Steroids and diabetes: The effect on high blood sugar

Steroids and diabetes

There are various reasons that people take steroid medications. Reasons include bone or muscle injury, pain, lung conditions such as asthma flare-ups, and influenza infections. COVID-19 can cause shortness of breath and breathing problems1 and steroids might be used. If your medical provider prescribes a steroid medication, here are some things you should know.


What are steroids?

The label “steroid” is a general term; glucocorticoid is the more specific medical term. Glucocorticoids are naturally made in the body (by the kidney’s adrenal glands) and they have anti-inflammatory properties. They also regulate metabolism (which includes glucose metabolism). 

In addition to steroids that the body naturally produces, there are also synthetic versions that are designed to act like hormones that reduce inflammation. Some common generic names of glucocorticoids that can affect the entire body system (called systemic) are prednisone, hydrocortisone and dexamethasone. 

There are inhaled glucocorticoids that affect the lungs directly and include beclomethasone, budesonide, fluticasone.2 Inhaled glucocorticoids are used for asthma and long-term lung conditions such as Chronic Obstructive Pulmonary Disease (COPD). There are also topical glucocorticoids in the form of lotions or creams which include hydrocortisone and betamethasone. 

In this article, we will focus on systemic (i.e. oral, injected, or inhaled) glucocorticoids that we’ll call “steroids” since these are the most likely to affect glucose levels.


What if I’m prescribed steroids and have diabetes?

A known side effect of systemic steroids is elevated glucose levels (hyperglycemia). As you know, this can be especially challenging for people with diabetes. Insulin is the best way to counteract hyperglycemia caused by steroids. In a hospital setting, individuals can receive steroids by IV (intravenous) route. IV doses are often much higher than you would get from oral pills. 

In the hospital, the medical providers might prescribe different types of insulin to be given at different times of the day to help reduce hyperglycemia.3 If you’re taking steroid pills at home, you might not be starting any new insulin, but you can ask your provider for guidance on the dose to take of your current insulin. Some steroids, such as prednisone, can raise the glucose level for part of the day. This will be most noticeable if the prednisone is only taken once per day, such as in the morning. 

Before you take the morning prednisone pill, your glucose level might be the same as it usually is. But later in the day, your glucose level could be a lot higher. This is because steroids increase insulin resistance causing your body’s own insulin or injected insulin to not work as well.4 Some people are especially worried about what they eat because they think the food is causing the unusually high glucose reading, but it is most likely from the steroid.


What should I keep in mind while taking steroids?

If you’re using an insulin pump, the basal rate can be increased slightly for part of the day, if needed.  You can do this using a temporary basal rate. If you are using the MiniMed 670G system, ask your provider if you should switch to Manual Mode during the time you are taking the steroid. 

One of the best ways to determine if you need a higher basal rate is by monitoring your glucose level using a continuous glucose monitor (CGM) such as the GuardianTM Connect system or MiniMedTM insulin pump systems. Consider how many days you will be taking the steroid. If you only take the steroid for a few days, the long-term impact of hyperglycemia is unknown. But you do want to avoid short-term consequences of high glucose such as dehydration or diabetic ketoacidosis (DKA)5:

  • Be sure to stay well hydrated with sugar-free beverages.
  • Check your glucose several times per day and as directed by your healthcare team.
  • According to the American Diabetes Association, experts advise checking for ketones every 4-6 hours when your glucose level is above 240 mg/dL. Let your healthcare provider know if you have ketones in your urine, especially if the level is moderate or higher.
  • Talk with your provider about your insulin dose and always follow their advice. If you do increase your insulin dose while you are taking steroids, be sure to go back to your usual dose when you stop taking the steroids.
  • Do not stop your steroid medication early, unless recommended by your healthcare provider.

We hope these tips are helpful for you! One of the most popular blogs of all time here at The LOOP is on steroid usage and diabetes, so we wanted to bring it back to you along with some new tips.  


[Originally published 2015-08-27. Updated 2020-10-29] 


1Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) Your Health: Symptoms of Coronavirus. Accessed October 21, 2020. 
2Egbuonu F, Antonio FA, Edavalath M. Effect of Inhaled Corticosteroids on Glycemic Status. The Open Respiratory Medicine Journal, 2014, 8, (Suppl 1: M7) 101-105. 
3Grommesh B, Lausch MJ, Vannelli AJ et al. Hospital Insulin Protocol Aims for Glucose Control in Glucocorticoid-Induced Hyperglycemia. Endocr Pract 2016; 22:180-189. 
4Bevier WC, Zisser PHC, Jovanovič L et al. Use of Continuous Glucose Monitoring to Estimate Insulin Requirements in Patients with Type 1 Diabetes Mellitus During a Short Course of Prednisone. J Diabetes Sci Technol 2008;2(4):578-583.
5American Diabetes Association. Diabetes Complications: DKA (Ketoacidosis) & Ketones. Accessed October 21, 2020. 
– Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems.
– Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms. 
Medtronic Diabetes Insulin Infusion Pumps 
– Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day. – Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately. 
Medtronic Diabetes Continuous Glucose Monitoring (CGM) Systems 
– The information provided by CGM systems is intended to supplement, not replace, blood glucose information obtained using a home glucose meter. A confirmatory fingerstick is required prior to treatment. – Insertion of a glucose sensor may cause bleeding or irritation at the insertion site. Consult a physician immediately if you experience significant pain or if you suspect that the site is infected. 


Important Safety Information 

The Medtronic MiniMed™ 670G system is intended for continuous delivery of basal insulin (at user selectable rates) and administration of insulin boluses (in user selectable amounts) for the management of type 1 diabetes mellitus in persons, seven years of age and older, requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin. The MiniMed™ 670G system includes SmartGuard™ technology, which can be programmed to automatically adjust delivery of basal insulin based on Continuous Glucose Monitor sensor glucose values and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values. The system requires a prescription. The Guardian™ Sensor (3) glucose values are not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a fingerstick may be required. A confirmatory finger stick test via the CONTOUR®NEXT LINK 2.4 blood glucose meter is required prior to making adjustments to diabetes therapy. All therapy adjustments should be based on measurements obtained using the CONTOUR®NEXT LINK 2.4 blood glucose meter and not on values provided by the Guardian™ Sensor (3). Always check the pump display to ensure the glucose result shown agrees with the glucose results shown on the CONTOUR®NEXT LINK 2.4 blood glucose meter. Do not calibrate your CGM device or calculate a bolus using a blood glucose meter result taken from an Alternative Site (palm) or from a control solution test. It is not recommended to calibrate your CGM device when sensor or blood glucose values are changing rapidly, e.g., following a meal or physical exercise. If a control solution test is out of range, please note that the result may be transmitted to your pump when in the “Always” send mode.
WARNING: Medtronic performed an evaluation of the MiniMed™ 670G system and determined that it may not be safe for use in children under the age of 7 because of the way that the system is designed and the daily insulin requirements. Therefore this device should not be used in anyone under the age of 7 years old. This device should also not be used in patients who require less than a total daily insulin dose of 8 units per day because the device requires a minimum of 8 units per day to operate safely.

Pump therapy is not recommended for people whose vision or hearing does not allow recognition of pump signals and alarms. Pump therapy is not recommended for people who are unwilling or unable to maintain contact with their healthcare professional. The safety of the MiniMed™ 670G system has not been studied in pregnant women. For complete details of the system, including product and important safety information such as indications, contraindications, warnings and precautions associated with system and its components, please consult  and the appropriate user guide at For more information, please visit:          

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Submitted by Laura Legg (not verified) on

In reply to by Commenter (not verified)

I have had to have several cortisone shots recently, and have worked out a very effective plan. I watch my CGM until my blood sugar starts to rise, then once it hits about 200 I do a temp basal of 120%. If it hits 300 I go up to a temp basal of 150% and then monitor my sugars and correct with boluses. After about 3 days it begins to taper off, and I start lowering my basal accordingly, keeping my sugars just a bit high to make sure they don't bottom out when the meds wear off. While this may not be ideal to run my blood sugar a bit high, it is low enough that I don't feel sick and high enough that I'm not in danger of any bad lows.

Submitted by LOOP Blog Editorial on

In reply to by Laura Legg (not verified)

Thanks for sharing your insights with us, Laura. I’m glad you’ve found what works best for managing your diabetes while taking cortisone shots.

Submitted by Tracey Romero (not verified) on

In reply to by LOOP Blog Editorial

Sara’s solution sounds similar to what I did PRIOR to the 670g. (Fortunately, I haven’t needed injections since starting this pump.) Since we can’t do temporary nasals with the 670g, what would be an alternative? I used to tell the pump I was eating 1.5 times the carbs I was actually seating for about 3 days after the injection & monitor the glucose closely. It seemed to work, back then!

Submitted by Karrie Hawbaker (not verified) on

In reply to by Tracey Romero (not verified)

Thanks for being a part of our community, Tracey. Temporary basal settings are still available with the MiniMed 670G system when it's used in manual mode. If you'd like to learn more, give us a call at 800.646.4633, option 1.

On October 8th I had epidural steroid injections in my lower back. Could my sugar still run high it is now February 10th. My sugar levels have been high ever since.

Judy, this is a good question for your healthcare provider. We are not able to provide medical advice or diagnose any specific conditions.

Submitted by Rose Willing (not verified) on

In reply to by Laura Legg (not verified)

I have Type II diabetes that runs around 200 and recently went on a steroid for another problem. After 2 days my blood sugar registered over 600 I was so shaky and weak and had blurry eye sight. The Dr should have checked my chart! I could have gone into a coma! My point is make sure you tell your Drs because they don’t read your chart ! What did we do before GOOGLE?

Submitted by Kurt Aaron Brace (not verified) on

In reply to by Rose Willing (not verified)

the problem is somebody besides the dr takes all your health info down over the phone when you make the appointment. I swear Drs. don't read the charts first. Afterall, you sign away any liability claims against them. I'm diabetic and was prescribed steroid pills without any mention of my diabetic condition. A friend told me about sugar being elevated and this site confirmed it.

Submitted by Charmane (not verified) on

In reply to by Commenter (not verified)

I have an insulin pump and twice now I have gotten an infection from my infusion. The first infection was treatable with an antibiotic , but the second one I had to have minor surgery for an abdominal abscess , I was able to go home but 2 days later I was back at the hospital because the oral antibiotics were not clearing the infection, I had to receive IV antibiotics and was admitted into the hospital, with abdominal wall cellulitis . I am home now , back on oral antibiotics for another week. I was wondering if other people on insulin pumps go through this,? My doctor is concerned about 2 infections within a year and my concern is I fear this happening again. I am thinking possibly I just might not be able to have a insulin pump. I am also afraid to infuse on the side of the infection, my Droctor told me to stay away from that side for 2 weeks and to just keep infusing on the opposite side, but to keep moving the infusion around. I would appreciate it someone could get back to me. Thank you, Charmane

Submitted by LOOP Blog Editorial on

In reply to by Charmane (not verified)

Charmane, I’m sorry to hear about this experience. I recommend following your doctor’s recommendation of staying away from the side of infection for two weeks until it heals, and continuing to change your infusion set every 2 to 3 days to keep your sites healthy and allow for proper insulin absorption. I will have a member of my team connect with you to discuss this in more detail.

Never allow infusion set to be used more than 3 days and maybe your doc would recommending changing site every 2 days. I have had an infection in the past but only after exceeding the 3 days, recommended change time.

What a great article. We sometimes forget that medication can have a big effect on blood glucose levels.

Michelle, I’m glad you found this article helpful!

Submitted by alison matthew (not verified) on

In reply to by LOOP Blog Editorial

hi sara
i have a doubt m taking wxxxxxxx from past 5 yr but this year my sugar level has been increased due to high dose of wxxxxxxx i want to now wheather with insulin can i reduce my sugar level. suggest me

Submitted by Nicole (not verified) on

In reply to by alison matthew (not verified)

Hi, Alison. I'm sorry to hear you're having trouble. I encourage you to speak with your healthcare team regarding your concerns. They have the most insight into your individual situation. Good luck.

Yes it does. I’ve experience this myself. I have diabetes 2

Submitted by Brenda (not verified) on

In reply to by Tracy Dyer (not verified)

I’m experiencing now. I had a steroid shot today for a bad sinus infection. A couple hours after I got home I started feeding bad. Light headed. I checked my sugar I have type 2 diabetes and my reading was 485. I took a insulin shot. I’m on pills but use the sliding scale for insulin. Then I started drinking lots of water and eating dill pickles. It’s down to 291 So I’m still drinking my water and checking it regularly

Are you kidding me, Dill pickles helped you with your dieabeatics. Any other suggestion you may have will be appreciated.

Submitted by Paul Cooper (not verified) on

In reply to by Brenda (not verified)

Dont forget exercise as a tool for reducing glucose levels.

Submitted by Kimberly Evans… (not verified) on

In reply to by Commenter (not verified)

Exactly how do steriods make cells insulin resistant, clinically? What happens at the cellular level?

Submitted by LOOP Blog Editorial on

In reply to by Kimberly Evans… (not verified)

Kimberly, this sounds like a great question for your healthcare team, as they have the clinical expertise to delve into steroid effects at the cellular level.

Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle), which treats a variety of conditions in which the body's defense system malfunctions and causes tissue damage.
Some pros, the good effects will most likely lead to the negative effects. These positive effects are only temporary.
Pros: Increases visual appearance, improves athletic ability, muscular strength and performance, loose weight, provides muscles more oxygen and increases muscle mass.

Cons: If you are an athlete taking steroids, you can be suspended from games and even be expelled from the league. Many people using steroids can get liver cancer, have organ damage, psychological defects, hormonal changes, and sometimes infertility. It should be legally used otherwise users could get arrested for using illegally. It increase the risk of Hepatitis B and C. It does have have enlarged breasts for men and increase facial hair in women, susceptibility to HIV and other transmitted diseases, etc.

While using streroids , it will give you a lots of pros to be a stud till you are young, but you will have to face a million cons when you reach 40.

They aren’t referring to anabolic steroid use.

I really like this amazing blog post that has provided the information about diabetes and how effected our glucose level. In this post you provide insulin pump for diabetes. I like your blog very much. Thank you for this awesome blog.

Submitted by Ali (not verified) on

In reply to by Commenter (not verified)

I took prednisone for a month as a combination drug with antitubercule (TB) immediately I developed DM2 told my doctor then said continue taking and I decided to stop taking. But now my bs is more than 300 even taking meds (metformin). Its been five months and I don't know what to do. ....

Submitted by Karrie Hawbaker (not verified) on

In reply to by Ali (not verified)

Ali, I'm sorry to hear that. This is a conversation that you need to have with your healthcare team.

Submitted by Chuck Sternlieb (not verified) on

In reply to by Karrie Hawbaker (not verified)

I'm type 2 for 10 years. Until a year ago my A1C Ave.6.5! Developed Ulcerative Colitis,went on Prednisone for a month, and a year later my last 4 A1Cs have been about 7.8 even though I have cut my carbs. in half or more and lost 45 pounds!!!! I can't seem to find a way to get my blood sugar levels down!!!!

Submitted by Karrie Hawbaker (not verified) on

In reply to by Chuck Sternlieb (not verified)

Sorry to hear that, Chuck. I recommend working more closely with your healthcare team since I'm unable to provide any medical advice. We wish you the best of luck.

Submitted by Brenda (not verified) on

In reply to by Chuck Sternlieb (not verified)

I know it sounds crazy but I know several people including my husband that does it. Eat dill pickles it has to be dill because they have no sugar he told his dr and all he said was that he had heard that before and if it works then keep doing it

Submitted by Soni Sers (not verified) on

In reply to by Commenter (not verified)

I recently had a steroid shot because I developed a rash that I couldn't control. Also was given a weeks worth of steroid pills. The next day I had an appointment with a hand specialist & got a steroid shot in the finger. Now my glucose levels shoot up to 450 at times. How long will this last?

Submitted by Esha (not verified) on

In reply to by Soni Sers (not verified)

I have the same problem . Plz tell how long will this last?

Submitted by Karrie Hawbaker (not verified) on

In reply to by Esha (not verified)

Thanks for reaching out, Esha. This is a good conversation to have with your healthcare provider. Individual needs vary by person and changes and adjustments should be talked through with your healthcare team.

I had steroid shots about 8 months ago to help with both shoulders ROM. Recently my A1C jumped from the 6's to the 8's and my normally steady glucose # went from 120 to 260. How long after steroid shots will they affect glucose? Also: I have a bone resorption disease (Paget's - spine) for 10 years now I've had a serious problem with excess calcium in the bones and joints (calcify / spine) yet none in the blood. How does calcium problems affect glucose? I very much appreciate your help.

Hi Dennis, I'm sorry to hear this and wish you best of luck in your recovery. Unfortunately, I'm unable to provide medical advice and recommend reaching out to your healthcare team for your individual care.

Submitted by Beverley Smith (not verified) on

In reply to by Commenter (not verified)

I have rheumatoid arthritis and am also a T1 diabetic. Since completing chemotherapy for cancer I have noticed that steroid injections no longer cause any increase in blood sugar levels. None at all. Previously I would need to increase basal rates by 200 - 300% following a steroid injection. Should I be concerned?

Submitted by Karrie Hawbaker (not verified) on

In reply to by Beverley Smith (not verified)

Beverley, thank you for reaching out! It sounds like you’ve gone through quite a bit and you’re a survivor! Keep in mind that every individual is different and if current medications aren’t impacting your BG levels, it is a good thing. Please continue working with your healthcare team if you have any specific questions.

Submitted by James (not verified) on

In reply to by Commenter (not verified)

I has a lumbar epidural and steroid injection on Tuesday and my levels have not fallen below 200 since. They've peaked at 340 and show no signs of falling. I've increased my bolus and i'm now at the point where i'm injecting double my normal doses which is worrying me as i dont want to fall into a serious hypo when the steroids wear off. Does anyone know how long such a steroid injection will last?

Submitted by Karrie Hawbaker (not verified) on

In reply to by James (not verified)

James, we recommend speaking with your health care provider on how often you should be taking steroid injections.

Submitted by Commenter (not verified) on

In reply to by James (not verified)

I'm having the same injections, for about a year now. I can't had any consistent those or duration of the elevated glucoses! Sometimes it starts the same day sometimes 24 hous later. Sometimes the increased insulin demand lasts about 3 days, others 1-2 weeks.
Just had them again yesterday and have been higher ever since. I'm watching the glucose, bolusing to correct with pump under a carb bolus, then watch.
Last time I switched to auto mode and set temporary basals at 150 to 200%, depending on the rise. Then keep watching the graph! I have a 670G. There is no set rule about what the injections will do in regard to your glucose, or for how long. Oh, water, water, water!!!

Submitted by Michel (not verified) on

In reply to by Commenter (not verified)

Helpful article except for this "inform your diabetes healthcare team immediately" stuff. There's no such team (this is America) and I'm lucky if I get through the automated phone system at my doctor's office and get the nurse. Plus they're closed on Friday, and Friday was when I got this shot from a PriMed doctor who knew I was on insulin but either didn't know or didn't care to tell me.

Keep up on the great advice. I reAlly appreciate everything you've done
I love watching the kids I miss them so much. thanks for all good advice! I am new to this celiac disease type 1 diabetic.
It's hard when ur signal.

Submitted by Janet (not verified) on

In reply to by Commenter (not verified)

Already submitted. Why am I being asked again. Very important question to to other posters and myself

Submitted by Karrie Hawbaker (not verified) on

In reply to by Janet (not verified)

Janet, I certainly understand. Everyone's experience is different and unfortunately there is not a set amount of time for blood glucose values to return to what you may feel is normal. This is why we consider this medical advice and based on our guidelines, we encourage you to work with your healthcare team for specifics.

Submitted by Irene Salerno (not verified) on

In reply to by Commenter (not verified)

I am a type 2 diabetic...had an injection of methylprednisolone acetetate 80 mg today in my knee. I asked the Dr. if it would affect my blood sugar and she said no. Geeze I just checked and my sugar is 18.4.....never over 9. Is there something I can do to bring this no. down. I only take pills for my diabetes. Is this just temporary?

Well steroids is really a raging topic of discussion nowadays. I think it is a personal matter of choice though.

Submitted by Commenter (not verified) on

In reply to by Commenter (not verified)

I'm having the same injections, for about a year now. I can't had any consistent those or duration of the elevated glucoses! Sometimes it starts the same day sometimes 24 hous later. Sometimes the increased insulin demand lasts about 3 days, others 1-2 weeks.
Just had them again yesterday and have been higher ever since. I'm watching the glucose, bolusing to correct with pump under a carb bolus, then watch.
Last time I switched to auto mode and set temporary basals at 150 to 200%, depending on the rise. Then keep watching the graph! I have a 670G. There is no set rule about what the injections will do in regard to your glucose, or for how long. Oh, water, water, water!!!

Submitted by Sandra (not verified) on

In reply to by Commenter (not verified)

I received a steroid injection in my shoulder today. I’ve had two previously which never affected my sugars but today I jumped to 25.2 in hours and it stubbornly does not want to come down without half hour testing and bolus. Am I better staying in auto mode doing a lot of testing or switching to MM and using a temp basal? How long will it last? A few days isn’t really an answer.

Submitted by Nicole (not verified) on

In reply to by Sandra (not verified)

Hi, Sandra. I'm sorry for the delay in replying. Everyone's reaction to medications vary and your healthcare provider would typically have the most accurate information for you in the future. How long did it take before you started to notice a difference after you had your shot?

Submitted by Danny (not verified) on

In reply to by Nicole (not verified)

It's very important to monitor your blood sugar when getting a steroid injection and taking steroid pills I went to the doctor yesterday got a shot didn't pay attention to it check my sugar in my glucometer could not register but I'm at 400 right now and it's going down been taking my insulin increase unit but thankfully I read up on everything y'all put here and it helped me out thank you everyone

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