Cushing’s Syndrome and Diabetes
Using corticosteroids is the most common cause of Cushing’s syndrome
Cushing’s syndrome is a condition in which can occur if you have high levels of the stress hormone, cortisol, in your blood.
Cortisol increases our blood pressure and blood glucose levels and diabetes is one complication which can result from untreated Cushing’s syndrome. ( Diabetes medication, 2015)
Symptoms of Cushing’s syndrome
Physical signs of Cushing’s syndrome may include:
- Fatty tissue building up typically around the waist, upper back, between the shoulders and the face.
- Slim arms and legs contrasting significantly with fat deposits around your middle
- Swollen cheeks with red patches
- Striae – red or purple stretch marks, which may resemble tiger stripes, commonly found on the abdomen, near the armpits or around the breasts and thighs
- Thin skin which easily bruises
Women may experience thicker than normal facial and body hair (hirsutism) and missed or irregular periods.
Men may experience a loss of libido, difficulty achieving erections and loss of fertility.
High blood pressure and high blood glucose levels may commonly be experienced with Cushing’s syndrome. ( Diabetes medication, 2015)
Causes of Cushing’s syndrome
Usage of corticosteroids is the most common cause of Cushing’s syndrome.
Steroids are used to treat illnesses including:
- Atopic eczema
- Chrone’s disease
Doctors will prescribe the lowest effective dose to reduce the likelihood of complications, such as Cushing’s syndrome, developing.
When Cushing’s syndrome results from steroid usage, this is known as iatrogenic Cushing’s syndrome.
A less common reason for Cushing’s syndrome developing is known as endogenous Cushing’s syndrome, which is caused by the development of a tumour in the pituitary gland, one of your adrenal glands or one your lungs.
A tumour in the pituitary gland is the more common cause for endogenous Cushing’s syndrome, accounting for about 7 out of 10 cases, and is referred to as Cushing’s disease.
Diagnosis of Cushing’s syndrome
Cushing’s syndrome can be diagnosed by measuring levels of cortisol in the urine, the blood or saliva.
You may be asked to take dexamethasone before the test is carried out. If you don’t Cushing’s syndrome, the dexamethasone should decrease your cortisol levels.
The NHS advise that these tests are helpful but cannot guarantee accuracy. ( Diabetes medication, 2015)
Treatment for steroid induced Cushing’s syndrome
When Cushing’s syndrome results from taking corticosteroids, the dosage you are taking will need to be reduced or stopped. If you have been taking higher doses of steroids for a significant period of time, the dosage you take will usually be reduced before they can be stopped. ( Diabetes medication, 2015)
Steroid Induced Diabetes
Steroids are used to reduce inflammation
Corticosteroids are used to reduce harmful inflammation but can lead to diabetes – often referred to as steroid diabetes.
People on steroids who are already at a higher risk of type 2 diabetes or those who need to take steroids for longer periods of time are the most susceptible to developing steroid induced diabetes.
What is the role of steroids?
Steroids are taken to reduce inflammation, brought on by the body’s immune system, and can be taken as treatment for a number of illnesses including:
- Rheumatoid arthritis
- Crohn’s disease
- Ulcerative colitis
To achieve their purpose, corticosteroids mimic the action of cortisol, a hormone produced by the kidneys and responsible for brining on our body’s classic stress response of higher blood pressure and increased blood glucose levels.
Corticosteroids increase insulin resistance thus allowing blood glucose levels to rise and remain higher.
Read more on steroids and their side effects.
What are the symptoms of steroid induced diabetes?
People taking steroids may notice the following:
- Dry mouth
- Blurred vision
- Increased thirst
- Increased need to urinate
- Tiredness and lethargy
However, symptoms may not be present unless blood sugar levels are significantly higher than normal.
Is steroid induced diabetes permanent?
High blood glucose levels whilst taking steroids may subside after you stop taking steroids, however, some people may develop type 2 diabetes which will need to be managed for life.
Type 2 diabetes is more likely to develop following longer term usage of steroids, such as usage of oral corticosteroids for longer than 3 months.
Am I at risk of developing steroid induced type 2 diabetes?
People at a higher risk of developing type 2 diabetes include:
- Those that are overweight
- If you have one or more close family members with type 2 diabetes
- If you have had gestational diabetes
- If you have PCOS (polycystic ovary syndrome)
- If you are over 40 and of caucasian origin
- If you are over 25 and are of South Asian , African-Caribbean or Middle Eastern origin
Did steroids bring on my type 2 diabetes?
There has been debate as to whether corticosteroids are a cause for diabetes or whether steroids advance the development of existing type 2 diabetes.
A study published in 2012, carried out by the University of Sydney, looked to investigate answers to the question.
The study, titled Steroid-Induced Diabetes: Is It Just Unmasking of Type 2 Diabetes?, found that those which developed new onset steroid induced diabetes had lower risk profiles than is typical of people with type 2 diabetes. (Steroid induced diabetes, 2015)
Diabetes medication 2015. Available from : http://www.diabetes.co.uk/diabetes-medication/costicosteroids-and-diabetes.html [accessed 10/03/2017]
Steroid Induced Diabetes 2015. Available from: http://www.diabetes.co.uk/steroid-induced-diabetes.html [accessed 10/03/2017]