Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

How do steroids primarily affect blood glucose levels?

1. Induce insulin resistance and affect glucose metabolism

2. Decrease the rate of insulin metabolism

3. Increase insulin resistance specifically in fasting levels

4. Suppress the immune system affecting endogenous insulin

The correct answer is: Induce insulin resistance and affect glucose metabolism

Steroids primarily raise blood glucose levels by inducing insulin resistance and affecting glucose metabolism. Corticosteroids, such as prednisone, can increase blood glucose through several mechanisms. They promote gluconeogenesis in the liver, a process where glucose is produced from non-carbohydrate sources, thereby increasing the amount of glucose released into the bloodstream. Additionally, steroids can hinder the effectiveness of insulin in facilitating glucose uptake by cells, leading to insulin resistance. The elevation of fasting blood glucose levels, along with postprandial spikes, is a common side effect of steroid therapy. This can be critical for patients with diabetes, as it may require insulin adjustments or the introduction of additional diabetes medications to manage these increased glucose levels successfully. Understanding this mechanism is essential for diabetes care and education specialists when developing management plans for patients on steroid treatment. It also helps explain why individuals without a prior diagnosis of diabetes may experience hyperglycemia while on steroid therapy.