The Goal Was Never to Manage Your Pain Forever | The Pained Brain, Chapter 15

Cortisone shot and blood sugar

Cortisone Shot Blood Sugar: What a Knee Injection Does to Your Numbers

A cortisone shot raises blood sugar for days after the injection, and in people with type 2 diabetes the rise is steep; a review of 7 studies found a rise in every one. Glucose is worth watching for up to a week, and A1c is worth knowing before the next shot.

A steroid injection is aimed at one joint, but the drug travels. For anyone with diabetes, prediabetes or extra weight, both the days after the shot and the success of the next treatment show up in measurable numbers.

A cortisone shot into a painful knee is sold as a local fix, but the drug does not stay in the joint. Anyone searching cortisone shot blood sugar is asking a fair question, and the answer has been measured: in people with type 2 diabetes, a single immediate-release knee injection pushed the highest glucose reading up by a median of 169.1 mg/dL over the next three days. The video above, The Goal Was Never to Manage Your Pain Forever, covers chapter 15 of The Pained Brain by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Dr. KrisJay Fucanan, MD. Its subject is injections, which Measura does not perform. The subject here is the numbers surrounding them, and every study is laid out in the book companion for chapter 15.

How much does a cortisone shot raise blood sugar?

That figure comes from continuous glucose monitors worn by people whose hemoglobin A1c already sat between 6.5 and 9.0 percent. With the ordinary immediate-release drug, 93 percent climbed above 250 mg/dL, the share of time spent in the 70 to 180 target range dropped to 48 percent, and the median time to reach 250 was 6 hours. The extended-release form did less harm, a median rise of 92.3 mg/dL with 50 percent crossing 250. The study was small and its analysis came after the fact, but an older review of 7 studies found a glucose rise in every one of them, with peaks as high as 500 mg/dL in the first days, and advised watching glucose for up to a week.

Blood sugar is not the only system that notices. An epidural dose of 40 milligrams switched off the body’s own stress-hormone axis for about 19.7 days, against 8.0 days for 20 milligrams, and the bigger dose relieved no more pain. Among older Medicare patients with sciatica, whose mean age was 76, those given epidural steroid had fractures at a rate of 49.1 per 1,000 person-years compared with 35.2 among those who were not. None of that makes the injection the wrong choice. It makes each injection a withdrawal from an account that deserves a balance check before the next one.

Why doesn’t the injection visit check your blood sugar?

A standard injection visit examines the joint: swelling, range of motion, perhaps an x-ray. It rarely examines the person attached to the joint. Three drivers keep it that way. The first is insulin resistance, which can hide behind a normal fasting glucose for years while the pancreas pushes out more insulin to hold that number in place. The second is fat stored around the organs and the slow, body-wide inflammation it feeds, which the book calls metaflammation, and which weight and body mass index describe poorly. The third is how care is organized. The visit is built around the procedure, relief comes quickly, and nobody is scheduled to ask what glucose did on day two or what the shrinking gap between shots is saying.

Dr. Padda is blunt that he spent years telling patients with an A1c in the prediabetic band that the number was not too bad. He now treats that number as one of the first things to measure, because the injection data below make the old reassurance hard to defend.

The same numbers predict whether a regenerative injection works

The book’s alternative to repeated steroid is platelet-rich plasma, and here the case for measuring gets sharper. In 120 patients with Achilles or patellar tendon pain treated with plasma, patients living with diabetes or prediabetes were 2.41 times as likely to fall short of a meaningful gain, and with every one-unit step up in hemoglobin A1c the odds of a poor result climbed 1.16-fold. A higher body mass index pushed the odds up as well. The platelets were not the weak link: in knee arthritis patients, growth-factor levels in the preparation did not differ between leaner and heavier groups. What differed was the tissue receiving them. The book pictures the injection as a seed and the body as the field, and the field has lab values.

What a measurement shows that a scale does not

Measura [Cardiometabolic and Autonomic Health Analysis] is a testing service. It performs no injections and provides no treatment. It measures, and every result goes to your physician. Two of its measurements speak directly to the terrain described above.

Laboratory panels. Blood work that describes the metabolic picture, including hemoglobin A1c, the three-month blood sugar average, instead of a single glucose reading taken the morning of a procedure.
Bioimpedance body composition. A measurement of fat and lean compartments, which says more about the load on a knee and the muscle available to protect it than height and weight can.

Why measure if your numbers are probably fine? Because probably fine is rarely true. On NHANES 2009–2016, under 12.2% of US adults met the criteria for metabolic health, and under 7% on the tighter criteria applied after 2021. In our own clinic the figure is under 3% overall and under 1% of chronic pain patients, practice-reported figures from our own population, not trial outcomes, and individual results vary. What insulin resistance looks like before diabetes describes the pattern behind those numbers.

What works better than a steroid shot for knee arthritis?

A measurement is only useful if it points somewhere. In a trial of 273 patients with knee arthritis and meniscal tears, twelve months of physical therapy built on exercise outscored a steroid injection by 22.70 points on a standard knee arthritis questionnaire. In an 18-month trial of 454 overweight and obese adults aged 55 and over, diet plus exercise removed 11.4 percent of body weight and produced the lowest pain scores, while interleukin-6, an inflammatory signal in the blood, measured 2.7 in the diet groups against 3.1 with exercise alone. Muscle answers to load, fat answers to food and insulin, and both show up on a body composition report and a lab panel long before they show up as a knee that fails the next injection. Chronic pain and metabolic health goes further into that link, and physicians can read metabolic screening before repeat joint injections.

What to ask before the next shot

How many steroid injections have I had in this joint, and how long did each one last?
If I have diabetes or prediabetes, how should I watch my glucose during the week after the injection, and who do I call if it climbs?
What was my most recent hemoglobin A1c, and has anyone measured my body composition rather than just my weight?
If platelet-rich plasma is offered, do my metabolic numbers change the result I should expect?
What is the plan for the months of relief, so the next interval is longer than the last one?

Do not adjust diabetes medication or skip a planned injection on your own. Take these questions to the physician who ordered it, and see questions worth asking your doctor for more.

Frequently asked questions

Does a cortisone shot raise blood sugar?

It can, and in people with diabetes the rise is large. In adults with type 2 diabetes wearing glucose monitors, a single immediate-release knee injection lifted the peak reading a median 169.1 mg/dL over three days, and 93 percent went above 250. People without diabetes were not part of that study. If you have diabetes or prediabetes, ask your physician how to monitor afterward. Insulin resistance and metabolic health explains why responses differ.

How long does blood sugar stay high after a steroid injection?

The biggest rises appeared within the first three days, and a review of seven studies found peaks within twenty-four to seventy-two hours and advised monitoring for up to a week. The extended-release form caused a smaller rise than the immediate-release drug. How long it lasts for you depends on the dose, your diabetes control and your insulin sensitivity. Laboratory panels describe that underlying metabolic picture.

Does A1c affect how well PRP works?

It appears to. In 120 tendon patients treated with platelet-rich plasma, every one-point step up in hemoglobin A1c lifted the chance of a disappointing result 1.16-fold, and patients with diabetes or prediabetes were roughly two and a half times as likely to fall short of a real improvement. That was a retrospective single-center study, so it shows association rather than cause. How insulin resistance shapes tendon pain covers related evidence.

Can Measura give me a cortisone or PRP injection?

No. Measura measures; it does not inject or treat. It documents the metabolic, body composition, circulation, nerve, autonomic, balance and cognitive picture, and the results go to your physician, who decides whether and when an injection makes sense for you. Who should be tested describes the people the testing is designed for.

Why measure body composition instead of just weight?

Weight cannot tell muscle from fat. Two people with the same body mass index can carry very different amounts of muscle protecting the knee and very different amounts of fat feeding inflammation. In knee patients treated with plasma, body mass index predicted failure, and body composition shows what that single number leaves out. Body composition, not BMI explains the difference.

Is a cortisone shot bad for diabetics?

It is a real load on blood sugar. In adults with type 2 diabetes, 93 percent climbed above 250 mg/dL after one immediate-release knee injection, and time in the 70 to 180 target range fell to 48 percent. The extended-release form did less harm. None of that makes the shot the wrong choice, but it calls for a glucose plan and a known A1c before the next one.

How long does cortisone stay in your system after a shot?

Longer than the needle visit suggests. An epidural dose of 40 milligrams switched off the body’s own stress-hormone axis for about 19.7 days, against 8.0 days for 20 milligrams, and the bigger dose relieved no more pain. Blood sugar effects peak in the first three days, and glucose is worth watching for up to a week after a joint injection.

Know your numbers before the next injection

Ask about metabolic laboratory panels and body composition testing before your next joint injection decision. Measura sends every result to your physician.

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References

Spitzer, A. I., Rodbard, H. W., Iqbal, S. U., Nakazawa, M., DiGiorgi, M., & Winston, R. (2024). Extended-Release Versus Immediate-Release Triamcinolone Acetonide in Patients Who Have Knee Osteoarthritis and Type 2 Diabetes Mellitus. The Journal of Arthroplasty, 39(9 Suppl 2), S218-S223.e1. https://doi.org/10.1016/j.arth.2024.05.055
Choudhry, M. N., Malik, R. A., & Charalambous, C. P. (2016). Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review. JBJS Reviews, 4(3), e5. https://doi.org/10.2106/JBJS.RVW.O.00029
Sim, S. E., Hong, H. J., Roh, K., Seo, J., & Moon, H. S. (2020). Relationship Between Epidural Steroid Dose and Suppression of Hypothalamus-Pituitary-Adrenal Axis. Pain Physician, 23(4S), S283-S294. https://pubmed.ncbi.nlm.nih.gov/32942788/
Yun, H., Liu, Y., Curtis, J. R., Saag, K., D’Erasmo, G., Haseltine, K., & Stein, E. M. (2025). Epidural steroid injections and fracture incidence among older individuals with radiculopathy. Journal of Bone and Mineral Research, 40(2), 176–183. https://doi.org/10.1093/jbmr/zjae162
Abate, M., Paganelli, R., Pellegrino, R., Di Iorio, A., & Salini, V. (2024). Platelet Rich Plasma Therapy in Achilles and Patellar Tendinopathies: Outcomes in Subjects with Diabetes (A Retrospective Case-Control Study). Journal of Clinical Medicine, 13(18), 5443 (article number from DOI; PubMed record lists volume 13, issue 18). https://doi.org/10.3390/jcm13185443
Wiciński, M., Szwedowski, D., Wróbel, Ł., Jeka, S., & Zabrzyński, J. (2022). The Influence of Body Mass Index on Growth Factor Composition in the Platelet-Rich Plasma in Patients with Knee Osteoarthritis. International Journal of Environmental Research and Public Health, 20(1), 40 (article number from DOI; PubMed record lists volume 20, issue 1). https://doi.org/10.3390/ijerph20010040
Lee, M., Jing, C., & Lee, K. (2025). Physical therapy vs. glucocorticoid injection in patients with meniscal tears and knee osteoarthritis: a multi-center, randomized, controlled trial. BMC Medicine, 23(1), 277. https://doi.org/10.1186/s12916-025-04113-y
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