QuestionSBA
QuestionChoice
Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. There is no evidence to support its use in the management of steroid-induced diabetes
32376
d
Start dapagliflozin
QuestionChoice
Insulin can be used for steroid-induced diabetes; however, NovoRapid is a fast-acting insulin and would not help maintain normal glucose levels throughout the day. Intermediate-acting human insulins such as Humulin I would be a better option and may be started as an alternative to gliclazide at a dose of around 10 Units in the morning
32374
b
4 Units of NovoRapid administered after breakfast
QuestionChoice
This patient has steroid-induced diabetes, and guidelines recommend starting treatment if blood glucose levels are greater than 12 mmol/L on two occasions in a single twenty-four hour period. A once-daily short-acting sulphonylurea such as gliclazide is the most commonly advocated treatment option. The dose can be increased up to 240mg in the morning, and an evening dose may also be added to achieve a maximum daily dose of 320mg
32373
a
Start gliclazide
QuestionChoice
Guidelines suggest starting treatment for steroid-induced diabetes if blood sugar levels are > 12mmol/L on two occasions in a single twenty-four hour period
32377
e
Monitor blood sugars and consider treatment if levels > 20mmol/l
QuestionChoice
Pioglitazone is not usually used as a treatment for steroid-induced diabetes unless gliclazide and insulin are not appropriate
32375
c
Start pioglitazone
QuestionComment
not bad lol 
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Yellow Zebras
QuestionComment
Great question, I hated it
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Mattp420
QuestionComment
Just until it goes down again?
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RNA Gastro
Concept
Chapter
# Summary

Secondary causes of type 2 diabetes mellitus (T2DM) encompass a variety of conditions and factors that can induce or exacerbate hyperglycemia. These range from pancreatic and endocrine disorders to specific medications and glycogen storage diseases. It's important to consider these in patients with new-onset diabetes that presents atypically or doesn't respond to typical management.

# Definition

Secondary diabetes refers to forms of the disease where there is a clear causative factor aside from the typical insulin resistance or pancreatic β-cell failure associated with T2DM.

# Epidemiology

The prevalence of secondary diabetes varies based on the causative condition. While some causes such as pancreatic cancer are relatively common, others, like glycogen storage disorders, are quite rare.

# Aetiology

Secondary causes of T2DM include:

**Pancreatic Causes**

- Cystic fibrosis: An autosomal recessive disorder leading to mucus accumulation in various organs including the pancreas, resulting in fibrosis and loss of exocrine and endocrine function.
- Chronic pancreatitis: Long-standing inflammation of the pancreas can result in damage to islet cells, leading to diabetes.
- Haemochromatosis: Iron overload can lead to deposition in various organs including the pancreas, leading to diabetes.
- Cancer: Pancreatic neoplasms can destroy the islet cells, leading to diabetes.

**Endocrine Causes**

- Cushing's syndrome/disease: Elevated cortisol levels increase insulin resistance.
- Acromegaly: Excess growth hormone leads to insulin resistance.
- Pheochromocytoma: These rare adrenal tumors can induce diabetes through chronic catecholamine-induced glucose intolerance.
- Thyrotoxicosis: Thyroid hormone excess can enhance hepatic gluconeogenesis and glycogenolysis and impair insulin secretion.

**Drug Causes**

- Steroids: Chronic use can lead to glucose intolerance and diabetes due to increased insulin resistance.
- Atypical neuroleptics: These medications can lead to weight gain and increased insulin resistance.
- Thiazides: These diuretics may impair glucose tolerance, possibly by reducing insulin secretion.
- Beta-blockers: They can impair glycemic control through inhibition of insulin secretion and promoting insulin resistance.

**Glycogen Storage Disorders**

- Glycogen Storage Disease Type 1 (von Gierke's disease): The inability to perform gluconeogenesis can lead to hypoglycemia and secondary hyperglycemia.
- Glycogen Storage Disease Type 2 (Pompe disease): It affects the heart and skeletal muscles more than it causes diabetes, but can present with variable symptoms.

# Management

Management primarily involves addressing the underlying condition responsible for secondary diabetes. In cases where this is difficult/not possible, for example, pancreatic cancer, patients may require insulin therapy to manage hyperglycemia.



# NICE Guidelines

[NICE CKS on type 2 diabetes](https://cks.nice.org.uk/topics/diabetes-type-2/)
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Secondary causes of diabetes
Topic
5
Endocrinology
6475
Giant cell arteritis can result in steroid-induced diabetes, requiring blood glucose monitoring and, if necessary, the use of oral hypoglycaemic agents such as gliclazide.
A 65-year-old man is diagnosed with giant cell arteritis (GCA) and is commenced on once-daily, high dose oral steroids as an inpatient.


He has no past medical history, and primary care records showed normal glycosylated haemoglobin (HBA1C) levels three months ago.


Routine capillary blood glucose testing consistently reveal levels in the range 14-19 mmol/L (normal <6.1 mmol/L) with normal serum ketone levels.


Which of the following is the most appropriate next step in management?
a