Can Steroids Cause Diabetes?

The development and proper use of steroids has been a modern day miracle in many respects. It has aided innumerable people to rapidly recover from a wide variety of ailments, resistant to other treatments. For all their good, however, steroids are dangerous drugs that can cause serious harm if misused or abused.

For many people, steroids conjure up the vision of muscle building and, in sports, illegal performance enhancement. While such reputations are quite well-deserved, in reality there are two classifications of steroids, the distinction of which is important. They are anabolic steroids and corticosteroids.

Anabolic Steroids

Anabolic steroids include the hormone testosterone and related compounds that have muscle-building (anabolic) and masculinizing (androgenic) effects. (1) They sometimes are used illegally and may be dangerous, but also may be needed for some people with blood levels of testosterone lower than normal.

In diabetes, especially type 2, some men have decreased levels of testosterone. The normal values for total testosterone in men is 270-1070 ng/dL or 9-38 nmol/L. (2) In general, values below 220 to 250 ng/dL are marked as low in most laboratories; values between 250 and 350 ng/dL should be considered borderline low. (3)

Studies have been done in patients with decreased levels of testosterone. A recent testosterone replacement study was conducted in Germany using the long acting testosterone undecanoate (not available in the United States). Patients were followed for up to four years. In this study, 56 percent of the patients had metabolic syndrome* at the start of the study, which dropped to 30 percent after they were treated with testosterone for 57 months. Lab values such as triglycerides and glucose dropped. Blood pressure dropped and waist circumference dropped by 11 cm. Statin and blood pressure medication was decreased in subjects as well as reported depression. (4)

(*The metabolic syndrome is defined by the International Diabetes Federation as:  a cluster of the most dangerous heart attack risk factors: diabetes and pre-diabetes, abdominal obesity, high cholesterol and high blood pressure. (5))

Preliminary data from the United States indicates that if testosterone replacement is needed, it can help reverse insulin resistance in men with type 2 diabetes after taken over a period of six months. (6)

Many men with low levels of testosterone benefit from using it, but it is not for everyone. The Cleveland Clinic has published a list of conditions where it may be contraindicated. This list may be found here.

If you have low levels of testosterone, have a discussion with your physician about the possible use of the hormone, which should include the pros and cons for you.

Abuse of Anabolic Steroids

Let’s now focus on anabolic steroid abuse by men and women. Reports indicate that people abuse anabolic steroids to improve athletic performance and to boost muscle size. (7) Unfortunately, there are many harmful side effects that are possible with their misuse or abuse. These include heart attack and stroke, liver cancer, non-reversible voice deepening in females, irreversible baldness and breast development in males, reduced sperm production and testicle atrophy.

Insulin helps athletes in two ways. In bodybuilders, it works alongside anabolic steroids such as testosterone or human growth hormone to consolidate muscle tissue. Steroids spawn new muscle, and insulin prevents it from being broken down.

Insulin also bolsters stamina in middle-distance runners and other track performers by enabling them to load their muscles with glycogen “fuel” before and between events. To do this, athletes would need to take insulin and glucose simultaneously for a couple of hours, infusing them using a technique called a hyperinsulinaemic clamp.

In the long term, taking anabolic steroids for non-medical uses can damage reproductive health. But an overdose of insulin can quickly trigger a fatal coma by clearing so much sugar from the blood that the brain is starved of energy and oxygen.

For anyone including those with diabetes, abusing steroids can cause serious harm. While there is no evidence of the effects of anabolic steroid use in athletes with type 1 diabetes, an article in Diabetes Spectrum states: “Due to the systemic disturbances associated with the use of these drugs, athletes with type 1 diabetes should not experiment with them.” (8) In fact, it is not wise for anyone to experiment with steroids. Please consult your medical team for a frank discussion on how they might affect you.