Steroid treatments and blood glucose levels

Information for people who have diabetes and are taking steroids.

Steroid treatment can temporarily worsen your diabetes control. This is because steroids increase the release of glucose from the liver, so it becomes harder to control blood glucose levels after and between meals; it also increases your insulin resistance so more insulin is needed to achieve blood glucose control.
It is essential to monitor your blood glucose more frequently and work with your diabetes team who will usually need to increase your diabetes medication significantly to achieve and maintain good blood glucose control; otherwise you may again develop symptoms of high blood glucose, including tiredness, thirst and passing more urine frequently and blurring of vision. Recovery from an illness, operation or infections will also be slower.
If your steroid dose is changed (either increased, decreased or stopped), your diabetes medication will need to be adjusted at the same time. Stay in close contact with the diabetes specialist team and contact them for advice each time your steroid dose is changed.

Be sure you are following your usual low sugar and personal portion size advice.

- Ask to see a dietitian if you are unsure or if you are losing too much weight.
Select starchy foods that are more slowly digested (low glycaemic index choices) such as wholegrain breads and cereals , pasta, couscous , basmati rice, flat breads such as pitta / wraps or chapattis made with coarse or medium flour. Include daily at least 2 generous portions of vegetables or salad especially peas / beans / pulses.
Limit fruit to 3 ‘hand size’ portions but spread out across the day
Avoid or limit afternoon snacks – as this is when the blood glucose level can be hard to control.
If overweight or your weight is increasing, be particularly careful to reduce fat intake as much as you can.
Maintain or increase exercise if possible.
See also our leaflet ‘Controlling your diabetes while in hospital’.

A side effect of taking steroid medication can be the development of high blood glucose (blood sugar).
- This is known as ‘steroid-induced diabetes’ and is usually temporary.
Diabetes is a medical condition of having a higher than normal blood sugar level which can lead to complications if not treated.
Blood sugars should be below 6 before eating, and be back at this level within 2 hours of finishing a meal.
Steroid tablets taken in the morning may dramatically raise your blood sugar levels during the afternoon and evening.
If steroid-induced diabetes is not treated, you may begin to develop high blood glucose symptoms, including tiredness, thirst, passing more urine frequently and blurred vision. Recovery from illness/operation/infections will also be slower.

Steroid treatment (usually taken in the morning) may make your blood glucose rise too high from midday onwards and into the evening meal period. The effect can in some people, last up to bedtime.
It may be necessary to start some short term diabetes treatment to help control your blood glucose while on steroids.
A low sugar diet will be tried first, (see advice on next page); if food changes are insufficient to control your blood glucose levels then medication will be started.
You will be taught how to monitor your own blood glucose levels and be provided with the equipment to do so.
When your steroid dose is reduced you will need to reduce or stop any diabetes medication. Any adjustments will depend on your blood glucose levels and you will be supported by the diabetes specialist team to do this.
Ask your GP to check that your blood glucose level has completely returned to normal a few weeks after finishing the steroid treatment and stopping all diabetes medication. This will require a fasting blood glucose test.
Occasionally blood glucose levels do not return to normal after finishing steroid treatment, in which case you will need longer term diabetes care.

As soon as you start steroids reduce the amount of sugar in your diet.

Use a sweetener instead of sugar in your drinks.
Avoid all pure sugar sweets, jellies, gums and mints.
- Sugar free sweets are allowed but they can cause laxative effects so limit how much you have.
Select drinks that have a low sugar content. Typically these are sold as ‘diet’, ‘zero’, ‘no added sugar’, ‘lite’ etc. The best choices have less than 1g of sugar per 100mls of drink.
- No-added sugar squash is a suitable choice.
Avoid fruit juice whether freshly squeezed, carton or UHT.
Maintain normal sized servings, about a third of a plate, of starchy foods such as potato, yam, rice, pasta, bread, chapatti etc. Limit biscuits to 2 a day
If you are overweight – it would be helpful to also reduce fat by eating less fatty foods, pastry and avoiding fried foods. This may help reduce insulin resistance that is worsened by steroid treatment.
If you are underweight and have difficulty in keeping your weight up, you can still have puddings and desserts but use sweetener to replace sugar as much as possible.