Steroids and Diabetes — SCE Dermatology MCQ

Correct answer: E — Systemic corticosteroids cause hyperglycaemia through increased hepatic gluconeogenesis and insulin resistance — insulin dose adjustment is often needed

Systemic corticosteroids (which may be used short-term for psoriatic emergencies like erythroderma or GPP) cause significant hyperglycaemia through: increased hepatic gluconeogenesis, reduced peripheral glucose uptake, insulin resistance, and increased glycogenolysis. In diabetic patients (type 1 or 2), blood glucose monitoring must be intensified and insulin/hypoglycaemic medication doses increased (often substantially — 20-40% increase in insulin may be needed). Steroid-induced hyperglycaemia can precipitate diabetic ketoacidosis in type 1 diabetes. This is a key reason why systemic steroids are avoided in psoriasis management whenever possible — particularly relevant as psoriasis patients have increased diabetes prevalence. Biologic therapies do not cause hyperglycaemia.

Reference: BAD 2020 Psoriasis Comorbidities; BNF; JBDS Steroid-Induced Diabetes