Injected steroids and blood glucose. What I learned this week.

By Nick1962 Latest Reply 2013-01-11 15:59:36 -0600
Started 2012-11-14 19:30:52 -0600

I haven’t seen this topic in a while, but I went through something this week that may be of interest. Many types of steroids (inhaled, ingested, creams) can raise your BG levels. Injected steroids really do a number on them. Steroids like corticosteroids and glucocorticoids are a potent class that are known to raise blood glucose levels, often quite significantly. Now many of you that are on steroids for things like arthritis or pain management probably already know this, but I’m sure there are a bunch of folks that have been taking them and quite frustrated with their levels without knowing why. Additionally each steroid may react differently with any diabetes meds you are already taking. It pays to ask your pharmacist.

Yesterday I had to go in for a spinal steroid/nerve deadener shot to hopefully help with my newly diagnosed case of moderate to severe spinal stenosis. I was pre-warned in the literature that this could raise my levels significantly, and in fact brittle diabetics could not have this done. This isn’t my first time getting injected, but it was the first time in my spine and I knew I’d be a little queasy about it, so about 2-1/2 hours prior I ate two hot dogs (w/ buns) to get something substantial in my stomach. Not my usual lunch, but fairly balanced protein and carbs. We didn’t test me before hand (but I knew I had to be running about 100-110). We did test afterward – 138. Not bad we thought, considering the nurse monitoring me said she had sent patients directly to the hospital a few times with high readings. She also informed me of something called “steroid induced diabetes” which sounded a lot like gestational diabetes.

Well, it took me an hour to drive back home and the whole procedure went really well. Pretty painless except when he actually found the problem nerve and injected it. Yeah, that hurt, but not much worse than the pain I’d already been experiencing. I got home and tested again – 85. Cool I though, no side effects. Two hours later after a nice nap, I sat down to a dinner of a lettuce and cuke salad and two grilled bologna and cheese “sandwiches” which were made on those little cocktail breads that are maybe 1/8 inch thick and 2 inches square - in reality, maybe less than half a sandwich. Looked pretty dinky in the pan and I flipped them with a salad fork. Tasty though, and I was in some pain so the comfort food was welcome, diabetes be damned.

Two hours later I tested again figuring I’d be at maybe 125. It was 195! Higher than I’ve been in years even after a pig fest on pizza and beer. I freaked, followed my own advice and tested again – still 195, and yet a third time, 195. I looked back in my discharge literature, and they told me if I hit 300 to call my doctor. Whew, still had some room.

Two hours later (before bed) I tested again, and STILL 195. I went to bed thinking if I do happen to get up in the middle of the night, I’d test, but since the shot was doing its trick, I slept a good comfortable 8 hours. My fasting this morning was 110 (about 15-20 points higher than normal), and I topped out at 150 after lunch. By about 6:30 tonight, I was back at 85.

Now, about an hour after a dinner of beef and bean soup (broth style) and crackers – about 30 carbs total meal – I’m up again at 185. This is way high for me (now) and I’ll feel this in the form of headaches mostly as long as it stays high.

I’m told this side effect (for injections) can last three weeks (creams and inhaled steroids much less). I’m scheduled to have at least one more injection, but with this side effect, I may just settle for what I’ve got so far. The spinal stenosis, thank heavens is not a diabetic complication, but more related to injury, long term obesity (both describe me), arthritis and other factors.

Why do steroids jack up glucose levels? They increase insulin resistance, causing your own to work less effectively in the body and glucose levels build up in your blood. Second, steroids can trigger your liver to release extra glucose, again, leading to high blood glucose levels. So, if you have to take them, for any reason, here’s what the experts say:

You’ll probably need to check your blood glucose levels more often than you usually do—four or more times a day isn’t uncommon.
If you take insulin, you’ll likely need to increase your dose, for example, by up to 20% (often called a sick-day booster), depending on your glucose levels.
If you take pills, you may need to increase the dose, add another type of pill, or possibly even take insulin, temporarily. Again, this all is dependent upon the level of your blood glucose.
Call your health-care provider or diabetes educator if your blood glucose levels increase while you’re on steroids and your medication dose isn’t enough to bring them down.
Carry treatment for hypoglycemia (glucose tablets, juice, candy) with you in case your glucose levels drop suddenly.

Thankfully, this is only a temporary situation for me (I hope), because this will drive me nuts, but hopefully to it puts some education out there to someone who might go through this in the future that hasn’t had as good luck with control as I have. Don’t want to see anyone go into the hospital.

32 replies

Lady.Grantham 2013-01-11 13:49:30 -0600 Report

I just came across your post and I have the issue with it causing insulin resistance, I have rheumatoid arthritis since 2000 and ankylosing spondylitis since 2011 I have been on steroids since 2000 well now that I have been on Humira rather successfully ( cross your fingers ) for the last 8 month) they have been trying to taper me off all has been going well except for the last month. December came around and I started crashing left and right up to 6 times a day and now my doc is trying to do this ACTH test next week she moved me back up to 5mg of prednisone just to keep me somewhat stable but I can't eat I feel sick and I still get close to the low 70 . I am for the first time scared cause now she said my adrenal glands might possible shot … I have always had this easy going attitude about everything I have been dealing with this since I was 17 I am now 44 so yeah a long time . The thing is nothing could ever bring me down but I think this time it is different cause I don't know ! Thanks for listening !!!

Nick1962 2013-01-11 15:59:36 -0600 Report

Its posts like yours here that let me know I’m not alone. Sorry to hear about all you’re going through. I can kind of understand how you feel. I’ve spent a lot of my life in poor shape, so I guess I shouldn’t expect that not to catch up with me. I spent the last 5 years getting healthy, losing a ton of weight, getting my diabetes under control, and really changing my attitude then BAM! Spinal stenosis, degenerative disks, onset of arthritis, and like you onset of ankylosing all at the same time. I’ve always tried to remain positive and upbeat, but yeah, I know what you mean, there’s days I really feel defeated.
Surgery is pretty much decided at this point if I want to avoid disability, but even that is only going to stave off the inevitable. Don’t want to take the steroidal drugs because they mess with my numbers, so I’m kind of stuck. Well, for now I’m pretty much trying to experience as much as I can, and as well as the pain killers will allow. I try to remain positive because it does help. Hope you can find that within yourself to do the same because each morning you’re allowed to open your eyes is another chance things will get better.

Bfbacon 2012-12-12 21:51:33 -0600 Report

Absolutely. Steroids will stimulate glucagon release so you have to hit back with more insulin.

Nick1962 2012-12-16 15:43:48 -0600 Report

Well, see there's my problem (sort of). I'm not on meds or insulin, so controlling this effect through food is kind of tough. Luckily (or unluckily) the effects started to wear off after about 3 weeks, but then so did the pain control I was taking them for as well.

Jan8 2012-11-19 08:54:51 -0600 Report

every time i get a corticosteroid injection in my knee , my diabetes doc double and sometimes triples my insulin. It stays out of whack for about a month. I don't know what i'd do without the insulin.

MrsCDogg 2012-11-19 06:55:02 -0600 Report

I was a CNA for a little over 25 years. I have taken care of a couple patients who had steroid induced diabetes.
Pain is no fun fo deal with on an occasional basis. It totally sucks to have to deal with it on a daily basis…I know because I have arthritis in my back, hips, shoulders, and knees. I certainly hope you can get some lasting relief.

Nick1962 2012-11-19 07:43:53 -0600 Report

Thanks MrsC. I'm used to some pain - being overweight nearly all my life was bound to do some damage, and my chiro keeps me relatively pain free. Guess it's just a part of getting older.

MrsCDogg 2012-11-19 14:23:26 -0600 Report

I've been overweight all my adult life as well. So I can relate to that as well. My dear husband keeps reminding me of a line from Men in Black II…Old and busted…lol

granniesophie 2012-11-18 08:43:48 -0600 Report

I got put on oral steroids back in 2008 for a couple weeks to see if they would help my neck pain. They didn't, but they did raise my BG some-which I just cut more carbs and that helped some. The other thing that helped was they gave me an enormous amount of energy! I had the cleanest house, cause I couldn't stop moving! So I burned off the carbs that way too! So, the steroids didn't work for what they were supposed to, but boy was my house clean, and when I finished with them, my BG went back to where it was supposed to, with no big issues!

Nick1962 2012-11-18 16:36:10 -0600 Report

Glad to hear things went back to normal. In my reading, I've seen a few stories where folks were goofed up for good, but then I don't believe everything I read either. I know what you mean about the energy. The next day I was crazy energized, thought it was just my body reacting positively to being pain free. Made the mistake of taking a pill form of asthma medication (which is also a steroid) and I was flying. Crashed pretty early that night and slept like the dead.

Set apart
Set apart 2012-11-17 07:31:15 -0600 Report

Nick first of all thank you for this, but it really scares me. I have been going through some tests because of high protein in my urine, so high that they know it's not D causing it since I've only had it a little over a year and it's been tightly controlled. Not sure whats going on, but if numbers don't go down we are looking at a kidney biopsy, possibly genetics another autoimmune disease. If they do go down kidney specialist said he would possibly put me on steroids, I don't want to be put on steroids, not sure what other options there are. I go see him Monday and will know then what thenext step is, any thoughts on this??

jayabee52 2012-11-17 22:00:09 -0600 Report

If it is Lupis (SLE) the streoids are not the only possible treatment. There are some newer "biological" meds which you might be able to use to treat your SLE. My "Jem" could not because she was allergic to them.

Set apart
Set apart 2012-11-18 07:25:32 -0600 Report

Well James, I still don't know and it's been over 2 months, the waiting can be hard! I will definitely talk to my doctor about other alternatives, if it gets to that! I have go tell you that Jem was such a lucky woman to have you, when you refer to her as as "My Jem" it makes my heart ache for you, but I am sure your memories and the love you shared continue to be with you every day. Thank you! Blessings!

Nick1962 2012-11-17 18:35:38 -0600 Report

Sorry to hear about the high-pro pee thing SA. You already know there's tons of benign, minor things that can cause it, so try not to worry, I'm sure/hope an answer is just around the corner. I had to go through an MRI to figure out what my back issue was, and unfortunately those things see more than you're looking for. It did locate some cysts on my kidneys also. Maybe an MRI would be next for you too.
Don't worry about the steroid thing. Once you know it happens and how bad, even though you can't really "manage" it, you can change your eating habits for the temporary time you're on them to minimize it. It's gonna happen no matter what, but it's just a chemical thing, and in me at least, once the food works it's way through, I go back to my normal. It just seems like every ounce of the glucose in foods goes stright to the blood, AND I get a liver dump on top of it.
Each type of steroid reacts differently too I read. Some do very little raising of BG's, others, like my injections do a lot and fast. Temporary insulin resistance.

You've got good control, and are on top of things so if needed, you may need to up insulin or meds to counteract. Thats the important thing, you're already way ahead of the curve, know what to look for, and know how to treat accordingly. It is sort of like starting all over again, but you already know what to do this time. I'm finding drinking lots of water helps, and I shouldn't say this, but a little extra BG lowering wine at night brings numbers down too.

Let me know how things go Monday if you wouldn't mind sharing.

Set apart
Set apart 2012-11-18 07:22:10 -0600 Report

Thanks Nick, this really helps me. I will let you know what happens this Monday, along with some other friends on D. It seems as if belonging to DC continues to be my comfort zone where I can share how I feel. I also get scared to gain weight if I get placed on steroids, already thinking of eliminating almost all carbs, not sure what's left! Thanks!

Nick1962 2012-11-18 16:48:25 -0600 Report

Yeah, DC is kind of the ideal freind. You don't have to deal with all their annoying qualities or awkward times when you don't feel much like talking, but they're there right when you need them.
I wouldn't worry about it too much. Gaining a little weight isn't the end of the world, and probably won't happen anyway. And yeah, the numbers might be out of whack for a while if you even have to go down that road (which we don't know you will yet). And don't go carb starving, you do still need them, and you'll only feel worse, but why am I telling you that, you already know, so nevermind about that part.
I know it's messing with your head right now, but just imagine if you were one of the "off the street" people who didn't know as much about their body and how to take care of it as you. My money says you got this no matter what comes up.

Just Joyce
Just Joyce 2012-11-15 09:42:46 -0600 Report

Nick I was tooling around WebMd and saw something about steroid induced diabetes. I didn't pay too much attention to it because I am not on any kind of steroid.

Years ago at the hospital I had a good friend who was an RN. She went on vacation with her husband to Hawaii. She woke up one morning and could not walk so her husband called an ambulance. The doctor at the ER gave her some kind of Steroid shot in her spine. When she returned home and went to her doctor he put her on on a pump and the meds was some kind of steroid. This woman went from a size 12 to a size 24 in about a year. She said she developed diabetes from the steroids. They changed her meds and she started losing the weight. She was good with her diabetes for about two years. She came in one evening to talk to me and told me her body was having trouble fighting infections. She got cancer that spread throughout her entire body and she was dead 8 months later.

I think anyone on any kinds of steroid medications should do research and definitely talk to their doctors about it.

I hope you feel better my friend. We have to come up with the worse foods for Thanksgiving Dinner that we have been served.

Nick1962 2012-11-15 11:03:44 -0600 Report

Thanks Joyce. Yes we do have to start the horrible holiday meal list. This year I'm on my own (projects I have keep me from traveling), so it's thanksgiving steak for me.
Right now anything I eat goes straight to my bloodstream. I woke up at 78 this morning (my normal) and even after coffee (which lowers me) my breakfast of an apple and nuts pushed me up to 160. Normally I wouldn't break 100. So yeah, I am taking this seriously, because much like your friend, that's about how my issues started.

jayabee52 2012-11-14 22:40:02 -0600 Report

They really messed with my 2nd wife "Jem" also. She had Rheumatoid Arthritis and also Systemic Lupis Erithramosis for which she had to occasionally take either prednisone or a corticosteroid shot. (In fact she had gotten one the day before the night of her death.)

Nick1962 2012-11-15 11:32:55 -0600 Report

I remember you mentioning that James, and thought of that when discussing the shots with my neuro. Depending on what is causing my issue, I don't want to be using steroids as a fix. I don't see me getting healthier as I age, so adding a steroid I think would just compound a lot of issues I already have and quite a few that can still crop up. I'm still young enough to endure surgery, so we've set a low threshold for that.

jayabee52 2012-11-15 14:33:04 -0600 Report

Jem didn't have a choice as the newer meds for the RA and Lupis she wasn't able to take for one reason or another.

Nick1962 2012-11-15 14:54:22 -0600 Report

My heart always breaks a little when you mention Jem James. All she went through, doesn't seem fair to heap that all on one person. But it does serve the purpose to show that there is a lot we can endure if we have to.

Harlen 2012-11-14 19:49:12 -0600 Report

Yep they do a number on me too

Nick1962 2012-11-14 20:21:11 -0600 Report

I'm not sure I could deal with this long term. The pains and discomfort of the highs vs the back pain. Gonna be an interesting next few months/year.

HeidiLynne 2012-11-15 14:38:25 -0600 Report

Nick, I truly hope every thing goes well for you

Nick1962 2012-11-15 15:00:27 -0600 Report

Thanks. I still consider myself extremely fortunate to only be dealing with what little I have on my plate compared to others. It just messes with my head a little. I've lost a lot of weight, got myself healthy and have a once-in-a-lifetime vacation planned and this shows up a month before. Poor family medical history weighs in as well. Like anythng else though, gotta handle what comes I guess.
Thanks again.