Steroid Medications Can Increase Insulin Requirements

Vials of Pills

Here’s what you need to know. 

Type 1 diabetes (T1D) care, and particularly glycemic control, does not exist in a vacuum. Even if someone with T1D were to eat the exact same diet every day, his or her insulin requirements could still change. Exercise, stress, and environmental factors can have huge impacts on blood sugar (BG) management. And, environmental factors can include non-diabetes-related medications that doctors may prescribe for various conditions.

One medication that has extremely pronounced side effects is prednisone. This drug acts in the body in the same way that corticosteroids (such as cortisol, a stress-related hormone) do. It is a strong immunosuppressant that may be given for a variety of conditions, including immune reactions, autoimmune disorders, and even to treat specific types of tumors. Many of these conditions respond extremely well to treatment with prednisone.

However, as mentioned, prednisone is known to have a wide variety of side effects, including but not limited to:

  • Weight gain & facial swelling
  • Psychological effects, including depression, confusion, mania, and/or anxiety
  • Stomach/abdominal pain, digestive problems, effects on appetite

Furthermore, adrenal suppression can occur if prednisone is taken for too long. That is, the body may lose the ability to produce its own glucocorticoids without prednisone. For this reason, doctors often prescribe limited courses of prednisone and also may recommend tapering off of the medication, rather than stopping all at once.

So, what are the implications for people with T1D and taking prednisone? We recently asked a Question of the Day about this topic.

Pred QOTD

A huge percentage of respondents in the Glu community said that prednisone has increased the amount of insulin they needed. To understand this further, we turned to a paper by Bevier et. al. entitled Use of Continuous Glucose Monitoring to Estimate Insulin Requirements in Patients with Type 1 Diabetes Mellitus During a Short Course of Prednisone, published in The Journal of Diabetes Science and Technology.

A small sample of 10 participants wore insulin pumps and Continuous Glucose Monitoring (CGM) technology to measure insulin requirements while taking prednisone. They wore CGM’s for five days, and took prednisone on days 2, 3, and 4.

The study resulted in robust findings — each participant responded to the prednisone in a similar way. On the first day of prednisone use, average blood glucose levels increased, as did insulin use, in every single participant. The increase in insulin ranged from 31% to 102% higher than baseline, with an average increase of 69%. These increases were consistent for each participant on each day of prednisone use.

Pred Graphs from paper

In my opinion, a sample size of 10 is quite small. However, it allowed the researchers to present each participant’s data individually, which means each person’s demographics and study results are available one-by-one.

This study has some interesting implications. The first and obvious inference is that people with type 1 diabetes who need to take prednisone should be made aware of its side effects by their doctor, and should limit their duration of taking the medication. However, one of the reasons the researchers conducted the study in the first place was to better understand how specific physiological conditions impact insulin requirements; more specifically, the researchers wanted to understand more about how physiological stress impacts blood sugar management.

“Prednisone, a synthetic corticosteroid, was administered to patients with T1DM to roughly mimic the natural hormonal response to acute stress…”

Prednisone’s mechanism of action mimics the stress-related hormone, cortisol. Cortisol is produced by the body throughout the day, and is also produced in response to acute stress. Cortisol is necessary for many metabolic functions, and is thought to prepare the body for “fight or flight” responses after stress. But, excessive cortisol production has been linked to many health problems, including high blood pressure, obesity (especially increased abdominal fat), poor wound healing, and decreased muscle, nerve, and bone functioning.

Because prednisone works likes cortisol in the body, it can cause insulin resistance. Cortisol, which increases during stress, may also cause insulin resistance over time, which is important for people with T1D to understand when considering how stress can impact BG values.

Has that been your own experience? Do you find that, when you’re stressed, you need a higher ratio of insulin to carbohydrate intake? Alternatively, have you noticed prednisone or other non-diabetes related medications affecting your insulin requirements?  Let us know!

GluDanielle– Danielle Gianferante

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