Do cortisone drugs raise blood sugar? What can be done to avoid it – breaking latest news

I had to start a cortisone treatment due to the onset of joint pain. I am 75 years old, have been diabetic for 12 years and take metformin. Informed of the cortisone therapy, the diabetologist advised me to carry out some blood glucose checks at home. I have noticed that it is high, even more than 170, especially in the afternoon: can I try to control my blood sugar better by changing my diet? Or is it necessary to change the therapy?

He answers Riccardo FornengoHead of Diabetology ASL TO4 – Piedmont, Association of Diabetologists (VAI AL FORUM)

Your question is very pertinent as often people with diabetes are afraid to start steroid therapy for fear that these drugs increase blood sugar and can frustrate the daily work done for the correct management of the disease. Steroids are a very important, useful and often irreplaceable class of drugs, but one that needs to be used judiciously, like all medicines. Patients who start using steroids, not in minimal dosages and for long periods, should be equipped with a blood glucose meter with an adequate number of test strips and carry out periodic blood sugar checks agreed with the GP or with the reference diabetologist, or following a pattern of several points per day, such as fasting and two hours after the start of meals. Checks should be performed more frequently at the beginning of therapy and then to be adapted according to the glycemic situation. Serial blood sugar checks allow us to understand how best to manage hyperglycemia.

The normo-glycaemic or hypoglycaemic therapy should then be adapted according to the effects of the steroid therapy. One may consider temporarily increasing or revising the therapy with drugs that are more powerful in controlling glycemia or revising the dosage of the therapy in progress, especially for those who are on insulin therapy. Very useful drugs can be the SGLT-2 inhibitors: they induce a loss of sugar (glucose) in the kidney and allow for better control of steroid-induced hyperglycemia. Another possibility for better management of steroid therapy divide the steroid into two daily administrations, taking half a dose at breakfast and the other half at lunch. This fractionation allows you to better control the increases in blood sugar induced by cortisone. Increased physical activity to cushion the hyperglycaemic effect of steroids not always easily feasible, especially if steroid therapy is started for joint pain, as in your case. A change in power supply it can be supportive, especially in those cases where the diet is incorrect and has room for improvement. Proper hydration is always useful and highly indicated in subjects using SGLT-2 inhibitors. A frank discussion with your doctor and with your reference diabetologist will allow you to manage this moment in the best possible way and with fewer fears related to hyperglycemia.