Q: A child was diagnosed with asthma at the age of 6 months and diabetes at the age of 4 years. Asthma treatment gradually reduced over 15 years with decreasing use of steroid inhalers since the age of 5, until steroid use is confined to controlling asthma during colds, chest infections etc. Diabetes has always been well controlled (as measured by long term blood tests) until diagnosis was reversed at age of 13 because sporadic high blood glucose readings obtained thereafter were associated with steroid use. Could this be a case of steroid induced diabetes and if so, what is the prevalence of this condition and what are the signs that should be recognised by the doctors treating the child?

A:Steroids can induce impaired glucose tolerance, they may also precipitate frank diabetes in people pre-disposed to it, namely those with pre-existing impaired glucose tolerance or a strong family history of diabetes. However, only inhaled corticosteroids are unlikely to precipitate frank diabetes in a child. Oral corticosteroids taken over a prolonged period are likely to cause this, but the situation reverts to normal after steroid withdrawal. It is worth mentioning here that childhood diabetes is usually insulin dependent, and once diagnosed, is unlikely to go into spontaneous remission, though there might be periods of variable insulin requirement, specially soon after the diagnosis of diabetes is made. Therefore, if this child did not require insulin, always had a very good diabetes control (a tough task, specially in young insulin dependent diabetics), and has gone into spontaneous remission it seems improbable that the child had diabetes.