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Diabetes in Pets

Steroids

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Adrenal

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[1].

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[2]. Their main uses are for medically supervised weight gain, [3]inappetance, (most commonly Winstrol/Stanozolol),[4], in treatment of some forms of anemia and cancer[5].


Why they are usedEdit

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[6].

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[7].

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[8][9]. 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[10][11].

Cushing's/Cortisone meds connectionEdit

Like diabetes, Cushing's can be caused by over-use of Cortisone-type medications[12].

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[13].

Common GlucosteroidsEdit

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[14].

Prednisone[15] and Prednisolone[16]
Dexamethasone (Azium)[17][18]
Trimacinolone (Vetalog) (Panalog) (Animax)[19][20][21]
Methylprednisolone (Medrol)[22][23]


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:Edit

Topical (skin) Steroids
Common Brand Names

Hydrocortisone Cream/Gel

Genesis[24]
Genesis Topical Spray[25]
Panalog[26]---ointment and cream--with antibiotics
Animax[27][28]
Corti-Care Spray[29]
Corti-Care Lotion[30]
Corti-Care Shampoo[31]
Dermigard Hydrocortisone Spray[32]
Dermigard Medicated Shampoo[33]
Cortispray[34]
GentaVed Topical Spray[35]
ResiCORT Leave-On Lotion[36]
Zymox Topical Wipes with Hydrocortisone[37]
Zymox Topical Spray with Hydrocortisone[38]
Zymox Topical Cream with Hydrocortisone[39]
Fuciderm gel-UK[40]

Opthalmic (eyes) with antibiotics-common brand names:Edit

Opthalmic (eyes) Steroids With Antibiotics
Common Brand Names[41]

Neobacimyx-H[42]
Gentocin Durafilm[43]
Vetropolycin HC
bacitracin, neomycin, polymixin & hydrocortisone acetate[44]
BNP with Hydrocortisone
bacitracin, neomycin,polymixin & hydrocortisone acetate[45]
Cortisporin[46]
NeoDecadron[47]
Trioptic S[48]
Neo-Predef[49]
Neo-Poly-Dex[50][51]

Opthalmic (eyes)--common brand names:Edit

Opthalmic (eyes) Steroids
Common Brand Names

Decadron (Dexamethasone)[52]
Pred Forte (Prednisolone)[53]
Econopred Plus (Prednisolone)[54]
Inflamase Forte (Prednisolone)[55]

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

Otic (ears) Steroids with Antibiotics
Common Brand Names

Otomax[56]
Tresaderm/Mintezol
(can also be used topically)[57][58][59]
Zymox with Hydrocortisone[60]
DVMax[61]
GentaVed Otic[62]
Aurizon-UK[63]
Canaural-UK[64]
Surolan-UK[65]
Cortisporin Otic[66]

Otic (ears)-common brand names:Edit

Otic (ears) Steroids
Common Brand Names

Synotic Otic Solution[67]

Inhalers--common brand name:Edit

Inhalers With Steroids
Common Brand Names

Amazacort (Triamcinolone)[68]

Oral & Injectable--generic and brand names:Edit

Oral and Injectable Steroids
Common Brand Names

Prednisolone: Solu-Delta-Cortef[69]
Prednistab[70]
PLT Tablets-UK[71]
Prednicare Tablets-UK[72]
Temaril-P[73]
Dexamethasone:[74][75] Azium[76]
Decadron[77]
Dexaject[78]
Dexadreson-UK[79]
Dexafort-UK[80]
Opticorten-UK[81]
Voren 14-UK[82]
Voren Suspension-UK[83]

Prednisone:

Meticorten
Sterapred[84]
Deltasone[85]

Methylprednisolone:

Depo-Medrol[86][87]
Medrol[88][89]
Medrone V-UK[90]
Solu-Medrone V-UK[91]
Depo-Medrone V-UK[92]

Triamcinolone:

Cortalone[93]
Vetalog[94][95]
Triamtabs[96]

Desoxycorticosterone
(Treatment of Addison's disease):

Pericorten-V[97][98]

Anabolic SteroidsEdit

Anabolic Steroid name Effects
Winstrol, Stanozolol[99][100] insulin dose
may need adjustment
Anadrol-50, Anapolon-50,
Oxymethalone[101][102]
insulin dose
may need adjustment
Durabolin,Deca-Durabolin,
Durabolin-50, Hybolin Decanoate,
Hybolin Improved, Durabolin-50,
Kabolin, Nandrolone[103]
insulin dose
may need adjustment
Oxandrin, Oxandrolone[104] insulin dose
may need adjustment

Further ReadingEdit

Wikicat3


Wikicat3Wikidog3

ReferencesEdit

  1. Merck Veterinary Manual-Glucocorticoids
  2. Mayo Clinic-Anabolic Steroids
  3. Mayo Clinic-Anabolic Steroids
  4. Merck Veterinary Manual-Drugs Affecting Appetite
  5. Mayo Clinic-Anabolic Steroids
  6. Merck Veterinary Manual-Glucosteroids Stimulate Appetite
  7. Childrenwithdiabetes.com-Ask the D Team-2006
  8. [1]
  9. [2]
  10. Steroid Treatment and Insulin Needs
  11. PetPlace.com-Insulin-Precautions & Side Effects
  12. Veterinary Partner-What Exactly is Cushing's Syndrome?
  13. Veterinary Partner-What Exactly is Cushing's Syndrome?
  14. Drugs.com-Corticosteroids
  15. Medi-Vet.com-Prednisone Tablets
  16. Medi-Vet.com-Prednisolone Tablets
  17. 1-800PetMeds.com-Dexamethasone--Azium
  18. Medi-Vet.com-Generic Dexamethasone Injection
  19. 1-800PedMeds.com-Animax--Different Brand Name for Panalog-type Product
  20. 1-800PetMeds.com-Panalog Cream
  21. Vetalog/Panalog-Petplace.com
  22. 1-800PetMeds.com-Methylprednisolone--Medrol
  23. Medi-Vet.com-Methylprednisolone Tablets
  24. Topical Corticosteroids Patient Information Sheet-Drs. Foster & Smith
  25. MediVet.com-Genesis Topical Spray
  26. Fort Dodge Reintroduces Panalog
  27. 1-800PedMeds.com-Animax--Different Brand Name for Panalog-type Product
  28. 1-800PetMeds.com-Panalog Cream
  29. 1-800PetMeds.com-Corti-Care Spray
  30. 1-800PetMeds.com-Corti-Care Lotion
  31. 1-800PetMeds.com-Corti-Care Shampoo
  32. 1-800PetMeds.com-Dermigard Hydrocortisone Spray
  33. 1-800PetMeds.com-Dermigard Medicated Shampoo
  34. Medi-Vet.com-Cortispray
  35. Medi-Vet.com-GentaVed Topical Spray
  36. Medi-Vet.com-Resi-CORT Leave-On Lotion
  37. Medi-Vet.com-Resi-CORT Zymox Topical Wipes with Hydrocortisone
  38. Zymox Topical Spray with Hydrocortisone
  39. Medi-Vet.com-Zymox Topical Cream with Hydrocortisone
  40. NOAH Compendium-UK-Fuciderm gel
  41. Steroid/Antibiotic Eye Medications Petplace.com
  42. Neobacimyx-H
  43. Antibiotic & Corticosteroid Opthalmic Patient Information Sheet-Drs. Foster & Smith
  44. Vetropolycin HC-Photo of Package Label
  45. 1-800PetMeds.com-BNP With Hydrocortisone
  46. Cortisporin-Petplace.com
  47. -Petplace.com
  48. Trioptic S-Petplace.com
  49. Neo-Predef-Petplace.com
  50. Neo-Poly-Dex-Drs. Foster & Smith
  51. Medication Sheet--note there's no information re: diabetes and corticosteroids
  52. 1-800PetMeds.com--Decadron--Dexamethasone
  53. 1-800PetMeds.com-Pred Forte
  54. Corticosteroid Opthalmic Patient Information Sheet-Drs. Foster & Smith
  55. 1-800PetMeds.com-Inflamase Forte
  56. Otomax-Photo of Tube
  57. 1-800PetMeds.com-Tresaderm
  58. Medi-Vet.com-Tresaderm
  59. Tresaderm/Mintezol-Petplace.com
  60. 1-800PetMeds.com-Zymox With Hydrocortisone
  61. Medi-Vet DVMax
  62. Medi-Vet GentaVed Otic
  63. NOAH Compendium-UK-Aurizon
  64. NOAH Compendium-UK-Canaural
  65. NOAH Compendium-UK-Surolan
  66. Cortisporin Otic-Drugs.com
  67. Medi-Vet.com-Synotic Otic Solution
  68. Corticosteroid Inhaler Patient Information Sheet-Drs. Foster & Smith
  69. Solu-Delta-Cortef-Photo of Vial Label
  70. 1-800PetMeds.com-Prednistab--Prednisolone
  71. NOAH Compendium-UK-PLT Tablets
  72. NOAH Compendium-UK-Prednicare Tablets
  73. Temaril-P Drugs.com
  74. Dexamethasone Sodium Phosphate--Generic Label Photo
  75. Dexamethasone Tablets--Generic Package Label
  76. 1-800PetMeds.com--Azium--Dexamethasone
  77. 1-800PetMeds.com--Decadron--Dexamethasone
  78. Dexaject--Photo of Vial Label
  79. NOAH Compendium-UK-Dexadreson
  80. NOAH Compendium-UK-Dexafort
  81. NOAH Compendium-UK-Opticorten
  82. NOAH Compendium-UK_voren 14
  83. NOAH Compendium-UK-Voren Suspension
  84. 1-800PetMeds.com-Sterapred--Prednisone
  85. 1-800PedMeds.com--Deltasone--Prednisone
  86. Depo-Medrol--Photo of Vial Label
  87. Medi-Vet.com-Depo-Medrol
  88. Medi-Vet.com-Medrol Tablets
  89. Methylprednisolone/Medrol/Depo-Medrol-Petplace.com
  90. NOAH Compendium-UK-Medrone V
  91. NOAH Compendium-UK-Solu-Medrone V
  92. NOAH Compendium-UK-Depo-Medrone V
  93. 1-800PedMeds.com--Cortalone
  94. Oral & Injected Corticosteroid Patient Information Sheet-Drs. Foster & Smith
  95. Vetalog Tablets--Labeling
  96. Triamtabs--Triamcinolone
  97. Desoxycorticosterone/Pericorten-V-Petplace.com
  98. About Pericorten-V-Novartis Animal Health
  99. Merck Veterinary Manual-Drugs Affecting Appetite
  100. Rx List-Winstrol/Stanozolol
  101. Rx List-Androl-50/Oxymethalone
  102. Drugs.com-Anabolic Steroids-Anapolon-50
  103. Drugs.com-Durabolin/Deca-Durabolin/Durabolin-50/Nandrolone, etc.
  104. Drugs.com-Oxandrin/Oxandrolone

Case studies:Edit

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

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