Steroid diabetes mellitus is also called secondary insulin-dependent diabetes mellitus 1. It appears as a result of excess blood volume of corticosteroids (adrenal cortex hormones) for a long time.
It happens that steroid diabetes occurs due to complications of diseases for which there is an increase in the production of hormones, for example, Itsenko-Cushing's disease.
However, most often the disease occurs after prolonged treatment with certain hormonal drugs, therefore one of the names of the disease is drug-induced diabetes.
Steroid type of diabetes by origin belongs to the extra pancreatic group of diseases, initially it is not associated with disorders of the pancreas.
In people who do not have disorders of carbohydrate metabolism in the case of an overdose of glucocorticoids, it occurs in a mild form and leaves after their cancellation. In about 60% of sick people, diabetes 2 provokes the transition of an insulin-independent form of the disease to an insulin-dependent one.
Drugs that cause steroid diabetes
Glucocorticoid medicines, such as dexamethasone, prednisone, and hydrocortisone, are used as anti-inflammatory drugs for:
- Bronchial asthma;
- Rheumatoid arthritis;
- Autoimmune diseases: pemphigus, eczema, lupus erythematosus.
- Multiple sclerosis.
Medicinal diabetes may appear when using diuretics:
- thiazide diuretics: dichlothiazide, hypothiazide, nefriksse, navidrex;
- birth control pills.
Large doses of corticosteroids are also used as part of anti-inflammatory therapy after kidney transplantation.
After transplantation, patients should take life to suppress immunity. Such people are prone to inflammation, which, in the first place, threaten the transplanted organ.
Not all patients form diabetes mellitus, but with a constant intake of hormones, the likelihood of its occurrence is higher than when they are treating other diseases.
Signs of diabetes, which appeared as a result of taking steroids, suggest that people are at risk.
In order not to get sick, fat people should lose weight; those who have a normal weight need to exercise and make changes in their diet.
When a person has learned about his predisposition to diabetes, in no case can one take hormone preparations based on one’s own considerations.
Features of the disease and symptoms
Steroid diabetes is special in that it combines the symptoms of diabetes and diabetes mellitus and diabetes mellitus 1. The disease begins with a large number of corticosteroids starting to damage the beta cells of the pancreas.
This corresponds to the symptoms of type 1 diabetes. However, beta cells continue to produce insulin for some time.
Later, the volume of insulin is reduced, and the sensitivity of tissues to this hormone is disturbed, which also occurs in diabetes mellitus 2.
Over time, the beta cells or some of them are destroyed, which leads to a cessation of insulin production. Thus, the disease begins to proceed in the same way as ordinary insulin-dependent diabetes mellitus 1. Demonstrating the same symptoms.
The key symptoms of diabetes mellitus are the same as for any type of diabetes:
- Increased urination;
- Fast fatiguability.
Usually these symptoms do not appear much, so they rarely pay attention. Patients do not lose weight dramatically, as with type 1 diabetes, blood tests do not always make it possible to make a diagnosis.
The concentration of sugar in the blood and urine are rarely unusually high. In addition, the presence of limit values of acetone in the blood or urine is rarely noted.
Diabetes as a risk factor for steroid diabetes
The amount of adrenal hormones increases in all people in different ways. However, not all people taking glucocorticoids develop steroid diabetes.
The fact is that on the one hand, corticosteroids act on the pancreas, and on the other hand, they reduce the effect of insulin. In order for the blood sugar concentration to remain normal, the pancreas is forced to work with a large load.
If a person has diabetes, the insulin sensitivity of the tissues is already reduced, and the gland is not 100% able to cope with its responsibilities. Treatment with steroids should be made only as a last resort. Risk increased with:
- use of steroids in high doses;
- prolonged use of steroids;
- overweight patient.
Care should be taken with those who occasionally increase blood sugar concentration for unexplained reasons.
Using glucocorticoids, the manifestations of diabetes are increasing, and this is a surprise for a person, because he could simply not be aware of his diabetes.
In this case, before taking glucocorticoids, diabetes was mild, which means that such hormonal drugs will quickly worsen the condition and may even cause such a condition as diabetic coma.
Before prescribing hormonal drugs, older people and women with overweight should be screened for latent diabetes.
Treatment of drug diabetes
If there is no insulin production in the body, then drug-induced diabetes, as well as type 1 diabetes, but it has features of type 2 diabetes, that is, tissue insulin resistance. Such diabetes is treated as diabetes 2.
Treatment depends, including on what kind of a violation the patient has. For example, for overweight people who still produce insulin, diet and hypoglycemic drugs such as thiazolidinedione and glucofage are indicated. Besides:
- If there is a reduced function of the pancreas, the introduction of insulin will give her the opportunity to reduce the load.
- In the case of incomplete atrophy of beta cells, over time, the function of the pancreas begins to recover.
- For the same purpose, a low-carb diet is also prescribed.
- For people with normal weight, diet number 9 is recommended; people with excess weight should follow diet number 8.
If the pancreas does not produce insulin, then it is given by injection and the patient will need to know how to inject insulin properly. Control over blood sugar and treatment are carried out similarly to DM 1. At the same time, dead beta cells cannot be restored.
A separate case of the treatment of medicinal diabetes is a situation where it is impossible to refuse hormone therapy, but a person develops diabetes. This may be after a kidney transplant or in the presence of severe asthma.
The sugar level is maintained here, based on the safety of the pancreas and the level of insulin susceptibility of the tissues.
As an additional support, anabolic steroids can be prescribed to patients, balancing the action of glucocorticoid hormones.