Steroid-induced diabetes is an unexpected increase in blood sugars that’s related to the use of steroids. It can occur in people with or without a history of diabetes.

Steroid-induced diabetes is more similar to type 2 diabetes than type 1. In both steroid-induced diabetes and type 2 diabetes, your cells do not respond appropriately to insulin. In type 1 diabetes, your pancreas does not create insulin.

In most cases, steroid-induced diabetes goes away shortly after you stop taking the steroids.

If you’re using steroids long-term, sometimes type 2 diabetes develops. If this happens, it will need lifelong management.

There are risk factors for developing type 2 diabetes after taking steroids long-term. You may be at a higher risk if you:

  • have close family members with type 2 diabetes
  • have overweight
  • developed diabetes during pregnancy (gestational diabetes)
  • have polycystic ovary syndrome
  • are 40 years or older and white
  • are 25 years or older and are of South Asian, African-Caribbean, or Middle Eastern descent

Environment and genes can both play a part in your risk of developing type 2 diabetes.

Historically marginalized groups tend to disproportionately face challenges that can increase risk of diabetes, such as lack of access to healthcare, discrimination in healthcare, and lower socioeconomic status. These inequities are often caused by systemic racism.

Typically, when your blood sugar is high, your pancreas creates insulin, which then goes to your liver. This causes less sugar to be released.

Steroids can make your liver less sensitive to insulin. This results in the liver continuing to release sugar, even while insulin is being sent to it. The continued production of sugar then tells your pancreas to stop making insulin.

In addition, steroids mimic cortisol. Cortisol is a hormone made by the adrenal glands, and is associated with your body’s stress response. If you become stressed, your body releases higher levels of cortisol. The extra cortisol makes your fat and muscle cells less sensitive to insulin. For people with diabetes, that means you may need to take more medication or insulin to keep your blood sugar in a normal range.

Long-term steroid usage can lead to insulin resistance. This is when the cells don’t respond to insulin anymore, and your blood sugar levels increase to a point that you are diagnosed with diabetes. This is steroid-induced diabetes.

Sometimes taking steroids cannot be avoided. People take steroids for a variety of conditions in order to help lessen inflammation.

If you’re taking steroids, it’s important to be aware of steps you can take to lessen the chance of potential side effects. You can do this by keeping a close eye on your symptoms and only taking steroids for a short period of time if possible.

The symptoms of steroid-induced diabetes are similar to those of type 1, type 2, and gestational diabetes. Sometimes symptoms of steroid-induced diabetes are not noticeable until blood sugar is significantly high.

Some symptoms of steroid-induced diabetes include:

There is currently no best way to treat steroid-induced diabetes that’s widely agreed upon by experts, according to a 2017 research review.

Before deciding on a treatment, it’s important for a healthcare professional to check your health and your potential for high blood sugar (hyperglycemia) and insulin resistance. The dose, type, and frequency of steroid use is also important to note.

For some people, it might be possible to treat steroid-induced diabetes with just diet and physical activity, but others may need oral diabetes medications or insulin.

The first approach to treatment will depend on the dose of steroid and your blood sugar levels. Choices of medications include insulin, metformin, and sulfonylureas.

All people with diabetes and those at high risk for developing steroid-induced diabetes should have access to blood glucose monitoring to help prevent high blood sugar emergencies.

As the steroid dose is being lowered, the diabetes medications or insulin should also be brought down to appropriate levels. A healthcare professional should follow up to evaluate your diabetes status and make sure that your levels are where they need to be.

Lifestyle has an important role in managing diabetes, including steroid-induced diabetes.

Eating a healthy and balanced diet, along with getting regular exercise, can help improve blood sugar management. Working with a dietitian may also help you manage blood sugar spikes after meals.

Although exercise can help you manage your blood sugar, talk with your doctor before starting any exercise program to make sure it’s safe for you and won’t affect any health conditions you might have.

Sometimes, taking steroids is necessary and there’s no other option.

If you have diabetes and need to take steroids, talk with your doctor first. Let them know about your diabetes diagnosis. This might change their decision about which drug to prescribe. If it’s not possible to avoid a steroid, your doctor may need to change the dosage.

When taking steroids while you have diabetes, there are things you can do to manage your diabetes:

  • Check your blood glucose levels more often — ideally four or more times a day — and talk with your doctor about whether continuous blood glucose monitoring is an option.
  • Increase your insulin or medication dosage based on your blood sugar levels and your doctor’s recommendation.
  • Monitor your urine or blood ketones.
  • Call your doctor immediately if your blood sugar is too high or if medication does not bring it down.
  • Carry glucose tablets, candy, or juice in case your blood sugars drop unexpectedly.

Like any medication, taking steroids carries some risks and potential side effects. One of these potential risks is developing steroid-induced diabetes.

Steroid-induced diabetes is treatable, but it is something to be aware of when taking steroids, especially when taking them long-term.

Steroid-induced diabetes usually goes away once the course of steroids is finished, but sometimes it can develop into type 2 diabetes, especially with long-term steroid use.

If you are at risk of developing type 2 diabetes, talk with your doctor before taking any steroids. Your doctor can help you make informed and appropriate decisions, as well as provide monitoring to help keep you healthy and lower risks.