Breaking the Myths of Steroids for Patients with Diabetes

Over the years, steroids have accumulated a long list of criticisms and false narratives. When many people think of steroids, they think of the anabolic steroids that are sometimes used by athletes and workout enthusiasts. These steroids impact muscle production and growth and can have some very harmful side effects. Anabolic steroids are very different than the corticosteroids that are used as treatments in almost every medical specialty. In the simplest of terms, these corticosteroids are man-made (synthetic) drugs that can be applied topically, ingested, or injected. Their primary use is to prevent, treat, and reduce inflammation in the body.  

Corticosteroids can be very useful in treating a wide array of illnesses, from seasonal allergies to life-threatening organ inflammation. Common ailments treated with steroids include:

  • Asthma 
  • Hay Fever
  • Eczema
  • Hives
  • Gout 
  • Lupus 
  • Inflammatory Bowel Disease (IBD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Multiple Sclerosis 
  • Rheumatoid Arthritis
  • Addison’s disease 

Some of the conditions listed above are autoimmune diseases. When patients have an autoimmune disease, the immune system doesn’t work properly and attacks the body’s bones, tissues, and organs. Corticosteroids can be effective in decreasing inflammation, preventing damage, and reducing the activity of the immune system.  

Topical Corticosteroids

Topical corticosteroids are a type of steroid medication that is applied directly to the affected area such as the skin or eyes. Like other steroids, topicals are used to reduce inflammation and irritation. Topical corticosteroids can be used to treat many skin conditions such as eczema, psoriasis, and contact dermatitis conditions like dandruff. These steroids can come as lotions, creams, gels, ointments, shampoos, skin patches, or eye drops. There are a few local and limited side effects that can occur from using topical corticosteroids, including burning and stinging sensations. However, over time as the skin gets used to the treatment, these side effects should lessen. Local reactions are typically mild and occur from a prolonged use of corticosteroids. Those reactions can include skin changes, muscle weakness, acne, and atrophy. Atrophy is the shrinking or degeneration of tissue, such as muscles. If you’ve been using topical corticosteroids for a long time, it may be advisable to speak with your medical provider to review your treatment plan.

Ingested Corticosteroids

Ingested corticosteroids come in the form of an oral tablet or pill. Oral steroids are commonly used to treat arthritis, allergies, anemia, lupus, and some skin conditions, including psoriasis. Since the drug is ingested, it works systemically, or throughout the body. Patients are advised to halt steroid ingestion if they have an ongoing widespread infection. If you develop an infection while taking corticosteroids, it is advised to speak with a medical professional. 

Injected Corticosteroids

Corticosteroids can also be injected. These injections may be made directly into muscle or a vein for a broader systemic effect, or directly into the eye, spine, joints, tendons, or bursa sacs for a more local effect. The steroid injections used for orthopedic reasons (bones and joints) most often used contain the man-made versions of cortisol, a hormone naturally made by the adrenal glands. These injections work to decrease inflammation and suppress the local immune system response.

Steroid Effects on Patients with Diabetes

Corticosteroids are commonly prescribed for a wide array of ailments; however, some steroid treatments may cause blood sugar problems for patients with diabetes. Steroids that are ingested or injected in the veins or muscles so that they have a broader systemic effect can lead to stubborn hyperglycemia for long periods. In addition, systemic steroids can suppress the effectiveness of insulin, increasing insulin resistance and causing the liver to release stored glucose into the bloodstream. When combined, these two issues can make blood sugar levels harder to maintain, often requiring much more insulin to manage. 

Locally injected steroids, such as those injected directly into the eye, typically do not cause issues with glucose regulation due to their limited systemic effect on the body. For local steroid injections, patients are first administered some form of local or topical anesthesia prior to the injection procedure taking place. In many cases, especially when injecting into the spine or joints, the medical professional will use an ultrasound to determine exactly where to give the shot to maximize its local effect. Pain levels may vary depending on the location of the shot and an individual’s pain tolerance. Overall, steroid can be highly effective when it comes to managing inflammation, decreasing pain and increasing function, however, they may not always cure the underlying cause of the inflammation or illness.

Benefits of Corticosteroids in the Treatment of DME

For patients battling diabetic macular edema, or DME, there are a few treatments out there, including two corticosteroid injections that have been approved and proven to reduce the symptoms of DME and help improve patients vision. These two drugs work very locally in the eye and target the inflammation and swelling of the retina. One steroid treatment is injected into the eye every few months, while the second option provides a lower dosage of steroid treatment continuously and consistently for up to 36-months with a single injection.

In general, ophthalmic steroid injections may help with the following:

  • Improving vision
  • Reducing fluids leaking into the retina
  • Reducing inflammation and swelling

Seeing your eye doctor every year is an important preventative step to take when taking care of your overall health. DME is a manageable condition. Early detection and strict adherence to your eye doctor’s treatment plan are the best way to prevent vision loss from DME. If DME does occur, corticosteroid injections may be an effective way to treat and manage your DME. If you want more information about DME and treatment options, click here.


DME and ME