Steroid-induced diabetes Prednisolone & other corticosteroids

[Lotties]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112077/

It looks like those receiving Prednisolone or other steroid treatment and who start developing type-2 diabetes may need different treatment and benefit from different test regime.
The main takeaways from this for me were that
*Steroids can reduce sensitivity of insulin recep tors.
* treatment with metformin is possibly not a good idea. Exenatide was mooted as an option.
*Post-prandial spikes rather than fasting levels are most affected hence HbA1c and fasting tests are not the best indiactors.
*Insulin therapy (temporary until steroids are discontinued) may be best BUT standard dosing guidelines are inappropriate and may cause nighttime hypos.

And, as with most things, early identification of a problem is best. This gibes with most practical, one size fits all, treatment regimes: wait and see with std thresholds, followed by standard drug prescribing on a linear progression.

The article has sections covering different groups such as transplantees that may receive steroid treatment.

 

[Tophat1900]

It is challenging, and everyone seems to have to deal with differing circumstances and differing health conditions. It is hard to control glucose levels and imo requires more testing to monitor levels, they can change very quickly. Keto seems to work well for me in regards to controlling levels and maintaining a hba1c below 6. I've learned over the years that eating to a pattern makes levels more predictable and also what foods will certainly upset them. So I have simply eliminated the problematic foods and the not so problematic ones can be eaten if the timing is right, before exercise for example.

IMO - testing levels while taking steroids is important even if a person isn't diabetic. However, I doubt anyone prescribing (Or very few) will have the slightest idea of the risk to patients in terms of developing T2. And there is the issue of patients simply not understanding the risks themselves.

While testing would ideal and a good step forward there is always going to be the issue of having to be taught how to use a meter and understanding what the results mean. I still think patients should be made aware of the risk of T2 up front when prescribed steriods and at least be given the option of testing. It would also be helpful that people be given proper advice on carb intake, both sugar and starch sugar should be kept to a minimum, but this is probably asking way too much.

 

[Lotties]

The article covers that and deals with a few scenarios. Written from the perspective of a hospital that treats conditions where steroids are a large part of treatment regime.

 

[Tophat1900]

The article covers that and deals with a few scenarios. Written from the perspective of a hospital that treats conditions where steroids are a large part of treatment regime.

Which part specifically are you referring to?