In almost all gyms and fitness centers across the country, trainers will find individuals who choose to take anabolic steroids as part of their training regimen. As fitness professionals, we cannot pass judgment one way or the other on the athletes’ choices. However, we can alert them to a unique hidden danger: steroid use raises blood sugar levels. For healthy individuals, this sometimes presents a problem; but for diabetic athletes, the danger intensifies, sometimes escalating to a life-threatening condition.
Anabolic Drugs and Diabetes
Androgenic-anabolic steroids (AAS) currently rank as a major public health concern. Approximately 3 to 4 million Americans use anabolic-androgenic steroids to increase muscle mass. This staggering number includes individuals striving to increase their sports performance as well as those who simply wish to enhance their physiques. In fact, researchers have noted a trend in usage, migrating from solely athletes to a much greater percentage of the population.
Anabolic-androgenic steroids (AAS) include natural androgens such as testosterone (the male sex hormone) or a synthetic form of the same endogenous male hormone. The potential side effects of anabolic steroid abuse vary from an inconvenience to a serious medical condition. Very often athletes purchase these substances online rather than receiving a prescription from a physician. As such, health care providers may not always have an opportunity to caution patients whose health history may pose an inherent risk when coupled with anabolic-androgenic steroid misuse.
The Human Body and Insulin
Insulin, the hormone which controls the concentration of glucose (sugar) in the bloodstream at any given point in time, gets released by beta-cells located in the pancreas. In an otherwise healthy individual, the beta-cells release insulin in response to the concentration of glucose in the blood. Insulin transports the glucose, the body’s preferred source of energy, into the cells wherever needed.
In the presence of a high concentration of blood glucose, the beta-cells release more insulin, in an effort to allow the glucose to get absorbed from the blood. In the case of a low concentration of glucose, the beta-cells release a much smaller amount of insulin. If they sense the need, these beta cells have the capacity to actually “switch off” insulin production. All of this gets accomplished as the body tries to re-establish homeostasis, keeping the blood glucose concentration balanced at the proper level to ensure normal bodily functions.
Normally, the liver reduces the amount of glucose it releases in response to the level of insulin present. Anabolic steroids, however, render the liver less sensitive to insulin. As a result, it continues to release glucose even as the pancreas releases insulin. Steroids also block glucose from getting absorbed by muscle and adipose tissues; as a result, it continues to circulate in the bloodstream. By diminishing the body’s sensitivity to insulin, it ultimately requires even more insulin in order to transport the glucose into the cells.
The Potential for Diabetic Ketoacidosis
The condition known as Diabetic ketoacidosis (DKA) develops when the body lacks sufficient insulin to bring glucose into the cells and bloodstream for an energy source. Instead, the liver must now take over the breakdown of fat to serve as a fuel source. This process in turn produces acids known as ketones. Often an excess of ketones builds up too rapidly, particularly if an individual also adheres to a strictly ketogenic diet, escalating to dangerous levels throughout the body. Athletes may not realize this occurrence until levels reach a life-threatening level, a condition we call DKA.
Diabetic ketoacidosis symptoms often come on quickly, sometimes within 24 hours. For diabetic athletes using anabolic steroids, this situation can rapidly result in coma and/or death.
Symptoms may include:
- Extreme thirst
- Frequent urination
- Nausea/vomiting/abdominal pain
- Weakness or fatigue
- Shortness of breath
- Fruity-scented breath
- Confusion
Absolute confirming signs of diabetic ketoacidosis include:
- High blood sugar level
- High ketone levels in urine
If an athlete or client presents with any of these symptoms, and the trainer knows that this individual has diabetes and currently uses anabolic steroids, he must take immediate action to get the individual to an emergency room. Knowing what to look for can save lives.
Frightening Case Studies
One study focused on a 56-year-old Caucasian male who came to his regular physician to obtain a routine general wellness check-up. He revealed a significant anabolic steroid history, using these substances over the course of thirty years up until the present day. The patient had a prior hemoglobin A1C level of 6.9%, but at that time the doctor had not made mention of it. As of the current check-up, the doctor diagnosed full-scale diabetes mellitus. The most surprising aspect of this result lies in the presence of diabetes mellitus despite the patient’s low body fat levels coupled with very high levels of physical activity throughout his life.
In another case study, a 36‐year‐old male professional bodybuilder arrived at a hospital’s emergency room complaining of severe pain in his right upper quadrant. The patient revealed his background of a 15‐year history of anabolic steroid and growth hormone misuse. Examination revealed mild liver enlargement and a random blood sugar of 30.2 mmol/l. At this conjecture, the doctor opted to admit the patient to the hospital.
The patient reported that 12 months after starting on a growth hormone, he experienced hyperglycemia (blood glucose 12–15 mmol/l), and self‐medicated with insulin.
During his 5‐day hospital admission, during which all growth hormone and insulin misuse ceased, his blood biochemistry panel improved, as did his blood sugar level. He resolved to give up all non‐prescribed drugs.
New research presented at a gathering of the European Association for the Study of Diabetes (EASD) meeting in Munich, Germany confirmed the direct relationship between anabolic steroid abuse and impaired insulin sensitivity. Dr Jon Rasmussen, Herlev University Hospital, Copenhagen, Denmark and colleagues who led the study tell us, “The current data suggest that a history of AAS misuse leads to impaired insulin sensitivity, even several years after AAS cessation, compared with healthy controls who had never used AAS.”
These cases shine a light on the potential need for extensive metabolic and cardiac evaluation in anabolic steroid users. While medical professionals and select coaches and trainers have some reasonable understanding of the effects of testosterone use alone, most other commonly used anabolic steroids have not undergone long-term studies; as a result, their side effects remain poorly understood.
Final Thoughts
The use of anabolic/androgenic steroids in an effort to improve physical performance or appearance continues to increase. The doses used atypically range from 10x to 100x higher than the therapeutic dose. Drug abuse, so common among competitive bodybuilders, sometimes involves substances combinations, potentially resulting in significant health risks ~ cardiovascular events, hormonal imbalances, and metabolic complications. Once again, this highlights the vital role that an athlete’s interprofessional team (coaches, trainers and medical professionals) plays in managing patients with this condition. Even the “weekend warrior” average visitor to our fitness centers deserves a personal trainer’s careful eye.
References:
https://pubmed.ncbi.nlm.nih.gov/3549761/
https://www.ncbi.nlm.nih.gov/books/NBK538174/
https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-024-00697-6
https://joe.bioscientifica.com/view/journals/joe/220/2/143.xml
https://www.sciencedaily.com/releases/2016/09/160913184951.htm
https://www.scienceopen.com/hosted-document?doi=10.24911/ejmcr/173-1645130837
https://pubmed.ncbi.nlm.nih.gov/11834135/
https://pmc.ncbi.nlm.nih.gov/articles/PMC2659071/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7861066/
https://www.medtronicdiabetes.com/loop-blog/how-to-spot-and-treat-diabetic-ketoacidosis-dka
https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-2037155
Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!
