WHAT IS STEROID?
Steroid or corticosteroid are synthetic version of cortisol (a catabolic endogenous glucocorticoid hormone or stress hormone) which is naturally secreted by adrenal gland located on the top of the kidneys.
WHAT IS THE MECHANISM OF ACTION OF STEROID?
Immunosuppression, anti-inflammatory effects along with the effects on carbohydrates, protein and fat metabolism are important mechanism of action of steroids in different pathological conditions.
USE OF CORTICOSTEROID IN DIFFERENT HEALTH ISSUES
Corticosteroid or steroid especially prednisolone is used in different inflammatory conditions such as asthma, chronic obstructive pulmonary disease (COPD), multiple sclerosis, autoimmune disorder like rheumatoid arthritis (in which immune system mistakenly recognize its own body as foreign body or as attackers), irritable bowel syndrome (IBS), eczema, psoriasis and hay fever.
SIDE EFFECTS ASSOCIATED WITH STEROID THERAPY
Raise of blood sugar (hyperglycemia), glaucoma and cataract, mood swing, depression, insomnia, osteoporosis, infection and thinning of skin are prominent sides effects of steroid therapy.
HOW STEROIDS CAUSES DIABETES OR HYPERGLYCEMIA
Cortisol has very critical physiological role in regulation of carbohydrates, protein and fat metabolism besides other physiological functions. Due to which corticosteroids synthetic version of cortisol hormone also has significant impact on carbohydrate, protein and fat metabolism. As a result of it, steroid raise the blood sugar level and can induce diabetes which is commonly known as STEROID INDUCED DIABETES OR HYPERGLYCEMIA. Let’s check out all the possible factors one by one,
ENHANCE GLUCONEOGENESIS OR INCREASE HEPATIC GLUCOSE PRODUCTION
Gluconeogenesis is the process in which there is increase release of glucose from the liver into the blood chiefly from the non-carbohydrate precursors such as amino acid, glycerol lactate and pyruvate. Proteolysis of protein produce amino acid and lipolysis of fat produce fatty acid and glycerol while pyruvate and lactate produce from the glycolysis.
INSULIN RESISTANCE BY REDUCING CELL SENSITIVITY TO INSULIN
Steroid therapy reduces the cellular uptake of glucose from the blood by reducing its sensitivity to insulin which leads to insulin resistance and ultimately hyperglycemia.
HEPATIC INSULIN RESISTANCE OR REDUCTION OF LIVER SENSITIVITY TO INSULIN
Physiologically liver in the presence of insulin stop producing glucose but with steroid therapy liver becomes less sensitive to insulin and continue to produce glucose and ultimately raise blood sugar by inducing hepatic insulin resistance.
HIGH DOSE OF STEROID REDUCES INSULIN SECRETION
Chronic use of steroids or high doses after long term use causes the pancreatic beta cell dysfunction and subsequently hyperglycemia.
LIPOLYSIS IMPACT ON INSULIN
Steroid promotes lipolysis which results in elevated level of fatty acids which subsequently causes pancreatic beta cell dysfunction and reduction in the secretion of insulin. It also causes interference in insulin signaling and increases insulin resistance and impair cellular uptake of glucose.
WEIGHT GAIN WITH STEROID THERAPY High doses of steroids or long-term use of steroid result in weight gain by affecting several metabolic pathways of body. Steroid stimulate hunger by binding to specific part of brain which regulate the appetite. Steroid by interrupting sleep cycle causes the disturbance in hormones which regulate appetite. Disturbance in carbohydrates, protein and fat metabolism, fat redistribution specially to neck, face and abdomen, compromised insulin singling due to steroid therapy and fluid retention due to disturbance in electrolyte and water balance stimulate appetite and eventually causes gain in weight.
WHAT IS THE LONGTERM EFFECT OF STEROID ON METABOLIC ACTIVITIES (CARBOHYDRATE, PROTEIN AND FAT METABOLISM) OF BODY?
High dose of steroid or its use for prolong period of time definitely become the risk factor for developing diabetes due to aforementioned factors, chronic hyperglycemia and insulin resistance. Use of steroid for short duration may induce diabetes temporarily which get over when someone stop taking steroid but chronic use of steroids will definitely induce diabetes.
CONCLUSION
Steroid is the medicine which can trigger diabetes especially in patients who are pre-diabetic. Close monitoring of blood sugar level and other possible sides effects (infection) under the supervision of physician with proper following of prescription (dose and duration) is required.
