Steroid induced diabetes

Glucocorticoids are potent inducers of insulin resistance. Steroid induced diabetes is therefore an iatrogenic form of T2DM. The mainstay of treatment is insulin therapy.

General examination

A thorough general and systems examination is still essential in order to detect any complications and to document the patient’s baseline condition.

Signs of other complication of steroid therapy such as hypertension, striae, myopathy and skin thinning should also be sought.

What is the patient’s BMI?

Overweight and obesity are associated risk factors for developing steroid induced diabetes and are also complications of steroid therapy in their own right.

Blood pressure

Is the patient hypertensive?

Hypertension is an important risk factor for many complications of diabetes including ischaemic heart disease, cerebrovascular disease, nephropathy and retinopathy and may be caused by steroid therapy.

Retinal screening

As with all newly presenting diabetes, some form of retinal screening should be undertaken - ideally by digital retinal photography as part of an accredited retinal screening programme - but at the very least dilated fundoscopy should be performed by the examining physician. 

Systems

A baseline cardiorespiratory and abdominal examination should be performed and recorded as a routine part of the new patient assessment in order to detect any unsuspected comorbidities and/or already established complications in all newly presenting cases of diabetes mellitus.

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