What is the primary concern when a diabetic patient is prescribed steroids like hydrocortisone?

The primary concern when a diabetic patient is prescribed steroids like hydrocortisone is the potential for elevated blood glucose levels. Corticosteroids, such as hydrocortisone, can induce insulin resistance, leading to an increase in blood glucose levels. This response can be particularly concerning for diabetic patients, who must manage their blood sugar levels carefully to avoid complications associated with hyperglycemia.

When corticosteroids are administered, they stimulate gluconeogenesis in the liver, raise glucose production, and inhibit glucose uptake in peripheral tissues, thereby resulting in hyperglycemia. Given that diabetic patients often already struggle with maintaining optimal blood sugar levels, the additional rise in glucose can complicate their management and increase the risk of diabetic complications. Consequently, monitoring and potentially adjusting their diabetes management plan may be necessary when introducing steroid therapy.

The other concerns mentioned, such as kidney damage, dehydration, and respiratory diseases, are generally less direct effects of corticosteroids compared to the immediate impact on blood glucose levels, making them less of a primary focus in this scenario.