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Diabetes

Long term cortisone use and my diabetes

09/14/2009

Question:

I have lupus for 35-40 years...I have been on cortisone for most of this time...presently, no adrenal function...0 cortisol re blood cortisol levels...I would like info re ability to control blood glucose...I cannot discontinue my corticosteroid therapy...is there any known successful treatments for a person as myself...thank you.

Answer:

If the blood sugars are abnormal, then they would be treated essentially the same way as any other person with diabetes.  The one subtlety is that in this situation, the high sugars depend more on resistance of tissues to the actions of insulin and less on a deficiency of insulin.  I would therefore want to emphasize first treatments which improve your body's ability to respond to the insulin that you do produce.  In theory there should be some advantage to a class of drugs called thiazolidinediones although I don't believe there are any studies that document a particular advantage, and they can be associated in some people with fluid retention and some weight gain.  The other major drug that I would tend to use early or first would be metformin, as long as there are no contra-indications or other safety concerns to its use in a particular individual.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati