Glucocorticoid diabetes with

The glucocorticoids are administered with caution to patients with renal or hepatic disease hypothyroidism, ulcerative colitis, diverticulitis, peptic ulcer disease, inflammatory bowel disease hypertension, osteoporosis, convulsive disorders, or diabetes. The glucocorticoids... 

Diabetes pretransplant Insulin Oral hypoglycemics Metformin Glucocorticoids, TAC, and CSA also increase hypoglycemic requirements insulin requirements will increase with improving renal function Avoid in those with Rl... 

Steroids have mineralocorticoid and glucocorticoid effects. Betamethasone has little, if any, mineralocorticoid effect. However, it should be used with caution in patients predisposed to hypertension since mineralocorticoid effects may lead to sodium and water retention and an increase in blood pressure. When used systemically, especially at high doses, steroid therapy is associated with a risk of psychiatric reactions such as euphoria, irritability, mood lability and sleep disorders. Glucocorticoid side-effects include diabetes and osteoporosis. 

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. 

Glucocorticoids must be used with great caution in patients with peptic ulcer, heart disease or hypertension with heart failure, certain infectious illnesses such as varicella and tuberculosis, psychoses, diabetes, osteoporosis, or glaucoma. 

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. 

Significant differences in the pharmacokinetics of methyl-prednisolone have been described in black and white renal transplant patients. Black patients had a slower clearance rate and a lower apparent volume of distribution. They had higher cortisol concentrations throughout the day, with higher nadir concentrations. Some of them had glucocorticoid-associated diabetes, and no white patients did. Further studies are needed to define the differences between the races (SEDA-20, 377 404). 

Impaired diabetic control has been reported with high doses of inhaled glucocorticoids. 

Fujibayashi K, Nagasaka S, Itabashi N, Kawakami A, Nakamura T, Kusaka I, Ishikawa S, Saito T. Troglitazone efficacy in a subject with glucocorticoid-induced diabetes. Diabetes Care 1999 22(12) 2088-9. 

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). 

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. 

Insulin and tri-iodothyronine (T3) increase the binding of LDLs to liver cells, whereas glucocorticoids (e.g. dexamethasone) have the opposite effect. The precise mechanism for these effects is unclear, but it may be mediated through the regulation of apo-B degradation. The effects of insulin and T3 on hepatic LDL binding may explain the hypercholesterolaemia and increased risk of atherosclerosis that have been shown to be associated with uncontrolled diabetes and hypothyroidism. 

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