent of a prednisone level of less than 10 mg per day), steroids increase the risk of developing new diabetes by 80%. At doses above 30 mg daily, the risk of new diabetes is more than 1,000% greater.

There are many other side effects of steroids like prednisone. They increase blood pressure and might cause behavioral changes ranging from anxiety to psychosis. When taken over a long enough time, steroids weaken bones and can prevent the body from making its own cortisone, a life-threatening condition when the body is under stress, called an Addisonian crisis.

I seldom discuss Type 1 diabetes, an autoimmune disease in which the body attacks the insulin-producing cells of the pancreas. An insulin pump mimics the body’s regulation of blood sugar by adjusting the insulin production and is an effective treatment, especially given the increasing ability for these units to adjust their own rates of infusion by a system that monitors blood glucose automatically. Type 1 diabetes should be managed by an endocrinologist.