Glucocorticoid and blood glucose

Glucocorticoid (GC) is one of the common glucocorticoids. Excessive intake of exogenous glucocorticoids and excessive secretion of endogenous GC may cause the increase of blood glucose in varying degrees through a variety of mechanisms. So, what are the characteristics of GC increasing blood glucose? How to deal with the increase of blood glucose caused by GC?

Excessive intake of exogenous glucocorticoids (GC) and excessive secretion of endogenous GC may lead to different levels of blood glucose raising through various mechanisms. Among them, the diagnostic standard of diabetes is called steroid diabetes (GIDM), which is a common type of special type diabetes. GC promotes blood glucose elevation through a variety of complex mechanisms. On the one hand, GC can affect many important organs and tissues related to glucose metabolism, such as liver, skeletal muscle and adipose tissue. For example, GC can promote liver gluconeogenesis and glycogen decomposition, increase liver glucose output and promote liver lipid accumulation; GC can inhibit muscle glycogen synthesis, promote skeletal muscle fat ectopic deposition and insulin resistance; The redistribution of adipose tissue increases visceral fat and aggravates insulin resistance.

On the other hand, GC leads to islets through direct action β The function of insulin secretion of cells is impaired and promotes β Apoptosis and increased glucagon synthesis and release. In addition, GC can reduce glucagon like peptide-1 (GLP-1) secretion and GLP-1 pair β Cell function, inhibit the synthesis and release of osteocalcin.

The development of GIDM is similar to that of type 2 diabetes, i. e. insulin resistance to islet. β Impaired cellular function to impaired glucose tolerance / diabetes.

 1. Abnormal blood glucose caused by exogenous GC

The risk of diabetes in patients treated with GC is related to the dose and duration of GC treatment. Therefore, the dosage and duration of GC should be limited as far as possible. Recommend a healthy lifestyle (healthy diet and adequate physical activity) to patients to prevent abnormal blood glucose.

For patients with GC induced hyperglycemia, the treatment principles are similar to those of type 2 diabetes, that is, drugs that increase insulin sensitivity, such as metformin and / or postprandial insulin secretion, such as sulfonylurea or glennaide, and two peptidyl peptidase IV (DPP 4) inhibitors, GLP 1 receptor agonists and oral drugs. 

2. Endogenous hypercortisolism

Patients with clinically diagnosed diabetes and metabolic syndrome should be screened for cortisol in combination with the actual situation. Patients with cortisol syndrome should be assessed for glucose metabolism, including OGTT. Clinically, blood sugar can be controlled according to the treatment principle of type 2 diabetes. While controlling blood glucose, the etiology of Cushings syndrome should be clarified as much as possible and corresponding etiological treatment should be carried out. 

When glucocorticoid therapy is applied to diabetic patients, we should try to choose the same type of blood glucose fluctuation under the same therapeutic effect. A recent study showed that dexamethasone had the greatest effect on blood glucose, while prednisone had little effect; Suh et al. Suggested that the administration time of glucocorticoid was noon or dinner, and medium effect insulin was given at the same time. The use of different administration time, dose and method, and administration methods such as inhalation, oral administration, injection or local application may affect the development of hyperglycemia.

People with past diabetes or pre diabetes should monitor blood sugar closely even if they use low-dose corticosteroids to prevent the occurrence of hyperglycemia emergencies. Patients with hypoglycemia need to monitor blood glucose levels more frequently than usual 1 ~ 3 days after glucocorticoid reduction.

All these aspects make the treatment plan of such patients need to be individualized, pay attention to blood glucose monitoring during treatment, adjust the hypoglycemic plan at any time according to the blood glucose value, reduce blood glucose fluctuation, reduce the occurrence of related complications, appropriately intervene the mental health during glucocorticoid treatment and improve the quality of life of patients.

 

Cindy