The Improvement of the Metabolic Regulation in a Diabetic Patient With Pulmonary Sarcoidosis Treated With Steroid

Year 2018, Volume: 2 Issue: 2, 93 - 98, 31.08.2018

Oytun Aydoğan Başak Delikanlı Çorakçı , Fatma Erboy , Bülent Altınsoy Emrah Çağlar , Taner Bayraktaroğlu

Abstract

After receiving a diagnosis of type 2 diabetes, he was diagnosed with lung sarcoidosis and steroid treatment, we present a case with chronic active hepatic disease and difficulty in metabolic control.

Thirty-two-year-old male patient was diagnosed with type 2 diabetes and diagnosed with Löfgren’s syndrome while metabolic control was good under metformin treatment. Steroid therapy started because of lung involvement. Oral antidiabetics were not used because of active liver disease. Hyperglycemia became evident when clinic and lung findings were improved. For this reason, metabolic control was attempted with basal / bolus insulin therapy.

When steroid doses of uncomplicated diabetic patients are reduced, blood glucose levels were also at optimal levels. High dose, longterm steroid use and diabetes mellitus association may lead to impaired blood glucose control in chronic lung diseases and increased complications. As in our case, it is recommended that the dose of the steroid be lowered to the lowest possible dose in the best possible time, without disrupting the treatment of diabetic patients.In addition, the use of alternative therapies instead of steroids will play an important role in the control of blood glucose levels.

Keywords

Diabetes Mellitus, Insulin, Steroid, Sarcoidozis, Löfgren’s syndrome

Tip 2 Diyabetik Pulmoner Sarkoidozlu Bir Olguda Steroid Tedavisi Altında Metabolik Kontrolün Sağlanması

Abstract

Tip 2 diyabet tanısı aldıktan sonraki takiplerinde akciğer sarkoidozu tanısı ile steroid tedavisi alırken kronik aktif bir karaciğer hastalığı bulunan ve metabolik kontrolünde zorluk yaşanan bir olguyu sunmaktayız.

Otuzaltı yaşında erkek hasta, tip 2 diyabet tanısıyla metformin tedavisi altında metabolik kontrolü iyi iken Löfgren Sendromu tanısı aldı. Akciğer tutulumu nedeniyle steroid tedavisi başlandı. Aktif karaciğer hastalığı da var olduğundan oral antidiyabetikler kullanılamadı. Kliniği ve akciğer bulguları gerilerken hiperglisemisi belirginleşti. Bu nedenle de bazal/bolusinsulin tedavisi ile metabolik kontrol sağlanmaya çalışıldı. Komplikasyonsuz diyabetik olgumuzun steroid dozları azaltıldığında kan şekeri değerleri de optimal düzeylerde seyretti.

Yüksek doz ve uzun süre steroid kullanımı ve diabetes mellitus birlikteliği kronik akciğer hastalıklarında kan şekeri kontrolünün bozulmasına ve diabetes mellitusa bağlı komplikasyonların artışına neden olabilir. Olgumuzdaki gibi diyabetiklerde tedaviyi aksatmadan steroid dozunun mümkün olan en uygun sürede en düşük doza düşülmesi önerilmektedir. Ayrıca steroid yerine alternatif tedavilerin kullanılması kan şekerinin kontrolünde önemli rol oynayacaktır.

Keywords

Diabetes Mellitus, İnsülin, Steroid, Sarkoidoz, Löfgren sendromu

References

• 1. De Bosscher K, VandenBerghe W, Haegeman G. Mechanisms of antiinflammatory action and of immunosuppression by glucocorticoids: negative interference of activated glucocorticoid receptor with transcription factors. J Neuroimmunol 2000; 109: 16-22.
• 2. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357: 2153-2165
• 3. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009;15:469-74.
• 4. American Diabetes Association. Standards of medicalcare in diabetes-2015. DiabetesCare 2017;40(Suppl.1):S11-S24.
• 5. Namzeh N. Sarcoidosis. MedClin North Am 2011; 95: 1223-34
• 6. Musellim B, Kumbasar OO, Ongen G, et al. Epidemiological features of Turkish patients with sarcoidosis. RespirMed 2009; 103: 907-12
• 7. Jara-Palomares L, Caballero-Eraso C, Díaz-Baquero A, Rodríguez-Portal JA. (2011). Updated Guidelines for the Treatment of Pulmonary Sarcoidosis, Sarcoidosis Diagnosisand Management, Prof. Mohammad Hosein Kalantar Motamedi (Ed.), InTech, DOI: 10.5772/22760. Available from: https:// www.intechopen.com/books/sarcoidosis-diagnosis-andmanagement/ updated-guidelines-for-the-treatment-ofpulmonary- sarcoidosis (Accessed Date 19.11.2017).
• 8. National Institute for Health and Clinical Excellence (NICE). Type 2 diabetes in adults: management. NICE guideline [NG28]Publisheddate: December 2015 Last updated: May 2017. https://www.nice.org.uk/guidance/ng28 (AccessedDate: 19.11.2017)
• 9. Kleiman A, Tuckermann JP. Glucocorticoid receptor action in beneficial and side effects of steroid therapy: lessons from conditional knockout mice. Mol Cell Endocrinol. 2007;275(1- 2):98-108.
• 10. 10-50. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract. 2009;15(5):469-74.
• 11. Álvarez-Rodríguez E, Agud Fernández M, Villa Álvarez MC, Caurel Sastre Z, Gallego Mínguez I, Carballo Cardona C, Juan Arribas A, Piñero Panadero R, Rubio Casas O, Sáenz Abad D, Cuervo Pinto R.[Recommendations for the management of emergencies in patients with diabetes, acute metabolic complications of diabetes, andsteroid-related hyperglycemia]. Emergencias. 2016;28(6):400-417.
• 12. 12-Gannon C, Dando N. Dose-sensitive steroid-induced hyperglycaemia. Palliat Med. 2010;24(7):737-9.
• 13. Kim SY, Yoo CG, Lee CT, Chung HS, Kim YW, Han SK, Shim YS, Yim JJ. Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease. J Korean Med Sci. 2011;26(2):264-7.
• 14. Fong AC, Cheung NW. The high incidence of steroid-induced hyperglycaemia in Hospital. Diabetes Research And Clinical Practice 2013; 99:277– 280.
• 15. Burt MG, Roberts GW, Aguilar-Loza NR, Frith P, Stranks SN. Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab 2011;96:1789–996.
• 16. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hypeglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J ClinEndocrinolMetab 2012;97:16–38
• 17. Clore J, Thurby-Hay L. Glucocorticoid-inducedhyperglycemia. EndocrinolPract 2009;15:469–74.
• 18. Tanaka K, Okada Y, Mori H, Torimoto K, Arao T, Tanaka Y. The Effects of Mitiglinide and Repaglinide on Postprandial Hyperglycemia in Patients Undergoing Methylprednisolone Pulse Therapy. InternMed. 2018;57(1):65-70.
• 19. Hwrang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014; 30(2): 96–102.
• 20. Walsh LJ, Wong CA, Oborne J, Cooper S, Lewis SA, Pringle M, Hubbard R, Tattersfield AE. Adverseeffects of oralcorticosteroids in relationtodöşe in patientswith lungdisease.Thorax. 2001;56(4):279-84.
• 21. Perez A, Jansen-Chaparro S, Saigi I, Bernal-Lopez MR, Miñambres I, Gomez-Huelgas R. Glucocorticoid-induced hyperglycemia. Journal of Diabetes 2014;6;9–20.
• 22. Raalte DH, Diamant M. Steroid diabetes: from mechanism to treatment? Netherlands The Journal of Medicine 2014; 7 2(2):62-72.
• 23. Gerards MC, Tervaert EC, Hoekstra JB, Vriesendorp TM, Gerdes VE. Physician’s attitudes towards diagnosing and treating glucocorticoid induced hyperglycaemia: Sliding scale regimen is stil widely used despite guidelines. Diabetes Res Clin Pract. 2015;109(2):246-52.
• 24. Katsuyama T, Sada KE, Namba S, Watanabe H, Katsuyama E, Yamanari T, Wada J, Makino H. Risk factors forthe development of glucocorticoid-induceddiabetesmellitus. Diabetes Res Clin Pract. 2015;108(2):273-9.