The development and proper use of steroids has been a modern day miracle in many respects. It has aided innumerable people to rapidly recover from a wide variety of ailments, resistant to other treatments. For all their good, however, steroids are dangerous drugs that can cause serious harm if misused or abused.

For many people, steroids conjure up the vision of muscle building and, in sports, illegal performance enhancement. While such reputations are quite well-deserved, in reality there are two classifications of steroids, the distinction of which is important. They are anabolic steroids and corticosteroids.




Anabolic Steroids

Anabolic steroids include the hormone testosterone and related compounds that have muscle-building (anabolic) and masculinizing (androgenic) effects. (1) They sometimes are used illegally and may be dangerous, but also may be needed for some people with blood levels of testosterone lower than normal.

In diabetes, especially type 2, some men have decreased levels of testosterone. The normal values for total testosterone in men is 270-1070 ng/dL or 9-38 nmol/L. (2) In general, values below 220 to 250 ng/dL are marked as low in most laboratories; values between 250 and 350 ng/dL should be considered borderline low. (3)

Studies have been done in patients with decreased levels of testosterone. A recent testosterone replacement study was conducted in Germany using the long acting testosterone undecanoate (not available in the United States). Patients were followed for up to four years. In this study, 56 percent of the patients had metabolic syndrome* at the start of the study, which dropped to 30 percent after they were treated with testosterone for 57 months. Lab values such as triglycerides and glucose dropped. Blood pressure dropped and waist circumference dropped by 11 cm. Statin and blood pressure medication was decreased in subjects as well as reported depression. (4)

(*The metabolic syndrome is defined by the International Diabetes Federation as:  a cluster of the most dangerous heart attack risk factors: diabetes and pre-diabetes, abdominal obesity, high cholesterol and high blood pressure. (5))

Preliminary data from the United States indicates that if testosterone replacement is needed, it can help reverse insulin resistance in men with type 2 diabetes after taken over a period of six months. (6)

Many men with low levels of testosterone benefit from using it, but it is not for everyone. The Cleveland Clinic has published a list of conditions where it may be contraindicated. This list may be found here.

If you have low levels of testosterone, have a discussion with your physician about the possible use of the hormone, which should include the pros and cons for you.

Abuse of Anabolic Steroids

Let’s now focus on anabolic steroid abuse by men and women. Reports indicate that people abuse anabolic steroids to improve athletic performance and to boost muscle size. (7) Unfortunately, there are many harmful side effects that are possible with their misuse or abuse. These include heart attack and stroke, liver cancer, non-reversible voice deepening in females, irreversible baldness and breast development in males, reduced sperm production and testicle atrophy. To read more on the side effects of anabolic steroids, click here. http://www.drugabuse.gov/publications/research-reports/anabolic-steroid-abuse/what-are-health-consequences-steroid-abuse.

For anyone including those with diabetes, abusing steroids can cause serious harm. While there is no evidence of the effects of anabolic steroid use in athletes with type 1 diabetes, an article in Diabetes Spectrum states: “Due to the systemic disturbances associated with the use of these drugs, athletes with type 1 diabetes should not experiment with them.” (8) In fact, it is not wise for anyone to experiment with steroids. Please consult your medical team for a frank discussion on how they might affect you.

Corticosteroids

The other Class of steroids are the corticosteroids. Medications in this class are naturally produced in the adrenal gland which is sometimes called the suprarenal gland. It is located directly above the kidney. The adrenal cortex is found on the outer part of this gland which produces and secretes the hormones hydrocortisone (cortisol) and corticosterone. Cortisol's action is on the use of fats, proteins and carbohydrates by the body and together with corticosterone, inflammatory reactions are suppressed. (9) Steroids are the most potent anti-inflammatories available. (10)

The use of corticosteroids in medicine is widespread. They are used, and greatly needed for many conditions to help reduce inflammation, to suppress the immune system and as replacement treatment when the body is not producing amounts needed for health. (11) When taking corticosteroids, make sure you understand how to take them, the risks as well as benefits and how to stop them. You must taper off them slowly according to your physician’s instructions. If this is not done it may cause steroid withdrawal syndrome. (12)

For a list of corticosteroid medications, click here.
 
Steroid-Induced Diabetes and Steroids taken when a Diagnosis of Diabetes has already been made:

The definition of Steroid-induced Diabetes is: Diabetes-range hyperglycemia in subjects who have normal glucose tolerance when not taking corticosteroids. (13)

It has been found that two of the possible negative side effects of taking steroids include an increase in both blood glucose levels and blood pressure. These negative side effects occur as they help the positive effect of preventing inflammation. (14) This can happen in diabetes that has been diagnosed before taking steroids as well as with those with steroid induced diabetes.

Steroids have an effect on raising blood sugar in the following ways:

1. They block the action of your insulin which causes insulin resistance.
2. Less glucose is able to move out of the bloodstream to be taken up by the muscles. This results in a high blood glucose level.
3. They cause the liver to start releasing extra glucose into the bloodstream. (15)

In many people with steroid-induced diabetes, the diabetes will go away after the treatment with the steroids is finished. Some people will continue to have diabetes after the course of treatment is over. (16) Factors that may increase the risk of developing steroid induced diabetes includes: the dose and length of treatment time, familial history of diabetes, obesity, history of high blood glucose, advanced age and route of administering the steroid (Example: injection, oral). (17)

For people with steroid-induced diabetes or people that already have diabetes before steroid use, it is important to monitor and treat the increased blood glucose. Sometimes in people with steroid-induced diabetes, fasting blood glucose level may be normal but at other times during the day, the blood glucose may be above 200 mg/dl. The doctor may consider prescribing neutral protamine Hagedorn (NPH) and rapid acting insulin to cover the blood sugars. (18) It is wise to see a certified diabetes educator to help with meal planning to keep carbohydrates consistent. An afternoon snack may be necessary due to the action of the NPH insulin if given in the morning. (19) Other people with steroid induced diabetes may have mildly high or high blood sugars at all time periods. To see treatment approaches your physician may consider, click here.

All people with diabetes including those with steroid induced diabetes should discuss with their medical team testing blood glucose with a meter to control their diabetes. They should be aware that their medications for diabetes may increase with steroid use and decrease as the steroids are tapered off. Amounts and timing of exercise recommended for them during their treatment with steroids and afterwards should be included in this conversation. All medications prescribed should be discussed (including the mediations for diabetes and steroids if taken). This should include knowledge of when and how to take them and the time and the proper dose should be understood. Meal plans should be developed with a registered dietitian/certified diabetes educator to maintain proper nutrition and to control blood glucose levels. Other diabetes skills and knowledge needed for proper self-care should not be neglected. 
 


Article Reference Links:

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, <a data-cke-saved-href="http://www.accessscience.com/studycenter.aspx?main=21 HYPERLINK " href="http://www.accessscience.com/studycenter.aspx?main=21 HYPERLINK " http:="" www.accessscience.com="" studycenter.aspx?main="21&questionID=5758&quot;&" hyperlink="" "http:="" target="_blank">14, 15, 16, 17, 18, 19