My six year old has had type 1 diabetes for four years, and my four year old shows symptoms (thirst, mood) but sugars stay below 120 mg/dl [6.7 mmol/L] except when he is taking a steroid for severe eczema, and they are (145-255 mg/dl [8.1-14.2 mmol/L] after three days. The general pediatrician said not to worry, but the endocrinologist said it should not have cause sugars in the 200s mg/dl [11.1 mmol/L] in a normal child. Now, my eight month old has been put on steroids for asthma.

Can steroid use cause onset of diabetes in a genetically predisposed child? Is it worth the risk because the eczema and the asthma symptoms are pretty bad?

What steroids do apart from their anti-inflammatory action is to enhance what is called gluconeogenesis — the production of glucose from amino acids. This raises blood sugar which calls for an increased insulin response. This can occur in perfectly normal children especially during an infection, but if insulin production is already compromised, as in prediabetes, this may precipitate or hasten the onset of insulin dependence.

In the case of your four year old, I would suggest talking to the doctor about getting an antibody test to see if he really has prediabetes. The chances are only about 1:20, but fasting blood sugars of 120 mg/dl [6.7 mmol/L] are in the realm of impaired glucose tolerance.

With your eight month old, I think you also have to judge whether the benefits of steroids outweigh the rather small, risk that they will precipitate a need for insulin in a predisposed individual.

DOB