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这个美国人用外用激素很多,也发了糖尿病.他认为是激素导至糖尿病,但医生不确认.Communications (October-November, 1997)
[BR]Diabetes as Psoriasis Treatment Fall-out?
from Randy C.
[BR]Dear Ed: You mentioned in one of your "briefings"
a few months ago that you had been diagnosed Type 1 diabetic (insulin dependent),
and then you said in a subsequent issue [of Flake HQ] that you had been
using powerful topical steroids for many years. Have you asked your doctors
about the possible connection? I ask because I, too, am diabetic (type 2,
non-insulin dependent) and also used rub-on medicines for psoriasis for
years before I got diabetes. I've read there is some evidence that overuse
of steroids can trigger diabetes. -Randy
*****
[BR]Ed's Reply:
[BR]Randy, I read about that connection, too—I think in
some recent NPF literature. I mentioned this to both my derm and my diabetes
doctor. Both responses were grunt-like. The similarities between the "pathologies"
of diabetes and psoriasis are interesting.
[BR]1. A genetic proclivity is suspected for both diseases.
2. Both appear to be "triggered."
3. Neither is curable.
4. Both are expensive to control.
[BR]Pragmatically, there's no way my dermatologist is going
to say over-use of topical corticosteroids caused my diabetes. Duh! My diabetes
doctor's attitude was to simply stop inquiring when she learned there was
a history of the disease in my family (maternal grandfather died of complications
stemming from diabetes). So the question is pretty much rhetorical as far
as the pros are concerned.
[BR]Still, from a personal angle, I've thought a lot about
it. My use of topical corticosteroids has escalated significantly over the
past seven years, concurrent with the spread of lesions from 0% of my skin
surface to 60+% at its worst. And it would be difficult for my derm to be
truly cognizant of the amount I use because it varies by the season of the
year and, by chance, the prescript usually come up for renewal at the end
of a "light" season. If he kept a running tally of the amount
of medicines I use over a year—or over the course of my disease—he
would see a different picture than he might see by looking at the most current
two or three pages of my file.
[BR]I'm sure there's also a diminishment of concern in my case
because I DO use the corticosteroids on a revolving regimen that cycles
from low-potency to high-potency formulas. When this cycle is in sync with
the seasons there's no problem, but if I happen to flame at a time when
I'm using a low-potency potion, I just use more of it. When it comes to
building up potentially toxic levels of steroids in my skin, what's the
difference between using a low-potency formulation three times a day or
a high-potency formulation once a day?
[BR]Not to let my derm off the hook so easily, let me also
say I've wondered why, for three+ years now, he hasn't bothered to actually
LOOK AT my psoriasis. He sees my hands and one calf (usually because I show
him without prompting) once a year. He hasn't asked to see the rest of me
for at least three years. There has never been a blood work-up intended
to reveal steroid artifacts. The only blood work-up my derm has ever ordered
prefaced his intent to get me on methotrexate. This was in 1992 or 1993.
Elevated liver enzymes nixed that idea. There was an incidental indication,
in 1994 or 1995, that I was systematizing steroids from direct intralesion
injections: lesions NOT injected were improving right along with those that
WERE, suggesting to my derm that my blood was distributing the steroid (not
good).
[BR]So, yes, I harbor a shadowy belief that somehow my psoriasis
treatment regimen has contributed to the triggering of my diabetes. But
given the myriad other ways I've abused my health throughout my adult life,
that belief can never be factually validated. By all rights my tombstone
should read: "Here lies Ed Dewke | Killed by Many People | But Mostly
By Himself." -Ed |
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