Steroid induced diabetes

Steroids can: 

• cause the liver to release more glucose into the blood 
• reduce the amount of glucose used by the body (muscle and fat)  
• reduce sensitivity to insulin (it can’t work as well). 

This can lead to high glucose levels in the blood. These high glucose levels are described as steroid induced diabetes. Steroids may also increase your appetite and cause weight gain. Sometimes people with steroid induced diabetes may go on to develop type 2 diabetes, or it may reveal type 1 or other forms of diabetes, but most people find their glucose levels return to a normal range when they stop taking steroids.

The treatment for high glucose levels is insulin, given as an injection.  

Insulin is a hormone that moves glucose from your blood into your cells to be used as energy. There are different types of insulin. The medical team will talk to you about which insulin you need, how much to take and when to take it. Insulin may need to be given with food, if this happens, a diabetes dietitian will explain what you need to do.  

When you are taking insulin, you will need to check your glucose levels and the team will teach you how to do this 

Other treatment advice may include healthy eating and being active.

Recommendations will depend on what other treatments are being used to manage your diabetes and what other conditions you have. If you usually see a dietitian as part of your health care team, you should continue to follow the advice they have given you. 

Making some changes to the way you eat may help manage your glucose levels.

Foods are made up of three main nutrients: carbohydrates, protein, and fat. Carbohydrate foods break down into glucose. It is mostly carbohydrate foods that impact your glucose levels in first 1-2 hours after you eat. A meal that is high in protein or fat may also affect your glucose levels 3-5 hours after eating. 

Carbohydrate foods

Grains: bread, porridge, breakfast cereals, rice, pasta, noodles, flour, quinoa, barley.

Fruit: all fresh fruits, dried fruit and canned fruits.

Starchy vegetables, legumes and pulses: potato, sweet potato, corn, taro, yam legumes - baked beans, beans and pulses including chickpeas, kidney beans and lentils. Legumes also contain protein.

Protein

Protein foods include; lean meat, chicken, fish, nuts and seeds, tofu, Qourn. Legumes such as lentils, broad beans, black eyed peas, kidney beans, chickpeas also contain protein.

Dairy foods

Dairy foods provide calcium for bone health as well as being sources of protein and carbohydrates.

Milk and dairy foods provide protein and some also provide carbohydrate.

Dairy foods with carbohydrate and protein include; milk, milk shakes, fromage frais, Skyr, custard and dairy desserts like rice pudding.

Dairy foods that contain protein without carbohydrate are cheese, cottage cheese and eggs.

Healthy fats

Unsaturated fats include sunflower oil, olive oil, groundout oil, peanut butter, nuts, sesame seeds, avocado, soya beans, chia seeds. Omega 3 rich foods such as mackerel, sardines, tuna and salmon are also sources of healthy fats and protein.

Fluids, vitamins and minerals

Having enough water or other fluids to drink each day is important for health. Drinking enough is also important for glucose sensors to work well. Vitamins and minerals come from all the food groups above plus vegetables and salad vegetables.

The glycaemic index (GI) is a guide to how quickly or slowly carbohydrate foods affect blood glucose levels. Foods with a high GI value are digested (broken down) quickly to produce glucose and foods with a low GI value are digested slowly to produce glucose. It can be helpful to choose low GI carbohydrate foods. You can read more about GI here.

If you usually see a dietitian as part of your health care team, you should continue to follow the advice they have given you. 

Aim to have a healthy balanced diet and meal routine. 

• Eat 3 meals a day with 1-2 small snacks in between if you are hungry. Try and leave a gap of at least 2 hours in between eating in the day. Try not to eat overnight. Snack examples: a piece of fruit, a small pot of yoghurt, 25g of nuts, hummus and 2-3 crackers.  
• Include low glycaemic index carbohydrate at each meal. 
• Include protein and high fibre foods with each meal to help you to feel full and avoid snacking.  High fibre foods include whole grain varieties of starchy foods as well as all fruits and vegetables, lentils and nuts/seeds.
• Be as active as it is possible for you to be.  
• Drink water as your main fluid. If you are going to have fresh fruit juice, drink it with a meal instead of between meals and limit this to 1 glass/250ml per day. 
• Swap any sugar containing drinks to sugar free alternatives. Avoid adding sugar, honey or syrups to cereals and drinks. If you want to add sweetness, try artificial sweeteners.  
• Limit processed foods such as biscuits, cakes, sweets, muffins, and chocolate. These tend to be higher in sugar, salt or unhealthy fats. 

Ideas to try:

Being active moves glucose from the blood into the muscles, this helps with managing glucose levels.  

The main fuel for active muscles is glucose. During and after activity we move more glucose into our muscles. After activity we usually need less insulin, so being active every day can help lower insulin requirements and help glucose levels.  

Take movement breaks if you can. This could be just standing up and then sitting down again every hour if movement is difficult.  

Doing some activity after meals can help manage glucose levels.

The children and young people’s diabetes service is made up of doctors, diabetes nurses and dietitians. Appointments will be made for you to see the diabetes team.  

During these appointments your blood glucose levels and medications will be reviewed as well as talking about any concerns or questions you may have about diabetes. 

If you have any questions or are worried about high or low blood glucose levels, please contact the team.

Emergency mobile: 07940 476811  

Email: uclh.cdorange@nhs.net or uclh.cddietitians@nhs.net   

Further information and fact sheets can be found on our Children and Young People’s Diabetes web page.