First, patients with steroidal diabetes have a clear history of long-term glucocorticoid use and no clear previous increase in blood glucose, and most are not at high risk for diabetes (family history of diabetes, obesity, history of gestational diabetes, and age >40 years, etc.).
Type 2 diabetes is often a clear-cut group at high risk of diabetes with no history of long-term glucocorticoid use. The blood glucose profile is different.
Type 2 diabetes is most markedly hyperglycaemic after breakfast due to the early phase of insulin hypersecretion 30-60 minutes after a meal and the peak effect of glucose-raising hormones such as endogenous cortisol occurring in the morning, as evidenced by the fastest post-breakfast blood glucose peaks and the highest peaks and fluctuations.
The glycaemic profile of steroidal diabetes caused by the application of glucocorticoids is characterised by the commonly used intermediate-acting preparation prednisone, for example, in the mode of oral administration once a day in the morning, patients often show elevated blood glucose in the afternoon, while fasting blood glucose is mostly slightly elevated or even normal, and in severe cases, both fasting and postprandial blood glucose are significantly elevated.
Secondly, those with Cushing’s syndrome with diabetes are more likely to develop hypertension and hypokalemia as well as cardiovascular accidents and psychiatric disorders.