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.

How long and how high is the dose of steroid therapy?

If considering the diagnosis of steroid-induced diabetes, it is essential to know the duration and dose of steroid.

Although any dose of glucocorticoid may induce diabetes, it is unusual at or below physiological replacement doses.

This diagnosis is more likely if the doses are high, the glucocorticoid is more potent (prednisolone and dexamethasone are the usual culprits), and the duration of the therapy is long.

It's also important to ascertain whether steroid therapy preceded the onset of diabetes. 

Has the patient been drinking more water and passing more urine than usual? 

Polyuria and polydipsia are the cardinal symptoms of diabetes and occur when the blood glucose level exceeds the renal threshold for glucose excretion - usually approximately 10 mmol/L.

Steroid induced diabetes often has a brisk and symptomatic presentation. The speed of onset can be such that the patient presents in full-blown hyperglycaemic, hyper osmolar state

Has the patient noticed a change in their eyesight - particularly an inability to focus? 

Variable difficulty with focusing, particularly if present for only a short period and fluctuating, is due to osmotically driven swelling of the lens and varies as the degree of hyperglcaemia varies.

Has the patient experienced generalised pruritis, or oro-gential thrush?

These symptoms are classical although less common symptoms of hyperglycaemia.

Has the patient any other relatives with diabetes?

A thorough family history is essential in order to detect other forms of diabetes, such as MODY, that might be present and not previously recognised in a steroid treated patient.

Diabetesbible is for health professionals