Steroids are common medications used for various conditions, from asthma to joint inflammation. They come in different forms, some of which have a greater impact on blood sugar. Steroids can make blood sugars run higher, but with the right strategies, you can stay in control. Let’s look at the steroid medications commonly prescribed and the simple steps that can help keep those numbers steady.

What Are Steroids?

Steroid medications, or corticosteroids, are a manmade version of a hormone naturally produced by the body to calm inflammation and suppress an overactive immune system. This type of steroid is different from anabolic steroids, which are primarily used for muscle growth. Inhalers and topical steroids can increase blood sugar as well, but to a lesser degree. Common types of corticosteroids include:

• Dexamethasone
• Methylprednisolone
• Prednisone

These medications are used for a range of conditions, including asthma, arthritis, COPD, muscle and joint inflammation, autoimmune conditions (lupus and rheumatoid arthritis), and post-organ transplant, to name a few (Shah et al., 2022).

Why Steroids Affect Blood Sugar

Steroid medications can raise blood sugar by making it harder for your body to use insulin and by telling your liver to release extra sugar into your bloodstream. This can cause blood sugar levels to rise, especially after eating (Shah et al., 2022).

Who Is Most Affected?

• People with diabetes or prediabetes.
• People taking higher or longer doses of steroids. This often includes those who have had an organ transplant to prevent rejection, or people with serious autoimmune or lung conditions (Shah et al., 2022).
• People without diabetes. Even if you don’t have diabetes, steroids can still raise blood sugar temporarily.

How to Manage It

Lifestyle interventions and medications are the best ways to help manage blood sugar when taking steroid medications, and monitoring should be more frequent.

Monitoring:

Taking a steroid medication will require close blood sugar monitoring for safety. A continuous glucose monitor (CGM) is a great option, especially when insulin is being used; otherwise, a standard glucometer can be used more often. For people with diabetes, monitoring blood sugar 3–4 times daily is recommended. Steroids (like prednisone) often raise blood sugar later in the day, so checking in the afternoon or evening can be especially helpful (Shah et al., 2022). In this case, a monitoring routine may fasting readings, pre-and post-meal checks as well as bedtime readings, if needed.

Even people without diabetes may be asked to monitor their blood sugar 1–2 times daily to see if there is a change in their blood sugar.

Diet:

Many of the same healthy lifestyle principles recommended for people with diabetes also apply when someone is taking steroids. Nutrition, physical activity, and sleep all play important roles in blood sugar control, and these factors become even more important when steroid medications are involved.

Nutrition tips:

• Balance meals and start with non-starchy vegetables and proteins first, and enjoy carbohydrate sources last for a more steady rise in blood sugar after meals.
• Carbohydrates matter and are needed, but consistent amounts and whole sources can really help support a more stable rise in blood sugar. Think whole fruit, whole grains (e.g., wild rice, brown rice, whole grain pasta, and bread), beans and legumes, and starchy vegetables like sweet potatoes and winter squash.
• Space meals 4–5 hours apart to allow time for digestion and blood sugar levels to come back down.
• Prepare starchy sides, like potatoes, rice, and pasta, ahead of time and refrigerate them overnight to create resistant starch. This means that when you eat them the next day, they don’t raise your blood sugar as quickly because they take longer to digest. Portions still matter, but this is a simple way to make these foods a little easier on your blood sugar.

Physical activity:

It is well known that moving our bodies makes us more sensitive to insulin and helps keep blood sugars stable, so it is especially important when taking medications like steroids that create insulin resistance. Since steroids often raise blood sugar later in the day (afternoon/evening), clinical guidance suggests targeting activity during times when blood sugar is highest, particularly after meals (Practical Guide, 2023). Therefore, a short walk after meals can help blunt steroid-related spikes. However, some people may be taking steroids for inflammation or respiratory issues, so it’s important to speak to your doctor about safe movement that’s right for you. This may look like gentle stretches, chair exercises, or light strength training.

Sleep:

Steroid medications (like prednisone) can disrupt sleep by causing insomnia, lighter sleep, and feelings of restlessness or increased energy. This can create a cycle where steroids worsen sleep, and poor sleep in turn raises blood sugar levels, potentially leading to higher glucose readings (Shah et al., 2022). Luckily, there are very practical tips for a good night’s rest:

• Take steroids earlier in the day (if prescribed that way)
• Aim for 7+ hours of sleep
• Keep a consistent sleep schedule
• Limit caffeine later in the day
• Try relaxation techniques before bed, like meditation

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Medications:

Despite your best efforts with healthy lifestyle changes, blood sugars can still run high. The good news is that medications can be added or adjusted to help your body manage things during this time. The type of steroid you’re prescribed, how long you take it, and how high your blood sugars run will guide what adjustments are needed.

Fast-acting medications, like mealtime insulin or certain oral drugs (such as sulfonylureas or meglitinides), help control the spikes that happen after eating. Longer-acting insulin provides steady background coverage throughout the day. Some people can stay on their usual diabetes medications, but insulin is often added or adjusted because it works the most reliably and can be timed to match when steroids raise blood sugar (Shah et al., 2022).

Not all steroids act the same. Their strength, how quickly they start working, and how long they last can vary. Oral steroids may cause a temporary rise in blood sugar, with the biggest effect several hours after taking them and less impact 12–24 hours later. Injected steroids, like cortisone for knee or shoulder inflammation, tend to raise blood sugar a few hours after the injection and can continue affecting levels for 4–8 days. Peak insulin resistance often shows up around 2–3 days after the injection.

If you’re using a basal insulin, Scheiner (2020) suggests increasing the dose to 1.5 times your usual amount on Day 1, increasing it to 2–3 times your usual dose on Days 2–3, and then tapering back down to 1.5 times your usual dose on Days 4–5. Still, it’s important to review any medication adjustments with your prescribing clinician before making changes to your regimen.

When Steroids Are Stopped

Once steroid treatment ends, blood sugar levels usually begin to come back down, sometimes quickly. This can feel like a relief, but it also means you’ll want to keep an eye on your numbers to avoid unexpected lows, especially if insulin or sulfonylureas, like glipizide, were increased during treatment. Most people can return to their usual diabetes routine within a few days, but the timing varies based on the type of steroid, the dose, and how long it was taken.

As your blood sugars settle, your healthcare team may reduce insulin doses or adjust medications back to your baseline plan. Continue monitoring for several days after stopping steroids so you can spot patterns and share them with your clinician. This helps ensure your regimen is safe and well matched to your body’s needs.

Key Takeaways

• Steroids can raise blood sugar by increasing insulin resistance and boosting liver glucose release.
• Higher doses, longer courses, and existing diabetes increase the risk of high readings.
• Check blood sugar more often, especially later in the day when steroids peak.
• Balanced meals, whole-food carbs, and movement after meals help soften spikes.
• Sleep can be disrupted by steroids, which may also raise glucose.
• Medication adjustments, often insulin, may be needed temporarily.
• When steroids stop, blood sugars usually drop back toward baseline, so doses may need to be reduced.