[Glucocorticoids and diabetes mellitus].

Diabetogenic effect of glucocorticoids is determined by dose volume, duration of administration and structure and type of particular preparation. The effect is influenced also by the state of glucocorticoid receptors (increased sensitivity of some gene mutations, resistance syndromes) and times of year and day when glucocorticoids are administered. Development of impaired glucose tolerance or diabetes mellitus depends on the ability of islets of Langerhans to control insulin resistance induced by glucocorticoids. The compensatory function of islets of Langerhans decreases with age and that is why steroid diabetes mellitus affects mostly seniors. Besides treatment regimes and application of sulfonylurea and insulin, there are some new therapeutic methods available: thiazolidindiones, metformin, short-acting secretagogue, alpha-glucosidase, and theoretically also antiglucocorticoids. Application of insulin in type 2 diabetics is justified by the effort to prevent nonketotic hyperosmolar coma. In type 1 diabetes, it is usually necessary to increase the overall insulin dose and change its dosage during the day.