How Prednisone Affects Blood Sugar

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It isn’t unusual for people with diabetes to sometimes require corticosteroid treatment. Corticosteroids, or steroids for short, are used to reduce inflammation and suppress the immune system. They are often a last resort for a wide variety of conditions, in everything from asthma to allergy attacks to arthritis and ulcerative colitis. Steroids are also prescribed to prevent the immune system from seeing donated organs as foreign bodies and rejecting them after an organ transplant. One of the most commonly used steroids is prednisone.

“Among all medications available to treat different medical conditions, prednisone and similar steroids have the most profound effect on glucose metabolism. Medications such as prednisone can significantly increase glucose levels in patients with diabetes as well as individuals with impaired glucose tolerance or pre-diabetes,” says William Sullivan, M.D., a senior staff physician at Joslin Clinic in Boston and the Medical Director at the Joslin Clinic at Beth Israel Deaconess Hospital, Needham.

Prednisone is amazingly effective at calming inflamed tissue and reducing pain, but that comfort sometimes comes at a high price. Prednisone’s list of side effects is long and scary. The longer you are on the drug and the higher the dose, the more likely it is that you will experience side effects. When you have diabetes, even a short course of prednisone at a low dose is likely to wreak havoc with your blood glucose levels. In fact, another name for corticosteroids is glucocorticoids in honor of the powerful effect they have on glucose metabolism.

Prednisone induces elevated glucose levels by stimulating glucose secretion by the liver as well as reducing glucose transport into adipose and muscle cells. The overall effect is a reduction in glucose clearance. Elevated glucose levels can lead to glucose toxicity further impairing insulin secretion. Prednisone can also impair GLUT-2 expression. GlUT-2 is a protein mediated glucose transporter that ferries glucose across cell membranes. That means that people with diabetes taking prednisone are likely to see a significant bump in their blood glucose numbers depending on the dose of steroid given.

One of the most difficult things about taking prednisone is that it doesn’t elevate glucose readings consistently throughout the day. Prednisone taken in the morning usually doesn’t cause glucose levels to start to rise until lunch time. Blood glucose readings usually stay high through the early evening hours and then decline over night. Many people have normal or low glucose readings in the morning while taking prednisone.

This type of action curve can make it difficult to use flat basal insulin such as Lantus® or Levemir ®to treat people taking prednisone. Sometimes the use of NPH can be helpful for people on prednisone as it has a peak mid-afternoon and if given in the morning its effects taper off toward the evening, mirroring the action of the prednisone. When using NPH the overall effect is a better balance between your glucose levels and your insulin throughout the day.

The good news about prednisone is that it is cleared from the system fairly rapidly and once you stop taking it, blood glucose levels return to normal fairly rapidly.

41 Responses to How Prednisone Affects Blood Sugar

  1. Gary Taylor says:

    What about prednisone shots? I have had shots for bursitus and the effect of prednisone lasts several weeks. My endocrinologist recommended a 25% increase in my basal (I am on a pump). Any thoughts?

    • Nora Saul, Manager Nutrition Services says:

      Dear Mr. Taylor:

      The response to steriod injections is very individual. High blood glucose levels can be maintained for a few days up to a few weeks. Therefore, it is important to monitor your blood glucose response after an injection and report persistent high numbers to your health care provider.

  2. Joan McGinnis says:

    what about those who take steroids for ulcerative colitis flare up and are already pre-diabetic, will they become diabetic and why isn’t this ever told to people as a possibility?

    • Nora Saul Nutrition Manager says:

      Dear Ms. McGinnis:
      Many people who take steroids for ulcerative colitis take them episodically. It is likely that your blood glucose will rise during the time you take the steroids, but will return to baseline after the flair is over. If the rise in blood glucose during the flair is significant your health care provider may suggest a medication to treat it.

      • Mohammed Belal Uddin says:

        UC patient does not need to take steroid relapsed UC. Now I am steroid resistant. I am suffering from UC for last 14 years. My UC was relapsed for 5 time till date. I experienced a lot of problem on oral and systemic Steroids. During last relapse I detected a herb and compound it hygienic way. I took it for 7 fays only. Now I am OK on Tab Mesacol.

  3. Marie says:

    Couple of questions: How do you recommend getting other specialty physicians to work with my endocrinologist when steroids are necessary? It seems like all physicians think they can handle my type 1 when I am seeing them for surgery or whatever, but they really cannot. Hospitals are even worse. Also, recently went thru 6 months of chemo where it seems that incuding a steroid in the chemical mix to prevent some side effects is standard. That happened to me once before I refused the steroids. It was not pretty! Is there some alternative to use or is one type of steroid less harmful than others? I’ve had a tough time with this all my life. Even though each physician is great individually, they dot seem to play well with each other for the benefit of the patient.

  4. matthew nannery says:

    what about people who are on pred for long periods of time for bad diseases?
    my little dog has gme, a terrible autoimmune disease of the central nervous system.
    pred is the most effective remedy to keep gme attacks at bay; however jake has been on it for 3 months and it has given him steroid induced diabetes. his sugar was initially in the 600s and is still quite high as we are only ramping down the pred now.
    does going to a low, every other day dose of pred, allow normal insulin and blood sugar metabolism to return, even somewhat? i imagine the answer would be much the same for mammals other than people, so an insight into how such situations effect people would help me and jake.
    thanks,
    matt nannery

    • Leah says:

      I’m not sure how old this post is, but for anyone reading, for cats (need prednisone instead of prednisone) and dogs, starting off at twice a day, the tapering to once a day, then every other day, and then decreasing the dose to the minimum effective dose will decrease side effects. It’s important that it’s every other day. There will be fewer side effects with a higher dose given every 48 hours than a lower dose being give more frequently. So the pet might need more pred per day on average at 48h dosing intervals than daily dosing. It’s the 48 hour break between doses that’s important.
      Ps-I’m a vet

  5. Just had biometric screening for work. Glucose levels were 141 after fasting 10 hrs. Had a heavy dose of cortisone injections in my right foot previous afternoon. Never had high level before, no diabetes in family history. Could this injection have contributed?

  6. Philip says:

    I’m having significant swelling in my foot after a bee sting. I’m on prednisone, amoxicillin, and mortin. The swelling as gotten better over the last two days and I move my toes now. I have been having morning normal BS 125-135 reading but daily reading of 250-400. I normally workout at night, but haven’t for the past three nights. Would prednisone effect me working out by going too low, or would you recommend not exercising until off of the prednisone in another 6 days?

    Thanks,
    Phil

  7. Peru says:

    I have been on 40mg prednisone for 6 months and am now just tapering off. I am wondering what tests I should ask for to make sure I don’t have glucose problems due to being on prednisone for so long, and when would be the best time to take these tests? After I have stopped the prednisone or now?

  8. Ray says:

    I was om 80 mg now tapering 10 per week. My blood glucose has been in the 280s to 380s. Does this mean I am diabetic? I didn’t feel any symptoms until now, that I am prednisone. My doctor wants me to take an ac-1 test, won’t that be in accurate cause I am still on prednisone?

  9. Eric Blanchard says:

    I am a Type 1 Diabetic of 25+ years taking a daily regimine of 28 units Lantus and Novolog, sliding scale, insulins and currently in my second day of a six day course of Prednisone, in addition to Keflex, prescribed for treating a particularly stubborn sinus infection. I’ve had consistently high BSL’s since starting the Prednisone. 300+ readings. No matter how much fast acting insulin I take, my BSL remains uncomfortably high. My question; are there general guidelines of how many units to increase bolus doses of Novolog to compensate for the Prednisone induced hyperglycemia? My concern is overdosing the Novolog and bottoming out my BSL. Thanks for reading my question.

  10. I’m takeing 100 mg of predosone in the early am I’m diabetic my numbers are usually 130 to 170 after I take the 100 mg my level in about 7 hours goes up between 500 and600 I’m a pill diabetic when it goes to 500 I take 10 units of insulin and it takes 6 hours to bring it down to200 not happy with those numbers but I only take the 100mg for 4days to help reduce the mass in my abdomem from lypphoma

  11. Naz says:

    I’m diabetic and have had a steroid dexamethasone shot and 5 additional pills to take 1 per day since Xmas eve. This was for extreme rotator cuff tendonitis pain. It is working but the glucose has been consistently between 273-430. I’m trying to avoid going to ER(again) for an IV. Wanted to know if I increase my reg. doses of glyberide 2.5 , and metformin 500 ER tabs to metformin 850MG (not extended release from a previous prescription long ago) , would it be alright on my liver. I would be OK on the glucose going lower and be able to handle it not dropping too low. Im just concerned about the length of time my levels are so high and also if the temporary change in med would be more harmful to liver. (I did stretch out my steroid pill doses because of the elevation) I have 1 more dose to take tomorrow. Having a hard time getting through to doc. during holiday season. I’m trying to complete the steroids.

  12. Naz says:

    I was prescribed the steroid at the ER not the IV. I was referred to go back to ER for an IV if levels didn’t come down. I do have ins. But lots of extra money still involved and Doc’s office doesn’t do IVs.

  13. Flora barnett says:

    I am concerned that a lot of people are paying a very high price trying to get the help they need. I know that it is said that a lot of research goes into medication before being released for public consumption but at what cost to some? I know that a lot of us need help but I don’t think the time to disclose harmful side effects are after the facts.

    I am just a little disappointed because my husband almost died from 2 doses of doxycycline. His tongue sword while he was asleep and he was put in an induced coma. Also, a shot of prednisone is taking his blood sugar on a high and it is not coming down. I would that there had been more disclosure before hand.
    I appreciate all the medical help. I believe most Doctors mean well.

  14. glen howell says:

    I have been weaned from pred for two weeks. My glucose levels are getting better but not where they need to be. Could the pred still be in my system adversely affecting my blood sugar?

  15. Sharan joles says:

    Poison ivy so bad can’t see had a shot for hit nothing type 2 diab gave me prednisone for it have diabetes for 32 years no medication nothing control with what I eat so if diabetes goes up 1 point I can fell it

    • norm says:

      Type 2 diabetic controlled with diet, I have contact dermititus and the Doctor’s assistant put me on prednizone 3 pills 10 mg 7 days 2 pills second week 1 pill third week. I have seen my test strip numbers go to 200 _ 250 with 192 this morning. Will these numbers create long term issues and should I stop using the prednizone or continue for the duration?

      • Jean says:

        I have type 2 Idiabetes I also have asthma I need to take some steroids by mouth sometimes from my asthma i wonder if it will Raise my blood sugar

        • A Chandler says:

          Yes, it will raise your blood sugar levels/readings. You should work with your Primary Doctor, or Endocrinologist, to plan how to counteract the Prednisone effects. I have the same asthma situation with Prednisone prescribed for it. Every time, it has the same side effect. You also need (to have) a kit to test your BSLs during Prednisone treatment..

  16. Buddy says:

    I have been a type 2 diabetic for a decade. I find it easiest to only use Novolog. Not the pen, but with old fashioned shots as needed. I have done a very good job of keeping my average blood sugars at 121. Then I was told to take a powerful steroid as a precautionary med for an MRI, for possible contrast dye reactions. I was only prescribed 2-3 days of this steroid (Methlyprednisolone 32 mg) Almost INSTANTLY my blood sugar more than doubled. Novolog became useless! it was as if I became immune to insulin. (EXAMPLE)…..Six hours ago I was at 265, so I shot 10 units of Novolog and ATE NOTHING! Normally this would get me down to the 100-140 range, upon awakening. This time I somehow went UP, to 282. My primary dr. told me not to worry & that it will leave my system soon & everything will be back to normal. All I know is that, I don’t feel safe & can’t relax when I am near 300!

  17. carla says:

    My husband type 2 diabetic and is hospitalized for shortness of breath. He went for all the test, but not told what causes the shortness of breath. Can he take prednisone tablets to help with the breathing? Is it safe to take?

  18. Laura Burgett says:

    I have the opposite reaction to steroids. I was diagnosed last year with diabetes with at 6.7 A1C, and after Metformin and Actos treatment, my A1C is down to 6.1. I have a history of insulin resistance, gaining middle-body obesity as a young child, and developing Polycystic Ovarian Syndrome as an adult. I was able to become pregnant at age 35 after 5 years of infertility simply by taking Avandia for 6 months. So, obviously, insulin resistance is an underlying factor in the development of my Type-II Diabetes at the age of 45. In the past 6 months, I have needed to take three courses of prednisone–once in January for Asthma with 40mg and ramping down over 10 days, once in March with 60 mg for a Reactive Arthritis flare-up (I have been diagnosed with Diffuse Idiopathic Skeletal Hyperostosis, which is strongly correlated with insulin resistance, early middle-body obesity, and diabetes), and most recently with a spinal injection at the site of severe lumbar spinal stenosis caused by the DISH. Could my diabetic/insulin resistant condition be related to cellular inflammation, and thus, when steroids hit my system, my cells are more amenable to receiving insulin? If so, how do I fix this? Thank you in advance for your response.

  19. Kurt Kemmling says:

    I was on intravenous prednisone for an allergic reaction to the drug SOVALDI. I was on IV for 3 days and released home with a 6_5_4_3_2_1 titration, each pill was 10 mg prednisone. I have been TOTALLY OFF of prednisone for since Saturday 15th of August 2015. Today is august 25, 2015 and my blood sugar levels run from a low of 429 to a high of 700+.

    My doctors are no longer answering my questions and keep changing the subject.

    I feel as if I am dying. Should I be worried?

  20. David Saller says:

    What about Vistamethasone eye drops how does it affect diabetics, in terms of glycemic control? Can it even be used in diabetics for catarract treatment?

  21. i have been on stroids for 2 weeks i am on insulin and my sugar counts r very how they climb after breakfast to about 28 and i have 1 weet bis and i yoghurt when i am high before , i eat lunch , how much should i take before i have one sandwich for lunch and i eat a small tea of chicken and veges at tea time and im still very high about 25 going to bedl please i need help thanks

  22. Bryon Martin says:

    i was put on prednisone for 5 days at 50mg a day. on the forth day i saw a significant spike in my glucose. At about 12 noon it was 502 and dropped to 315 by 210 pm. my vision became somewhat blurred and has gotten a little better but is still fuzzy. how long should it take for my vision to clear up?

  23. Virginia says:

    I started on 80 mg Of prednisone in 2010 i went down to 20 two years ago And i cant go down anymore. If i go down 15or 10 i get soo sick. Im taking prednisone to treat and control The syndrome Of Churg Strauss And alergies. Lately i have been Having low blood sugar in The 60’s i felt tired, shaky, nervousness, sweetness and fatigued(weaken) inpatient, I could not think clearly.
    I asked the nursed from my work to test my blood and it was in the 60’s. How can I low my doses of prednisone ? I made an appointment with a doctor to tell her about my condition. I have been on prednisone for 6 years every day. And still have shortness of breath and all this new symptoms. I want to get off of it but idk how and idk if it is possible. When I try to go down I ended up very very sick with cough pneumonia and shortness of breath. I guess all these are side effects of prednisone.

  24. Shakeel Ahmed says:

    I am 58 years old not diabetic, since last 6 months having Hair dye reaction, so taking Prednisolone , of & on with tapering dose, now it is 5 mg daily with 80 mg prednisolone depo injection, I have Hb1c test & fasting test.

    Hb1c = 6.7

    FBS = 107

    Random 135
    This hb1c is due to Cortisone usage or advise.

  25. Debbie says:

    I have a possible diagnosis of temporal arteritis . They have me on 60mg of Prednisone to start. Until they can confirm my diagnosis, biopsy of temporal artery. If I indeed have TA, I may have to be on steroids for up to 2 years. I am a type 1 diabetic with a pump. I am terrified to possibly be on a steroids for this long. I have doubled my Basel rates and the increase my Bolus rate is incredible. I believe my insulin sensitivity is bad while taking steroids. Has anyone with type 1 ever had any experience with this diagnosis???

  26. Luz Cruz says:

    I just found out I have arterisrlte, they tell me if I don’t take prednisone I can have a stroke, this medication is driving my sugar blood very high I’m doing a low sugar diet as if I’m diabetic but doesn’t work all the time I don’t know what to do, is this the only medication in the market for it

  27. Luz Cruz says:

    I want to know what to do to control the high sugar blood and if there is any other medication to control my illness

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