Cortisone Injections in Diabetics

Cortisone injections are commonly used to treat a variety of orthopedic conditions. People with diabetes are especially prone to side effects from cortisone injections, often experiencing a temporary rise in blood sugars in the following hours or days. That can be alarming if you're not expecting it.

Cortisone is a powerful anti-inflammatory medication that can be injected around tendons or joints where inflammation is present. Cortisone injections are often used in the treatment of conditions including tendonitis, bursitis, and arthritis.

Several common, and many uncommon, side effects can occur after a cortisone shot, and before having this treatment you should discuss these possible complications with your doctor. 

While most cortisone side-effects are mild and temporary, it is worthwhile to discuss these possible problems so that you know what to expect after your injection.

Diabetes and Cortisone

A 2015 study investigated the use of cortisone injections in people with diabetes having injections for hand problems (such as trigger finger and carpal tunnel syndrome). The participants were then surveyed daily until their symptoms resolved. 

The study found:

  • 80% of the patients reported elevated blood sugar following the injection.
  • The rise in blood sugar corresponded to the severity of diabetes as measured by hemoglobin A1c (HbA1c). In those whose HbA1c was greater than 7%, blood-sugar elevations were higher following the injection and the increase lasted longer.
  • Blood sugar levels gradually returned to normal over several days, and no one reported blood-sugar-control problems lasting longer than 5 days.

This was a relatively small study (25 patients), only included people who had injections into their hands, and only studied the effects of a single brand of cortisone. However, it provides some data on a subject that's well known but not well documented in medical literature.

The study recommends avoiding cortisone injections if your HbA1c is greater than 7%. If the benefits of cortisone outweigh the risks, changes in diet and diabetes medication doses may help minimize the risk.

Benefits vs Risks

Any treatment should be considered based on weighing the risks and the benefits of the treatment. In the case of cortisone injections, there are known side-effects that should be considered, but there are also potential benefits. 

People with diabetes should be aware of the possible rise in blood sugar. Furthermore, more poorly controlled diabetics may want to avoid cortisone injections until alternative treatments have been exhausted.

You should discuss with your doctor how high they might expect your blood sugar to rise so you know if there is a problem that requires more urgent evaluation.

Managing Increases

The good news is that elevations in blood sugar tend to be transient and usually resolve spontaneously after a few days. The peak elevation tends to occur anywhere from 5 to 84 hours after the injection.

If you self-administer insulin, you may need to:

  • Keep a close eye on blood sugars for 5 days following the injection
  • Monitor your blood sugar at least four times daily
  • Increase your insulin and oral medications if needed

While the majority of people who have elevated blood sugar following cortisone injections won't have serious repercussions, some cases may require more aggressive treatment.

Any time you have symptoms of rapidly elevating blood glucose, get immediate medical attention.

A Word From Verywell

If you're diagnosed with diabetes and receiving a cortisone injection, be aware of the potential for elevated blood sugars. Talk to your doctor about the best way to manage this, as you may need to adjust your insulin dosage.

Remember these temporary elevations tend to resolve without treatment, but seek treatment if your blood sugars appear to be behaving in an extreme or unexpected manner.

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  2. Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord. 2010;11:206. doi:10.1186/1471-2474-11-206

  3. Kim N, Schroeder J, Hoffler CE, Matzon JL, Lutsky KF, Beredjiklian PK. Elevated Hemoglobin A1C Levels Correlate with Blood Glucose Elevation in Diabetic Patients following Local Corticosteroid Injection in the Hand: A Prospective Study. Plast Reconstr Surg. 2015;136(4):474e-9e. doi:10.1097/PRS.0000000000001624

  4. Waterbrook AL, Balcik BJ, Goshinska AJ. Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review. Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585

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