There is evidence that glucocorticoids (GC) or corticosteroids and diabetes are linked. Corticosteroids are used in relation to protein, carbohydrate, lipid, and nucleic metabolism, as well as inflammation and immune response both of which are related to diabetes. Rachel Derr, M.D. defines the effect of GCs on hyperglycemia as impaired transport of glucose to the muscles. The link between diabetes and corticosteroids, particularly in the elderly population, can be found both in the prevalence of corticosteroid use with 10% of inpatients over the age of 60 using some form and 3% of outpatients with prescriptions. Of the 10%, 54-65% had GC-induced hyperglycemia without history of diabetes. The risk of requiring a new form of diabetes medication doubled in outpatients and those suffering chronic obstructive pulmonary disease (COPD)
Instance of Diabetes and Corticosteroids Use in the Elderly Population,
In a study presented to the Society of General Internal Medicine, researchers compared the effects of inhaled and oral corticosteroids on the development of diabetes in the elderly population. The study found that new users of oral corticosteroids nearly doubled their risk of diabetes while inhaled corticosteroids did not. These findings are further supported by a case study of a 60 year old woman suffering from both diabetes and COPD. Presented by Douglas S. Paauw, M.D., in Clinical Diabetes, the study found that the woman’s well-managed glucose levels were increased by the use of corticosteroids, with an increase in hepatic glucose production and inhibited uptake of glucose in surrounding tissues.
Corticosteroids: Diabetes and Other Diseases
The use of corticosteroids in the treatment of a variety of diseases and disorders is widespread. There have been several studies to examine the effect of long-term steroid treatment and the development of a hyperglycemic state or aggravation of pre-existing diabetes. In a study published in The American Journal of Medicine in November 2010, found the use of inhaled steroids commonly used to treat asthma may increase the risk of developing type 2 diabetes. Examining 388,500 people over five and a half years, the researchers found that those who used corticosteroids had a 34% higher chance of developing diabetes. In their conclusion the researchers also pointed to the decreased level of exercise in sufferers of asthma, which could also cause diabetes. Ultimately those at greatest risk of developing diabetes from their inhalers are those that have COPD, also known as emphysema. In another study of neurological disease, steroid use, and diabetes, it was found that “excess steroids impair the suppression of glucose production and stimulation of glucose utilization” (http://www.medscape.com/viewarticle/473201). Thus, when both insulin and steroid medications are used, both must be adjusted in proportion to the other.
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