Cortisone treatment may trigger diabetes or reveal latent diabetes. For a person with diabetes, cortisone increases the need for insulin and raises the blood sugar level.
Cortisone is used to treat various inflammatory diseases. Tablets may be taken orally for a relatively short period of time, e.g., to treat an acute exacerbation of asthma or weeks, as in the case of an intestinal inflammation, or even several years to treat some forms of rheumatic diseases, for instance.
Corticosteroids increase the need for insulin and can raise the blood sugar level depending on the individual, product or dose. Usually, a person with diabetes will need more medication or insulin therapy. For a person using insulin therapy, the insulin dosage needs to be increased.
Both the doses of cortisone products and the effect of different products on blood sugar vary. The need to intensify blood sugar management becomes apparent by monitoring blood sugar levels. Cortisone used in skin creams does not usually affect blood sugar in conventional use.
The effect on blood sugar of inhaled cortisone sprays or powders varies from one person with diabetes to the next but, in normal doses, the effect is usually minor.
During the acute exacerbation of asthma, the stressfulness of the situation as well as the increased use of bronchodilators added to the use of cortisone may result in a rise in blood sugar
A local cortisone injection, for example into a shoulder or knee joint, can raise blood sugar levels for an entire day over several days or a week.
In such cases, tablet treatment for blood sugar or basal insulin treatment may need to be temporarily increased. With multiple daily injections (MDI), correction doses of rapid-acting insulin can be taken based on blood sugar levels at mealtime. If necessary, the dose of long-acting basal insulin can also be increased for a few days. Those using an insulin pump can temporarily increase the basal dose for the entire day.
Because the effect of cortisone is individual, it is important to monitor blood sugar closely until the effect of the cortisone has ended, to allow for the safe adjustment of insulin doses.
Cortisone tablets are used with even or decreasing dose for a period of few weeks or months. Some cancer treatments may entail a large dose of cortisone administered for a period of one day or a few days.
An intermediate-acting cortisone tablet (prednisone, prednisolone, methylprednisolone) taken once in the morning raises blood sugar especially in the afternoon when its effect peaks. The effect on blood sugar depends on the size of the cortisone dose. The blood sugar level normally drops at night as the effect of the cortisone fades.
Long-acting corticosteroid (dexamethasone) raises blood sugar for the whole 24-hour period.
