Steroid diabetes – the endocrine pathology developing as a result of high content in plasma of blood of hormones of bark of adrenal glands and violations of carbohydrate exchange. It is shown by hyperglycemia symptoms: bystry fatigue, the thirst strengthening which is speeded up by a plentiful urination, dehydration, increase in appetite. Specific diagnostics is based on laboratory identification of a hyperglycemia, assessment of level of steroids and their metabolites (urine, blood). Treatment of steroid diabetes includes the cancellation or decrease in a dosage of glucocorticoids, surgeries reducing production of kortikosteroidny hormones, and anti-diabetic therapy.
The Steroid Diabetes (SD) can be provoked by long increase in secretion of corticosteroids or their reception in the form of medicines. In the second case the disease has the synonymous name – medicinal diabetes. Initially it is not connected with a functional condition of a pancreas, develops against the background of hormonal treatment and can independently pass after cancellation of medicines. SSD provoked by increase in natural hormones most often is observed at Itsenko-Cushing's disease. At this group of patients epidemiological indicators reach 10-12%. There is no exact information on prevalence of SSD among the general population.
Reasons of steroid diabetes
On an etiologichesky sign steroid SD is subdivided on endogenous and exogenous. At an endogenous form of violation of work of a pancreas are caused by primary or secondary giperkortitsizm. Treat the reasons of this group:
- Cushing's syndrome. The secondary giperkortitsizm arises at increase in the AKTG level – the hormone produced by a hypophysis and regulating activity of adrenal glands. Secretion of kortikoid increases, there is a high risk of violation of functions .
- Tumors of adrenal glands. At primary giperkortitsizm production of kortikosterid is stimulated with the growing new growth. SSD is often diagnosed at a kortikosteroma, an aldosteroma, a kortikoestroma, an androsteroma.
The second option of an origin of steroid diabetes – exogenous. Patients with autoimmune pathologies, a chronic renal failure, arterial hypertension treat group of the increased risk. Diabetes develops at long therapy by the medicines which are slowing down insulin secretion by beta cages in a pancreas. Such medicines are glucocorticoids, tiazidny diuretics, hormonal contraceptives.
Basis of development of SSD is long influence of the increased concentration of glucocorticoids on internals and processes of metabolism. Steroid hormones oppress synthesis and strengthen disintegration of proteins. Release of amino acids from fabrics increases, in a liver reactions of their reamination and deamination accelerate that becomes the reason of increase in speed of gluconeogenesis – synthesis of glucose from not carbohydrate connections. In cells of a liver the glycogen is more actively postponed. Influence of kortikoid on metabolism of carbohydrates is shown through increase in activity of the glyukozo-6-phosphatase which is responsible for reactions of formation of glucose and phosphatic group and through braking of activity of a glucokinase, that is delay of process of processing of glucose in a glycogen.
Sugar utilization by fabrics is reduced by peripheries. Change of fatty exchange is presented by stimulation of a lipogenez therefore it is not observed characteristic of SD 1 and 2 like loss of body weight. Anti-ketogene effect of steroids – an obstacle to oxidation of pyrogrape acid, increase in a blood-groove of lactic acid. In character of a current of SSD at the first stages it is similar to diabetes of the first type: β-cages are surprised, production of insulin is reduced. Over time insulin resistance of fabrics increases that is characteristic of diabetes of the II type.
Symptoms of steroid diabetes
The clinical picture is presented by a diabetic triad – a polidipsiya, a polyuria and bystry fatigue. In general the symptoms which were less expressed than at diabetes of 1 type. Patients notice strengthening of feeling of thirst, constant dryness in a mouth. The volume of the consumed liquid increases several times, to 4-8 liters a day. Thirst does not weaken even at night. Appetite happens raised, weight remains the same or increases. Desires to an urination become frequent. Per day 3-4 liters of urine are allocated, at children and elderly people night enuresis develops. Many patients have sleeplessness, feel tired in the afternoon, do not cope with usual things, test drowsiness.
At the beginning of a disease symptoms accrue quickly, as at diabetes of 1 type: the general health worsens, headaches, irritability, heat inflows develop. The long course of disease is followed by emergence of an itch of skin and mucous membranes. There are pustulous defeats more often, rash, wounds long do not heal. Hair become dry, nails are stratified and break off. Deterioration in a blood-groove and nervous transfer is shown by violation of thermal control in extremities, feeling of a pricking, sleep and burning in , is more rare – in fingers of hands.
The long hyperglycemia leads to a diabetic angiopatiya – defeat of large and small vessels. Violation of blood circulation in capillaries of a retina is shown by decrease in sight – a diabetic retinopathy. If the vascular network of kidneys suffers, then their filtering function worsens, there are hypostases, arterial pressure increases – the diabetic nephropathy develops. Changes in large vessels are presented by atherosclerosis. Atherosclerotic injuries of arteries of heart and the lower extremities are most dangerous. The imbalance of electrolytes and insufficient blood supply of nervous tissue provoke development of diabetic neuropathy. It can be shown by spasms, a sleep a foot and fingers on hands, failures in work of internals, pains of various localization.
In risk group on development of a steroid form of diabetes – persons with an endogenous and exogenous giperkortitsizm. Periodic researches of level of glucose for the purpose of identification of a hyperglycemia are shown to patients with Cushing's disease, tumors of adrenal glands, to the persons accepting medicines of glucocorticoids, diuretics of group of tiazid, hormonal contraceptives. Full examination is conducted by the doctor-endocrinologist. Treat specific methods of a research:
- The analysis on glucose on an empty stomach. At most of patients the normal or slightly increased glucose level in blood is defined. Total values are in range from 5-5,5 to 6 mmol/l more often, sometimes make 6,1-6,5 mmol/l and above.
- Glyukozotolerantny test. Measurement of glucose later after carbohydrate loading gives two hours more exact information on existence of diabetes and predisposition to it. About violation of tolerance to glucose indicators from 7,8 to 11,0 mmol/l, testify to diabetes – more than 11,1 mmol/l.
- The test on 17-KC, 17-OKC. The result allows to estimate gormonosekretiruyushchy activity of cortical substance of adrenal glands. Biomaterial for a research is urine. Increase in indicators of an ekskretion of 17 ketosteroids and 17 oxycorticosteroids is characteristic.
- Research of hormones. For additional data on functions of a hypophysis and a cortical layer of adrenal glands hormonal tests can be carried out. Depending on the main disease the level of cortisol, aldosteron, AKTG is defined.
Treatment of steroid diabetes
Etiotropny therapy consists in elimination of the reasons of a giperkortitsizm. The events aimed at restoration and maintenance of a normoglikemiya, increase in sensitivity of fabrics to effect of insulin, stimulation of activity of safe β-cages are at the same time held. At an integrated approach medical care to patients is conducted in the following directions:
- Decrease in level of corticosteroids. At an endogenous giperkortitsizm first of all methods of treatment of the main disease are reconsidered. If correction of a dosage of drugs is not effective, the issue of surgical intervention – removal of adrenal glands, a cortical part of adrenal glands, tumors is resolved. Concentration of steroid hormones decreases, the level of sugar of blood is normalized. At an exogenous giperkortitsizm cancellation or replacement of the medicines provoking steroid diabetes is made. If it is impossible to cancel glucocorticoids, for example, at the heavy course of bronchial asthma, for neutralization of their effects anabolic hormones are appointed.
- Medicamentous correction of a hyperglycemia. Medicines are selected individually taking into account an etiology of SD, its stage, weight of a current. If the pancreas is affected, beta cages partially or are completely atrophied, then insulin therapy is appointed. At easy forms of a disease, safety of ferruterous fabric and reversible resistance of cages to insulin oral hypoglycemic means, for example, medicines of group of sulfanylurea are appointed. Sometimes the combined use of insulin and hypoglycemic drugs is shown to patients.
- Anti-diabetic diet. The medical diet No. 9 is shown to most of patients. The diet is formed so that the chemical composition of dishes was balanced, did not provoke a hyperglycemia and contained all necessary nutrients. The principles of low-carbohydrate food are used: sources of light carbohydrates – sweets, pastries, sweet drinks are excluded. In a diet proteinaceous products and products with the high content of cellulose prevail. The glycemic index is considered. Meal is carried out in the small portions, 5-6 times a day.
Forecast and prevention
Steroid SD, as a rule, proceeds in softer form and SD of the first and second type will easier respond to treatment, than. The forecast depends on the reason of development of a giperkortitsizm, in most cases it is favorable. Prevention assumes timely and adequate therapy of a disease of Cushing and tumoral diseases of adrenal glands, the correct use of medicines of glucocorticoids, tiazidny diuretics and oral contraceptives. Persons need to carry out screening researches of glucose of blood from risk groups regularly. It allows to reveal violations of exchange of carbohydrates at a prediabetes stage, to correct the main treatment, to begin to observe the principles of dietary food.