September 18, 2003
Other Medications, Research: Causes and Prevention
Question from Caseyville, Illinois, USA:
I recently read the question from Australia about a child who developed type 1 diabetes after receiving prednisone. When my son was four years old, he also received prednisone for a bad case of poison ivy, and I too was not informed that prednisone could cause high blood sugars. After four days on prednisone, he was showing signs of hyperglycemia. I checked his blood sugar because his older brother has type 1 diabetes, and it was 357 mg/dl [19.8 mmol/L].
A call to the pediatrician resulted in an emergency room visit where the endocrinologists had a difficult time deciding whether he had diabetes or whether it was hyperglycemia from prednisone. After two days in the hospital and numerous blood tests, it was decided that he did not have type 1 diabetes.
When the prednisone was out of his system, blood sugars returned back to normal, but two years later, he developed type 1 diabetes. I know that you stated that the prednisone did not trigger the diabetes in the Australian case, but I wonder also whether my son would have developed diabetes if he had not taken the prednisone. I feel as though I caused the diabetes because I didn’t understand that prednisone can cause high blood sugars. If I had known and since his older brother has type 1 diabetes, I would have never administered it. The doctor who prescribed the prednisone didn’t know of our family history as he was an on call doctor. I suffer from guilt. A response would be appreciated.
Answer:
Prednisone use certainly is associated with higher sugar levels. If one has a predisposition to developing diabetes, this could precipitate hyperglycemia and insulin resistance. While your guilt is understandable, it isn’t likely that prednisone was anything but a precipitating event. Since the high sugars went away when the prednisone was discontinued, and true diabetes did not develop for some time afterwards, I would guess that prednisone was not a culprit at all but merely tipped him over at that moment in time.
Your question raises a good point, however, which is that family history is important for physician and nurses to know about since it may or may not alter what one chooses to prescribe. If the poison ivy were severe enough, there also may not have been any alternative as a treatment. Even if the history were known. So, you may want to consider discussing some of this guilt and other emotions with a good social worker or psychologist who can help you get some understanding of why and how this type of emotion arises, alternative ways to deal with it as it crops up, etc.
SB
