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(08) 6110 0570admin@pdchealthhub.com.auSteroid induced diabetes is high blood glucose caused or unmasked by corticosteroid medicines such as prednisolone. It often settles once the steroid stops, and sometimes it does not.
Corticosteroid medicines such as prednisolone, dexamethasone and hydrocortisone raise blood glucose. They block the way insulin works, so muscle takes up less glucose from the blood and the liver releases more into it.1 In some people that is enough to push glucose into the diabetes range for the first time, and in others it unmasks diabetes that was already on its way. Steroids in skin creams, asthma inhalers and ear or eye drops are unlikely to raise glucose.2 The risk goes up with a stronger steroid, a higher dose and a longer course.3
The timing is what sets this apart from type 2 diabetes. After an oral steroid dose, glucose starts to climb within about four to eight hours.2 With a single morning dose of prednisolone the rise builds from late morning, carries into the evening and eases overnight.3,4 A fasting morning test can look reassuring and still miss it, which is why a check before lunch or the evening meal, or one to two hours after a meal, is more useful.3,4
While the steroid continues, monitoring means finger prick checks timed to catch that afternoon and evening rise, with more frequent checks if the readings run high.2,4 Changes to the steroid dose, and changes to diabetes tablets or insulin, are made by the prescriber, and those doses need to come down again as the steroid is tapered so glucose does not drop too low.1,3 Oral steroids should never be stopped suddenly.1 If glucose stays high afterwards, UK guidance recommends a formal diabetes test about three months after the steroid finishes.4
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This page follows the NDSS and Diabetes Australia information on steroid medications and diabetes. The monitoring timing and the follow up testing after steroids stop come from the Joint British Diabetes Societies inpatient guideline and a 2023 practical review from the United Kingdom, because Australian guidance on steroid induced diabetes is brief. Emergency advice for diabetic ketoacidosis and for a severe low glucose level follows Healthdirect and the NDSS.
For many people glucose settles after the steroid course ends. For some people it does not settle, and the diabetes stays. That is why a formal diabetes test about three months after the steroid finishes is recommended if your glucose has been high.
That is the usual pattern with a morning steroid dose. Oral steroids start lifting glucose about four to eight hours after the dose, so the rise lands in the afternoon and carries into the evening, then eases overnight. It means a fasting morning test is the least likely time to pick the problem up. Checking before lunch or the evening meal, or one to two hours after eating, shows much more.
No. Oral steroids that have been taken for a while must not be stopped suddenly, and the steroid is usually treating something important. Contact the doctor who prescribed it and tell them what your readings are doing. They decide whether to change the steroid dose, the diabetes medicine, or both.
Sometimes, and often only for as long as the steroid continues. Whether it is tablets, insulin or neither depends on how high the readings are, what else you take and how long the course will run. Your GP or specialist prescribes it. A diabetes educator can then show you how to use it and how to step the dose back down as the steroid is reduced.
The NDSS advises that steroids in skin creams, asthma inhalers and ear or eye drops are unlikely to raise blood glucose levels. Diabetes Australia says the same about inhaled steroids used for asthma. Tablets and injections are the ones that matter most. A steroid injection can lift glucose soon afterwards and keep it up for days.
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