This common steroid can have a big effect on blood sugar

By Dr. Keith Roach

Dear Dr. Roach: My son was diagnosed with type 1 diabetes in March 2020. We recently learned for ourselves that prednisone greatly affects blood sugar. This must be more common knowledge. We found out when my son’s blood sugar was averaging 250 a day, 100 higher than usual. We called his endocrinologist, who temporarily increased the dosage of his pump. -K J

To respond: Prednisone is a synthetic glucocorticoid. It is a steroid, but it has nothing to do with anabolic steroids, like testosterone. It is very similar to cortisone, which is essential to the body’s response to stress.

One of the effects of cortisone is to oppose the action of insulin by raising blood sugar through several mechanisms, including causing the liver to produce sugar and preventing fat cells from absorbing sugar . Steroids always raise blood sugar, but the effect differs between people and depending on the dose of steroid.

Used in low doses (the equivalent of prednisone levels of less than 10 mg per day), steroids increase the risk of developing new diabetes by 80%. At doses greater than 30 mg per day, the risk of new diabetes is greater than 1000%.

There are many other side effects of steroids like prednisone. They increase blood pressure and can cause behavioral changes ranging from anxiety to psychosis. When taken for a long enough period, steroids weaken bones and can prevent the body from making its own cortisone, a life-threatening condition when the body is under stress called Addisonian crisis.

I rarely talk about type 1 diabetes, an autoimmune disease in which the body attacks the insulin-producing cells of the pancreas. An insulin pump mimics the body’s blood sugar regulation by adjusting insulin production and is an effective treatment, especially given the growing ability of these units to adjust their own infusion rates by a system that automatically monitors blood sugar. . Type 1 diabetes should be managed by an endocrinologist whenever possible.

Dear Dr. Roach: When Alzheimer’s disease first came to medical attention decades ago, some experts believed aluminum was the cause of the disease and feared that antiperspirants containing aluminum were dangerous. Should I be alarmed? I’m also worried that antiperspirants and deodorants cause breast cancer. —PG

To respond: I also remember that in the 60s and 70s, aluminum was found in the brains of people with Alzheimer’s disease, and it was feared that drinking from aluminum cans or cooking from aluminum pans would put people in danger. Many studies have looked into this question and have failed to demonstrate a risk for aluminum, whether ingested (antacids contain large amounts of aluminum) or used topically (only antiperspirants contain aluminum). I don’t think aluminum is a big factor in Alzheimer’s disease.

The role of aluminum in breast cancer is not as well studied. Several small studies have shown no risk; however, a study interviewing women with breast cancer suggested that women who shaved and used more deodorants had an earlier age of diagnosis of breast cancer. There are several reasons why this might be the case without concluding that aluminum causes breast cancer. The preponderance of evidence shows no significant link between breast cancer and aluminum-based antiperspirants.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

Rachel J. Bradford