I will begetting a course of steroid treatment. I heard this could throw my diabetes out of control. What should I do?

Steroids are a type of medication based on compounds naturally produced by the body. Naturally occurring steroids are of several types, but one type, the glucocorticoids, have anti-inflammatory properties and are used to combat inflammation in a variety of conditions from asthma and allergic reactions to serious chronic diseases such as chronic bronchitis (COPD) and rheumatoid arthritis. Short courses of potent steroids, which can be given by mouth or injection, are generally effective and safe, but have the tendency to raise the blood sugar. Depending on the dosage, the potency of the steroid itself, and the underlying condition for which they are given, they can raise the blood sugar by a modest to a very marked degree. This will usually occur within a day of starting the course and will persist until the dosage is either lowered to levels normally produced by the body, or until a few days after discontinuing their use. In the case of a steroid injection given into an area of inflammation, such as the spine or a joint, the elevated blood sugars may persist for several days or even weeks, but are generally not as severe as when steroids are orally administered. In some people, administration of steroids may expose their tendency to diabetes for the first time.

Short courses of potent steroids, which can be given by mouth or injection, are generally effective and safe, but have the tendency to raise the blood sugar.

Steroid-induced high blood sugars do not respond well to pills.

If you have diabetes and are either managed by pills or lifestyle adjustment alone, a course of high dose steroids may mean that you will need to take insulin for a period of time. This is because steroid-induced high blood sugars do not respond well to pills. Sometimes, when the course of steroids will be short, elevation of blood sugars, unless excessive, can be tolerated with the knowledge that it will resolve fairly rapidly when the medication is stopped. You should monitor your blood sugars regularly during a course of steroids and contact your doctor if the readings are climbing much above usual levels. Steroids taken in the morning often only have the tendency to raise the blood sugar in the afternoon and evening, with a return to your usual level by the next morning, so this is an expected pattern. If you already take insulin, you will probably need to raise your insulin dosage to combat rising blood sugars. Your doctor or diabetes educator can give you a strategy to do this, using supplemental insulin and possibly increasing your usual set doses, also.

Isometric exercise

Tensing or rigidity of the muscle against forceful resistance, such as in weightlifting.

Isotonic exercise

Repeated movement against minimal resistance, such as jogging, swimming, or dancing.

How can I manage my blood sugar during sports and exercise activities?

Sports and exercise can affect the blood sugar in various ways. The use of energy by the body during the exercise will have the tendency to lower the blood sugar, as might be expected. If the exercise is vigorous, stressful to the body, or competitive, the release of stress hormones may occur, which will actually serve to raise the blood sugar. Also, so-called "isometric" exercise (meaning that tensing or rigidity of the muscle against forceful resistance is involved, such as in weight-lifting) tends to raise the blood sugar more than "isotonic" exercise (such as repeated movement against minimal resistance, such as jogging, swimming, or dancing), which will generally tend to lower it. Finally, the management of the blood sugar in the aftermath of exercise, meaning from hours to as much as half a day later, may be as important and challenging as during the period of activity itself. This is because the replenishment of depleted glycogen (starch) into the muscle requires drainage of glucose from the bloodstream into the muscle as the building blocks for the starch.

Exactly how best to manage your blood sugar during and after exercise is somewhat unique to each individual and becomes clearer after you have performed the same activity several times. It helps to plan ahead for the calorie consumption that may occur during anything other than brief exercise. Taking additional calories prior to, and sometimes during, exercise is preferable to cutting or stopping your diabetes medication during or prior to exercise, although sometimes it can be beneficial to reduce the insulin dosage modestly when exercise is planned ahead. This planning is helped by knowledge of your blood sugar levels leading up to the exercise and sometimes during it and certainly after it. Finally, account for the replenishment of glycogen stores over the hours following significant exercise by eating a sustaining meal later in the day afterward. It is not unusual for the blood sugar to be significantly lower, occasionally seriously so, the morning after exercise the previous evening if this is not factored into meal consumption.

 
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