Steroid diabetes: an important, common, but easily overlooked diabetes

Author: Chief Physician Mei Gaocai, Department of Nephrology and Endocrinology, Huaihua Cancer Hospital (Huaihua City Second People's Hospital) Some time ago, the department admitted a diabetic patient, Li Moumou.
He was found to have elevated blood sugar due to nephrotic syndrome for 3 months.
Admitted to hospital 1 week.

The patient was diagnosed with "nephrotic syndrome" in our hospital 3 months ago and was treated with glucocorticoids, taking 60 mg of prednisone (a glucocorticoid) by mouth every day.

During the recheck one week ago, it was found that blood glucose was elevated, fasting blood glucose was 8.
6mmol/L, 2 hours postprandial blood glucose was 22.
6mmol/L, and glycosylated hemoglobin was 8.
4%.
It was obviously diagnosed as diabetes.

The patient felt very surprised that he did not have diabetes in the examination 3 months ago, nor did he have symptoms of dry mouth, polydipsia, or polyuria.
Why did he get diabetes? In fact, this is diabetes caused by "long-term oral glucocorticoids", that is, steroid-induced diabetes mellitus (SDM).

 1.
What is steroid diabetes? SDM refers to a glucose metabolism disorder caused by excessive glucocorticoids in the body (endogenous or exogenous glucocorticoids), which meets the diagnostic criteria for diabetes, called steroid diabetes, also called secondary diabetes.

 Clinically, steroid diabetes is a kind of glucose metabolism disorder syndrome that is highly related to drugs.
With the long-term and large-scale clinical use of steroid hormones, SDM has become more and more common.

The incidence of SDM after the application of glucocorticoids is about 8.
8%-40%.

 2.
What can cause steroid diabetes? 1.
The wide application of exogenous steroid hormones Steroid hormones are the direct cause of SDM.

Large doses of steroid hormones can antagonize the hypoglycemic effect of insulin, reduce the uptake and utilization of glucose by cells, and cooperate with the glucose-increasing effect of other endogenous hormones such as glucagon, accompanied by pancreatic β-cell dysfunction.

 2.
Excessive production of endogenous steroid hormones.
The increase in endogenous steroid hormones is very closely related to high blood sugar.
In Cushing’s syndrome (a disease that causes the body to produce a large amount of glucocorticoids for various reasons) 20%-60% Patients may develop impaired glucose tolerance or diabetes.

 3.
What are the clinical manifestations of steroid diabetes? 1.
The onset of the disease is faster and the condition is mild.
People who have no history of diabetes can gradually develop diabetes after glucocorticoid treatment.

The typical "three more and one less" symptoms of diabetes are rare, and they are mostly found during blood glucose screening.

 2.
Low proportion of concurrent ketosis.
Steroid diabetes is not easy to be complicated by ketosis.
Diabetic ketoacidosis is rare.

 3.
Not some patients have antagonistic response to insulin treatment, and compared with ordinary patients, a larger dose of insulin is needed to effectively control blood sugar.

 4.
Most of the blood glucose recovered quickly after drug withdrawal.
After glucocorticoids are stopped, hyperglycemia can be relieved, and only part of it cannot be recovered.

 5.
The characteristics of elevated blood sugar.
Hyperglycemia caused by glucocorticoids is usually mainly caused by elevated blood sugar after lunch to bedtime, and fasting blood sugar is often slightly elevated or normal.

 4.
How to diagnose steroid diabetes? The patient has no diabetes in the past.
After oral glucocorticoids or excessive endogenous glucocorticoid production, the blood sugar rises and reaches the diagnostic criteria for diabetes, that is, SDM can be diagnosed.

 The specific diagnostic criteria for diabetes are as follows: ➤With the typical symptoms of diabetes "three more and one less", fasting blood glucose ≥7.
0mmol/L or random ≥11.
1mmol/L can be diagnosed as diabetes; ➤If there are no typical symptoms of diabetes, another day is needed Recheck fasting blood glucose ≥7.
0mmol/L or oral glucose tolerance test (OGTT) 2-hour blood glucose ≥ 11.
1mmol/L.

 5.
What types of diabetes need to be differentiated from steroid diabetes? 1.
Differentiate Type 1 Diabetes from Type 1 Diabetes Mellitus type 1 diabetes mellitus usually occurs in children and adolescents, with a rapid onset, accompanied by the typical "three more and one less" symptoms, prone to diabetic ketoacidosis, the root cause is insulin deficiency, diabetes related The antibody is positive. 2.
Differentiate from Type 2 Diabetes Type 2 Diabetes usually starts in middle-aged and elderly people, and the onset is slow.
The symptoms of "three more and one less" are often atypical.
Diabetic ketoacidosis is not prone to occur.
The root cause is insulin resistance and diabetes-related antibodies Is negative.

 6.
How to prevent and treat steroid diabetes? Glucocorticoids are extremely important physiological hormones in the human body and are clinically used to treat many diseases.

However, glucocorticoids are a double-edged sword.
There are also many side effects.
Long-term high-dose application can cause a significant increase in blood sugar.

 First of all, we must strictly grasp the indications for the use of hormones, and resolutely put an end to the phenomenon of hormone abuse.
During the period of high-dose use of hormones, we must pay attention to the changes in the patient's blood sugar.

 Secondly, once diagnosed with SDM, we should consider whether the hormone can be stopped or reduced according to the needs of the original disease.
Of course, life>
 Finally, choose hypoglycemic drugs under the guidance of doctors according to the condition.
At present, all types of oral hypoglycemic drugs can be used for SDM patients.

For patients with fasting blood glucose ≥ 11.
1mmol/L, insulin is usually the drug of choice.

Back to the case The patient Li mentioned at the beginning of the article was treated with metformin sustained-release tablets combined with insulin aspart 30.
The patient's blood sugar control was satisfactory.
After repeated explanations by the doctor, he finally understood that glucocorticoids can also cause diabetes.

Source: Friends of Diabetes