Sunday, January 13, 2013

Steroids increase glucose levels , GLP-1 agonist may help


Steroids *
Steroids , oral or injectable , are useful tools in medical practice and provides welcome relief for a multitude of medical problems. The short term use of steroids , one injection or a 4 to 5 day course of oral steroids, causes a temporary increase in glucose levels and is not a significant problem. The long term use is a little more complicated.

Down side
 For people with prediabetes and type 1 and type 2 diabetes the benefits of steroids comes with a down side , elevated blood sugars . Steroids increase glucose levels by making tissues resistent to the glucose lowering effects of insulin , increases glucagon levels and decreases insulin secretion.

side effects are dose related
  The effects of steroids is dose related, higher doses cause high blood sugars.


Dosing methods and different doctors complicates glucose management
  Steroid dosing methods another level of difficulty for some one with diabetes. It is not uncommon to start with high doses and then tapering the dose as need decreases or to use every other day doses.There are also frequent communication breakdowns between the doctor ordering the steroids and the diabetes doctor.

Multiple Insulin injections are usually necessary
Insulin with changing insulin doses based based on blood glucose levels and steroid doses can be complex and far from perfect . Patient education , frequent glucose testing and insulin self management protocols are usually necessary.

GLP-1 Agonist ** may improve and simplify this diabetes management problem
A recent article published ;
 Internal medicine vol.52 (2013) no.1 p.89-95
 Evaluation of the effects of Exenatide administration in patients with type 2 diabetes withworsened glycemic control caused by glucocorticoid therapy.
Dept. of Diabetes Mellitus and Endocrinology , Osaka Red Cross Hospital ,Japan

I have not yet seen the entire article. I have read the abstract and obtained the first 2 pages of the article and review the first case.  She is 63 years old with type 2 diabetes who developed Rheumatoid Arthritis and was started on steroids. Insulin was required and she gained 16 kilograms  over the next year. She was switched to exenatide (Byetta ) 5 ug twice daily . Four months after starting exenatide her glucose control , weight , Bp and LDL cholesterol and triglycerides showed significant improvement.
The story was similar in al 4 patients.

I believe this is a significant report that will lead to more study and improved management of a difficult problem.

Have fun, Be smart and be thankful for the wonderful medications that will improve the lives of everyone with diabetes
David Calder,MD

*commonly used steroids
 prednisone ( deltasone), dexamethasone ( decadron ,Dexpak , dexazone), betamethasone ( celestone), cortizone, methylprednosolone( solu-medrol) , triamcinolone (kenalog) ,fludrocortsone (florinef)

** GLP- 1 Agonist 
     Exenatide (Byetta ,Bydureon )
     liraglutide ( Victoza)
Please review the older post for more information GLP-1 Agonist

1 comment:

  1. Imagine cheesy garlic bread on steroids… that you can pull apart with your fingers. Yes, it's every bit as amazing as you're imagining it to be. testoterone

    ReplyDelete

Your comments and questions are appreciated. David Calder,MD