1. The concept of steroid diabetes mellitus
Steroid diabetes is a disorder of glucose metabolism caused by exogenous administration of glucocorticoids that meets the diagnostic criteria for diabetes, known as steroid diabetes mellitus (SDM), without a previous history of diabetes. About 10-40% of glucocorticoid applications will develop steroid diabetes, which can occur at any time of treatment.
2. Mechanism of glucose elevation by glucocorticoids
(1) Glucocorticoids stimulate hepatic gluconeogenesis.
(2) Inhibition of glucose uptake and utilization by peripheral tissues.
(3) Increase hepatic gluconeogen synthesis.
(4) “Permits” and “synergizes” the glucose-raising effects of glucagon, adrenaline and growth hormone.
(5) Decrease the reabsorption of glucose by the renal tubules.
3. Factors related to the development of steroid diabetes
(1) Dose and duration of treatment are closely related to the occurrence of diabetes mellitus. The higher the dose of glucocorticoids and the longer the application time, the more serious the damage to glucose metabolism, which is obviously positively correlated with the dose.
(2) Patients with kidney disease are prone to steroidal diabetes mellitus.
(3) Age, family history of diabetes, obesity, and other predisposing factors for type 2 diabetes, also have a significant effect on the occurrence of steroid diabetes. Therefore, the elderly, positive family history of diabetes and obesity should be considered as high-risk groups.
4. Clinical characteristics of steroidal diabetes mellitus
The process of glucocorticoid-induced diabetes is similar to the development of type 2 diabetes, i.e. insulin resistance – impaired B-cell function – reduced glucose tolerance – diabetes. However, there are some differences: (1) the disease develops faster, and most of them do not have the typical “three more and one less” symptoms; (2) the threshold of sugar excretion in the kidney is lowered, and the blood glucose is not proportional to the urine sugar value; (3) it is reversible, and the hyperglycemia of many patients can be gradually relieved after stopping the drug, and some of them do not recover, suggesting that the disease is irreversible.
Blood glucose characteristics of steroid diabetes: (1) postprandial blood glucose is elevated, especially in the afternoon to bedtime blood glucose is difficult to control. (2) Fasting blood sugar is mostly normal or slightly elevated. (3) Hypoglycemia is easy to occur in early morning and morning.
6. Treatment strategy of steroidal diabetes mellitus
The treatment principles of steroid diabetes are the same as those of type 2 diabetes, including diet, exercise therapy and selection of reasonable hypoglycemic drugs, etc., but with its own characteristics
(1) For normal fasting blood glucose and participant blood glucose <10mmol/L, reasonable diet and moderate exercise and close monitoring of blood glucose changes are possible.
(2) When the effect of simple diet control and exercise treatment is not good, and postprandial blood sugar >10mmol/L, oral hypoglycemic drug treatment or insulin treatment should be considered.
(4) Monitor blood glucose, to monitor blood glucose at multiple points: fasting blood glucose, postprandial blood glucose and bedtime blood glucose.
(5) Blood glucose control target: fasting blood glucose <6.1mmol/L, 2h postprandial <10mmol/L and <7.8mmol/L at bedtime. The blood glucose control target of the elderly, patients with slow response to hypoglycemia and patients with short course of treatment can be relaxed appropriately.