How To Recognize And Manage Steroid Diabetes Mellitus In The Patient With Kidney Disease

Steroid-induced Diabetes Mellitus (SDM) is a special kind of metabolism disorder syndrome. Inside or outside glucocorticoid (GC) excess responds to glucose metabolism disorders. Steroids affect post-meal glucose much more so than morning fasting sugars. A typical patient of SDM will have elevated glucose values after lunch, dinner, and at bedtime but will have a normal or slightly increased glucose level after breakfast and a significant drop toward normal glucose overnight. The familiar side-effect of treatment with glucocorticoid is insulin resistance, abnormal glucose metabolism, hypercholesterolemia, and hypertension especially in large dose and/or within a long time. In patients with normal glucose metabolism the prevalence of SDM is 10%-55%.Patients with DM have postprandial hyperglycemia after three meals,whereas patients with SDM have elevated glucose values after lunch, dinner, and at bedtime and a significant drop toward normal glucose overnight in the state of taking GC one time a day in the early morning. Insulin and oral agents(especially acting 24 hours hypoglycemic agents) more easily provoke hypoglycemia overnight. Therefore, in the patients with kidney disease, the treatment of hyperglycemia of SDM should be decided according to the state of renal function and the character of serum-glucose. The results of the recent research about SDM in the patients of kidney disease will be introduced in the review.