Steroids and surgery, not insulin, may be cause
DEAR DR. ROACH: I am 70 years old and had a kidney transplant 18 years ago. I developed diabetes, but it was controlled through oral medication. I recently went into the hospital for pneumonia and was given large doses of steroids and injections of insulin. Now I am unable to bring my sugar down with the pills I was taking. Could the cause be the insulin I was given? Your answer would really be appreciated. — P.I.
ANSWER: The major cause for diabetes in older people is resistance to insulin. Being overweight is a contributing factor to Type 2 diabetes, but some people can be insulin resistant even with a normal weight.
Steroids (I mean glucocorticoids, like cortisone or prednisone) act against the action of insulin, and tend to make insulin resistance worse. This can precipitate or worsen diabetes. Any kind of serious illness, especially infection but even something like a heart attack, can also worsen diabetes. Between the higher dose of steroids and the pneumonia, it’s not surprising your diabetes went out of control and you required insulin.
The insulin you got in the hospital was not the cause of the difficulty controlling your diabetes now. In fact, it may have helped: The pancreas gradually loses the ability to respond to high blood sugar with prolonged high blood sugar levels, a condition known as glucose toxicity. Keeping the blood sugar near normal, using insulin if necessary, helps protect the insulin-secreting cells in the pancreas from damage. Current care is to try to get the blood sugar into a near-normal range as soon as possible after diagnosis while being cautious of the risk of dangerously low blood sugars.
Type 2 diabetes tends to worsen over time, and many people require additional medication as time goes on. This is especially the case if people gain weight, another common problem with high-dose steroids. Still, getting the blood sugars back under control now, with weight loss (if appropriate), careful diet and regular exercise, and additional oral medications or insulin if necessary is still the best way of protecting you from worsening diabetes over time. Diabetes care is ideally managed by a team, including a nutritionist, diabetes educator and expert doctor.
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