Diabetes mellitus glucocorticoids

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Autoimmune polyglandular syndrome-Chron c autoimmune thyroiditis may occur in association with other autoimmune disorders. Treat patients with concomitant adrenal insufficiency with replacement glucocorticoids prior to initiation of treatment. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens. Nontoxic diffuse goiter or nodular thyroid disease Use caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis. If the serum TSH is already suppressed, do not administer levothyroxine. 

Shapiro AMJ, Lakey JRT, Ryan EA. 2000. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. NEJM. 343 230-238. 

The effect was observed in those with renal transplants (9.8% versus 2.7%) and those with other organ transplants (11.1% versus 6.2%), and among patients who were taking equal doses of concomitant medications in both treatment arms (12% versus 3%). Further factors associated with diabetes mellitus after kidney transplantation were older recipient age, a cadaveric organ, hepatitis C antibody status, an episode of rejection, and the use of tacrolimus (versus ciclosporin) cumulative glucocorticoid dose and calcineurin inhibitor trough concentration were not associated factors (1100). 

Besides the adverse effects just described, glucocorticoid therapy is contraindicated under the following circumstances diabetes mellitus, digitalis therapy, glaucoma, hypertension, infection, osteoporosis, peptic ulcer, tuberculosis, and viral infection. 

Shapiro, A. M., Lakey, J. R., Ryan, E. A., Korbutt, G. S., Toth, E., Warnock, G. L, Kneteman, N. M. and Rajotte, R. V. (2000). Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N. Engl. J. Med. 343, 230-238. 

Increased lipoprotein levels are seen in diabetes mellitus but not in starvation. Glucocorticoids have a protein catabolic activity in all tissues except liver. There, glucocorticoids stimulate protein synthesis. 

Cyclosporine is an important drug in preventing rejection after kidney, hver, heart and other organ transplantation (Haberal et al., 2004). Cyclosporine usually is combined with other immunosuppressives especially glucocorticoids and either azathioprine or mycophenolate mofedl and sirolimus (Krensky et al., 2005). In renal alio transplants it has improved graft acceptance in most clinics to 95 percent. In addition to its use in transplantation cyclosporine is used for the treatment of a number of autoimmune diseases. In autoimmune diseases, as might be anticipated, cyclosporine is most effective in those which are T cell mediated. These include several forms of psoriasis, rheumatoid arthritis refractive to all other therapy, uveitis, nephrotic syndrome and type I diabetes mellitus. 

A 56-year-old Nigerian woman, with a previous history of sickle cell trait, osteoarthritis, and non-insulin-dependent diabetes mellitus, took amlodipine 5 mg/day for hypertension for 2 weeks and developed a lichenoid eruption (15). Histological examination confirmed the diagnosis of lichen planus. Amlodipine was withdrawn and there was rapid symptomatic and clinical improvement after treatment with glucocorticoids and antihistamines. 

Tendinopathy and partial or complete tendon rupture as adverse events of fluoroquinolones have been reported during or shortly after the use of fluoroquinolones (80-84). Pefloxacin and ofloxacin have been implicated, as has ciprofloxacin (85,86). In six patients taking fluoroquinolones risk factors included renal insufficiency, glucocorticoid therapy, secondary hyperparathyroidism, advanced age, and diabetes mellitus (87). Cases have also been reported among immunocompromised renal transplant recipients (88). 

Successful glucocorticoid therapy involves counseling the patient, monitoring the patient, and recognizing complications of therapy (Table 74—10). The riskibeneflt ratio of glucocorticoid administration should always be considered, especially with concurrent disease states such as hypertension, diabetes mellitus, peptic ulcer disease, and uncontrolled systemic infections. 

Albuterol is used to relieve and prevent bronchospasm in patients with reversible obstructive airway disease and in individuals with exercise-induced bronchospasm. The onset of action of albuterol is 5 to 15 minutes, peak of action is 0.5 to 2 hours, and duration of action is 3 to 6 hours. Albuterol does not cross the blood-brain barrier. It must be used cautiously in patients with hyperthyroidism, diabetes mellitus, coronary insufficiency, and hypertension. The concomitant use of albuterol with monoamine oxidase inhibitors or tricyclic antidepressants should be discouraged. Glucocorticoids (beclomethasone, dexametha-sone, flunisolide, or triamcinolone) may be used 15 minutes after inhalational albuterol. 

Glucocorticoids have an anti-insulin effect and aggravate the pathologic consequences of diabetes mellitus. They increase gluconeogenesis, inhibit the peripheral utilization of glucose, and cause hyperglycemia and glucosuria. Cortisol s effect, for example, is opposite to that of insulin s. 

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