Steroids

Adrenal gland: Cortisone or cortisol is produced by the outer, or cortex (shown at right) area).

Cortisone (now mainly referred to as cortisol) is the main hormone produced by the adrenal gland, and belongs to a group of hormones called glucocorticoids, which is a class of steroids. Glucocorticoids antagonize or counter the effects of insulin and increase gluconeogenesis--basically they have an overall blood sugar raising effect.

All of us produce extra cortisol daily; it's done shortly before we awaken. The body prepares itself to go into "wake mode" and releases cortisol to ready itself for wake up.

In non-diabetics, it happens virtually unnoticed, as the properly working pancreas produces more insulin to handle the cortisol release. Persons without diabetes are unlikely to be checking their blood glucose values on a regular basis, so any temporary increases would not be measured.

But with diabetes, it can become a problem known as Dawn phenomenon; the rise in cortisol levels brings with it a corresponding rise in blood glucose, meaning high morning testing values--even before eating. Everyone with diabetes does not have this occurrence, just as all cats aren't white or all dogs brown.

Cortisol is involved in the response to stress; it increases blood pressure and blood sugar levels and suppresses the immune system. Note that this is why stress is known to raise blood sugar levels and cause hyperglycemia in diabetic pets.

Pets with Cushing's disease are self-administering extra cortisol from the adrenal glands, all the time, leading to hyperglycemia and secondary diabetes.

There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosterone. Their main uses are for medically supervised weight gain, inappetance, (most commonly Winstrol/Stanozolol),, in treatment of some forms of anemia and cancer.

Why they are used

The glucosteroids are very helpful for a wide number of medical conditions; in some cases they are the only effective way to treat some problems. At times, they are prescribed as appetite stimulants.

As with anything else, they can come with a price tag: Short-term use can mean a temporary diabetic condition, which (usually) resolves after stopping steroid use.

Long-term use can cause permanent diabetes. For pets and people who are diabetic, the use of oral or injected steroids brings with it higher blood glucose levels.

This is not to say that you should totally rule out any use of steroids with a diabetic pet, but need to be watchful regarding them. Ask if there is an alternative medication for the problem which is non-steroidal.

If you must use steroids, try to use local or inhaled versions, which are less likely to raise blood sugar. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary.

Cushing's/Cortisone meds connection

Like diabetes, Cushing's can be caused by over-use of Cortisone-type medications.

Because the pituitary gland also acts as a sensor, it detects the high levels of cortisol in the body and does not signal the adrenal gland to produce more. The adrenal gland becomes inactive and can atrophy from disuse, much in the way non-used muscles do, losing the ability to function normally.

Exogenous cortisone puts the adrenal gland into a sort-of hibernation. While they are being administered, they furnish the body's cortisol needs in addition to treating the condition they were prescribed for. The adrenal gland needs to be "awakened" from its rest gradually so it can begin full function once again. This is why cortisone and similar drug treatment is slowly and carefully withdrawn. Simply stopping the medication means leaving the body without sufficient cortisone--exogenous or endogenous.

Common Glucosteroids

Many people are familiar with the use of cortisone for medical conditions such as allergies/asthma, arthritis, and poison ivy. Glucocorticoid hormones (glucosteroids) are given in drug form for their anti-inflammatory properties. Some medications that are glucosteroids are:

Common Glucosteroids MANY brand names at link.
Prednisone and Prednisolone
Dexamethasone (Azium)
Trimacinolone (Vetalog) (Panalog) (Animax)
Methylprednisolone (Medrol)

Steroids are dispensed in many different ways-they can be given as oral or injected medications, rubbed on the skin (topical), for eye (opthalmic) and ear (otic) use as ointments or drops, and inhaled. Here are some common ones and their patient information sheets:

Topical (skin)-common brand names:

Topical (skin) Steroids Common Brand Names
Hydrocortisone Cream/Gel
Genesis Genesis Topical Spray
Panalog---ointment and cream--with antibiotics
Animax
Corti-Care Spray Corti-Care Lotion Corti-Care Shampoo
Dermigard Hydrocortisone Spray Dermigard Medicated Shampoo
Cortispray
GentaVed Topical Spray
ResiCORT Leave-On Lotion
Zymox Topical Wipes with Hydrocortisone Zymox Topical Spray with Hydrocortisone Zymox Topical Cream with Hydrocortisone
Fuciderm gel-UK

Opthalmic (eyes) with antibiotics-common brand names:

Opthalmic (eyes) Steroids With Antibiotics Common Brand Names
Neobacimyx-H
Gentocin Durafilm
Vetropolycin HC bacitracin, neomycin, polymixin & hydrocortisone acetate
BNP with Hydrocortisone bacitracin, neomycin,polymixin & hydrocortisone acetate
Cortisporin
NeoDecadron
Trioptic S
Neo-Predef
Neo-Poly-Dex

Opthalmic (eyes)--common brand names:

Opthalmic (eyes) Steroids Common Brand Names
Decadron (Dexamethasone)
Pred Forte (Prednisolone)
Econopred Plus (Prednisolone)
Inflamase Forte (Prednisolone)

Otic (ears)-with antibiotic(s)-common brand names:

Otic (ears) Steroids with Antibiotics Common Brand Names
Otomax
Tresaderm/Mintezol (can also be used topically)
Zymox with Hydrocortisone
DVMax
GentaVed Otic
Aurizon-UK
Canaural-UK
Surolan-UK
Cortisporin Otic

Otic (ears)-common brand names:

Otic (ears) Steroids Common Brand Names
Synotic Otic Solution

Inhalers--common brand name:

Inhalers With Steroids Common Brand Names
Amazacort (Triamcinolone)

Oral & Injectable--generic and brand names:

Oral and Injectable Steroids Common Brand Names
Prednisolone:	Solu-Delta-Cortef Prednistab PLT Tablets-UK Prednicare Tablets-UK Temaril-P
Dexamethasone:	Azium Decadron Dexaject Dexadreson-UK Dexafort-UK Opticorten-UK Voren 14-UK Voren Suspension-UK
Prednisone:	Meticorten Sterapred Deltasone
Methylprednisolone:	Depo-Medrol Medrol Medrone V-UK Solu-Medrone V-UK Depo-Medrone V-UK
Triamcinolone:	Cortalone Vetalog Triamtabs
Desoxycorticosterone (Treatment of Addison's disease):	Pericorten-V

Anabolic Steroids

Anabolic Steroid name	Effects
Winstrol, Stanozolol	insulin dose may need adjustment
Anadrol-50, Anapolon-50, Oxymethalone	insulin dose may need adjustment
Durabolin,Deca-Durabolin, Durabolin-50, Hybolin Decanoate, Hybolin Improved, Durabolin-50, Kabolin, Nandrolone	insulin dose may need adjustment
Oxandrin, Oxandrolone	insulin dose may need adjustment

Further Reading

• Wiki cases-Steroid-induced Feline Diabetes cases
• Steroids and Cats
• Hemodynamic Effects of Methylprednisolone Acetate Administration in Cats-American Journal of Veterinary Research 2006

• Good article-Steroid Use-Veterinary Partner
• Use of Corticosteroids in Veterinary Dematology
• The Veterinary Use of Steroids-Drs. Foster & Smith-Pet Education Library
• LA Care Health Plan Formulary
  This 5 page list shows many steroid-containing brand names of human drugs, according to what they are used for.
• Prednisone/Prednisolone-Petplace.com
• Dexamethasone-Petplace.com

Case studies:

See steroid-induced cases of diabetes here.

Steroid-Induced Diabetes--Feline--Fuzzer: Caution: Graphic

Steroid-Induced Diabetes and Recovery--Feline--Peanut

Diabetes Mellitus Induced in a Dog After Administration of Corticosteroids and Methylprednisolone Pulse Therapy-Journal of the American Veterinary Association-1991