Steroids and diabetes: A safe strategy for managing blood sugar spikes

For many people living with diabetes, being prescribed steroids can feel worrying. These medications are known to raise blood sugar levels, and patients often wonder whether taking them is safe at all. According to Dr Rajiv Kovil, Head of Diabetology and weight-loss expert at Zandra Healthcare and Co-founder of the Rang De Neela Initiative, steroids can be safely used in people with diabetes when medically necessary and under proper supervision.
When steroids become essential
Steroids are often life-saving or disease-controlling medicines and may be unavoidable in several situations. They are commonly prescribed during acute asthma exacerbations, chronic obstructive airway disease flare-ups, severe allergies, autoimmune disorders such as ulcerative colitis, certain infections, cancer therapy, and post-transplant care.
Dr Kovil explains, “Steroids can be safely used in people with diabetes when clinically necessary and under medical supervision.” He adds that short courses are generally metabolically safer, though in unavoidable situations they may be prescribed for 6 weeks to 3 months with close monitoring. Importantly, steroids should never be started, stopped, or tapered without medical guidance.
How steroids affect blood sugar
Steroids increase blood glucose levels by causing insulin resistance and increasing hepatic glucose production. Short-term effects often include rapid post-meal spikes, particularly with intermediate-acting steroids such as prednisolone, while long-acting steroids like dexamethasone can cause prolonged hyperglycaemia throughout the day.
Over the long term, steroid therapy may contribute to weight gain, osteoporosis, muscle weakness, Cushingoid features, and even secondary steroid-induced diabetes. The extent of glucose rise varies depending on dose, duration, timing, and an individual’s insulin reserve.
Does the type of steroid matter?
Yes, the metabolic impact differs by route of administration. Oral and injectable steroids commonly lead to significant increases in blood glucose, while inhaled steroids used for asthma or COPD generally have minimal systemic metabolic effects at standard doses, though high-dose or prolonged use can occasionally influence glucose control.
Because responses vary, patients with diabetes should monitor their glucose levels whenever steroid therapy is initiated or modified.
Precautions diabetics should follow
Patients should ideally consult their diabetologist before or immediately after starting steroids. Blood sugar monitoring should be intensified, especially after meals, as steroid-induced hyperglycaemia is often postprandial. Some patients may temporarily require insulin therapy, even if they were previously controlled on oral medications.