Prednisone And Diabetes: How Does It Affect Your Blood Sugar?

One of the primary goals of managing diabetes is to keep your blood sugar levels from getting too high. 

What happens if your healthcare provider recommends that you take a medication known to raise blood sugar levels, then?

Prednisone is a medication known to raise blood sugar levels, even in people without diabetes. 

If you have diabetes and are prescribed prednisone, you probably have many questions, which this blog will try to answer.

What is prednisone?

Prednisone is in a class of medications called corticosteroids or glucocorticoids, which treat various health conditions. Glucocorticoids like prednisone are most often referred to as steroids.

Glucocorticoids are not the same as anabolic steroids, the drugs used by athletes and bodybuilders to build muscle mass and increase testosterone levels.

Patients take Prednisone orally in the form of tablets or a liquid. Prednisone isn’t available for IV administration, but other steroids can be administered through an IV. 

The dose of prednisone ranges from 5 to 60 milligrams daily. You don’t apply Prednisone topically like other types of steroids like hydrocortisone creams.

Healthcare providers usually start their patients on Prednisone for 5-14 days initially. If your symptoms improve, you can discontinue Prednisone. However, if your symptoms don’t improve, you may need to take Prednisone for longer.

If you take Prednisone for a prolonged period, you may require your dose to be gradually tapered off when it’s time to discontinue Prednisone.

What is prednisone used for?

Your body can make steroids on its own such as cortisol and testosterone. Glucocorticoids, like prednisone, are used to mimic the steroids your body naturally produces. 

Taking in higher levels of steroids than your body makes can help minimize inflammation. Prednisone can help reduce swelling and inflammation by lowering your immune system’s response. 

Prednisone is similar to cortisol, a hormone released in times of stress. Cortisol increases blood sugar and slows down some bodily functions like your digestive and reproductive systems to promote the fight-or-flight response, while also altering your immune system.

Prednisone can treat several health conditions including types of arthritis, severe allergic reactions, multiple sclerosis (a chronic disease of the nervous system), lupus (an autoimmune disease), and other conditions affecting the lungs, skin, eyes, kidneys, blood, thyroid, stomach, and intestines. 

What are the side effects of prednisone?

There are several potential side effects of taking prednisone, such as:

• Headache
• Nausea
• Vomiting
• Acne
• Thinning skin
• Weight gain
• Restlessness
• Trouble sleeping

More serious prednisone side effects include:

• Severe allergic reactions (skin rash, itching, hives, swelling of your lips/face/tongue)
• Mood changes or depression
• Eye pain or vision changes
• Fever
• Cough
• Sore throat
• Difficulty urinating
• High blood sugar (hyperglycemia)

How to counteract prednisone side effects

Some of the prednisone side effects can’t be minimized, but you may be able to reduce the severity of certain side effects.

Reduced immune system

Taking prednisone lowers your body’s natural immune system response, making you more susceptible to illness and infection. 

To support your body’s immune health, you can practice good hand hygiene, avoid being around sick people, eat a healthy diet, and get enough sleep.

Fluid retention

Prednisone can cause you to retain fluid and develop swelling, especially in your face. This tends to happen when you’ve been on steroids for a long time. 

To help reduce fluid retention, try limiting high-sodium foods and keeping your sodium intake below 2,000 milligrams per day.

Restlessness and sleeping problems

If possible, take prednisone in the morning (or at least avoid bedtime doses) so it wears off a bit by the time you go to bed. 

Prednisone’s half-life (the time for the drug level to reduce by 50% after taking it) is only 2-3 hours.

Stomach upset

As with any medication that can cause nausea, taking prednisone with food can minimize unpleasant gastrointestinal side effects.

What is the link between prednisone and diabetes? 

Taking prednisone can increase your blood sugar levels. In the hospital setting, nearly 90% of people taking steroids have at least one incidence of high blood sugar levels.

Insulin is a hormone your pancreas produces that helps lower blood glucose levels. Steroids raise your blood sugar levels and can make you insulin resistant. When you’re insulin resistant, your body doesn’t respond to insulin the way it should.

Over time, insulin resistance can lead to type 2 diabetes and insulin deficiency, which is when your pancreas doesn’t produce enough insulin.

Steroid-induced diabetes mellitus 

If you have to take steroids long-term, you may be at risk of developing steroid-induced diabetes. 

Steroid-induced diabetes mellitus is defined as “an abnormal increase in blood glucose associated with the use of glucocorticoids in a patient with or without a prior history of diabetes mellitus.” 

This means that you’d be diagnosed with diabetes for the first time due to taking steroids and didn’t already have diabetes before taking steroids.

Diagnosis of steroid-induced diabetes is based on The American Diabetes Association’s criteria:

• Fasting (8 hours minimum) blood sugar greater than/equal to 126 mg/dL
• Blood sugar greater than/equal to 200 mg/dL two hours after consuming 75 grams of carbohydrate by oral glucose tolerance test
• Hemoglobin A1c of 6.5 or greater with symptoms of diabetes
• A random blood sugar of 200 mg/dL or greater

Steroid-induced diabetes is treated as type 2 diabetes. Steroid-induced diabetes is monitored to determine if your blood sugars will decrease over time, especially when steroids are reduced or discontinued.  

One study found an almost 15% prevalence in the diagnosis of steroid-induced diabetes among participants taking steroids for health conditions like pneumonia. The mean duration of steroid treatment in this study was 193 days, which shows how quickly steroid-induced diabetes can occur.

Symptoms of steroid-induced diabetes

The symptoms of steroid-induced diabetes are the same as those of type 2 diabetes and can include:

• Frequent urination – as blood glucose levels rise, your body attempts to rid the excess blood sugar through urination.
• Increased thirst – frequent urination is dehydrating which can make you feel more thirsty.
• Increased hunger – your body’s cells are starved of glucose when insulin cannot get sugar into the cells, which increases hunger.
• Unintended weight loss – when your body can’t use glucose for energy due to insulin resistance, it will start to burn fat stores, which can cause weight loss.
• Fatigue – glucose is your body’s preferred fuel source, so without enough glucose to enter your cells, it can cause fatigue.
• Blurred vision – high blood sugar causes the lens of the eyes to swell, which can blur your vision.
• Frequent infections – high blood sugar can weaken your immune system, which increases your risk of serious illness and infection.

Risk factors for developing steroid-induced diabetes

The risk factors for developing steroid-induced diabetes are similar to those for type 2 diabetes. You may be at increased risk of developing steroid-induced diabetes if you have one or more of the following risk factors:

If you:

• Are overweight or obese
• Have a family history of diabetes
• Have high blood pressure
• Are age 45 or older
• Have a low level of HDL (“good”) cholesterol or a high level of triglycerides
• Have a history of gestational diabetes or gave birth to a baby weighing nine pounds or more
• Are African American, Alaska Native, Native American, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
• Have a history of heart disease or stroke
• Have depression 
• Are not physically active
• Have polycystic ovary syndrome (PCOS)
• Have acanthosis nigricans—dark, thick, and velvety skin around your neck or armpits

How steroids affect diabetes and your blood sugar

If you already have diabetes, you probably wonder how steroids can impact you. 

Taking steroids isn’t ideal if you have existing diabetes, but if your healthcare provider recommends steroids, it will be because they believe the potential benefits outweigh the risks.

You may notice that your blood sugar levels are more difficult to control while taking steroids, which is expected. 

If you’re on steroids short-term, your blood sugar is more likely to return close to normal once you discontinue the steroids compared to taking steroids long-term.

If you have to take steroids long-term, it can become more challenging to manage your diabetes. You may need to alter your diabetes medications (or start taking diabetes medication if you weren’t already) and/or make lifestyle changes to help lower your high blood sugar.

Taking steroids with diabetes

If you have to take steroids with diabetes, there are several things you can do to help minimize the negative effects steroids have on your blood sugar.

Diabetes medication

If your blood sugar control plummets when you start taking steroids, you might need to take diabetes medication until your steroid therapy is complete.

If you already take medication to treat your diabetes, you might need to increase your dose, add another medication, or change your medication regimen entirely.

Insulin injections are the most effective at lowering blood glucose levels and can be a useful addition to oral medications. Insulin comes with the risk of low blood sugar, so you should speak with your healthcare provider about the potential risks and benefits.

Physical activity

You’re probably already aware of the numerous benefits of regular exercise. Regular exercise can help you manage your weight, lower cholesterol levels, improve overall blood sugar control by improving insulin sensitivity, and promote healthy blood pressure levels.

Aim to get 30 minutes of moderate-intensity exercise most days of the week. Choose an activity you enjoy, whether it’s walking, doing group exercise classes, swimming, or working in your garden. 

It’s ideal to get a mixture of cardiovascular exercise (walking, jogging, etc.) as well as strength-based or resistance exercise like weight lifting or bodyweight exercises.

Physical activity helps improve insulin resistance, which is worsened by taking steroids. When your body becomes more sensitive to insulin, blood sugar levels improve.

Weight loss

Prednisone can cause weight gain, which can further worsen insulin resistance. Losing weight if you’re overweight can help improve blood sugar levels while taking steroids like Prednisone. 

Weight loss of 5-10% of your initial body weight can help improve blood glucose control in people with existing diabetes. For a 200-pound person, that would equal a weight loss of 10-20 pounds.

The key to losing weight is to do it sustainably. Otherwise, you won’t be able to maintain those habits or the weight loss.

You can promote weight loss just by making some healthy lifestyle changes. Sustainable, non-restrictive habit changes resulting in weight loss are the best way to lose weight.

For instance, cutting back on sugary drinks, going for a walk during your lunch break, and eating more meals at home instead of eating out are all small changes that can add up and help you lose weight.

Cut back on high-salt foods

Prednisone causes fluid retention, which can raise your blood pressure. This means that you might develop high blood pressure while taking it, or your blood pressure control might worsen if you already have high blood pressure.

While taking Prednisone, try your best to avoid high-sodium foods. Sodium (part of table salt) causes your body to hold on to water, increasing your blood pressure and making your heart work harder to pump blood throughout your body.

Sodium is often in processed and convenience foods like fast food, frozen entrees, canned soups, and deli meats. Other sources of sodium might not be as obvious, but they can add up quickly if you eat several servings of them per day, such as bread.

According to the Centers for Disease Control, 40% of the sodium in the typical Western diet comes from these ten foods:

• Bread and rolls
• Pizza
• Sandwiches
• Cold cuts and cured meats
• Soups
• Burritos and tacos
• Savory snacks (pretzels, jerky, chips, etc.)
• Chicken
• Cheese
• Eggs and Omelets

It’s recommended to keep your sodium intake below 2,300 milligrams per day. However, the average American consumes 3,400 milligrams of sodium per day. So, be extra mindful of your sodium intake while on Prednisone, especially if you already have pre-existing high blood pressure.

Possible prednisone drug interactions

Prednisone can negatively interact with certain medications, which could be dangerous. Some of the known prednisone interactions are:

• Potassium-depleting agents (including certain diuretics for high blood pressure and heart failure)
• Macrolide antibiotics
• Anticholinesterase
• Anticoagulants
• Antidiabetic drugs
• Isoniazid
• Bupropion
• Cholestyramine
• Cyclosporine
• Digitalis glycosides
• Estrogens (including oral contraceptives)
• Fluoroquinolones
• Barbiturates
• Phenytoin
• Carbamazepine
• Rifampin
• Azole antifungals
• Ritonavir
• Indinavir
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenytoin
• Quetiapine
• Thalidomide
• Live or inactivated vaccines

Conclusion

Prednisone can make it more difficult to manage your diabetes and can raise blood sugar levels in patients without a history of diabetes. However, Prednisone can be beneficial and help you recover from serious health problems like respiratory infections or allergic reactions.

If your healthcare provider recommends Prednisone and you already have diabetes, it’s because they believe the perceived benefits outweigh the potential risks.

You can do things to minimize the negative effects Prednisone can have, such as adjusting medications, changing your diet, and being more physically active. 

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