Manage your patient’s diabetes when they are taking corticosteroids
Giving corticosteroids to someone with diabetes will worsen their glycaemic control, so test blood glucose four times a day (based on expert opinion).
Synthetic corticosteroids can cause hyperglycaemia by affecting carbohydrate metabolism and inducing insulin resistance.
For patients with diabetes, use the same doses of corticosteroid as for patients without diabetes, but adjust diabetes medication, as their glycaemic control will get worse.
If hyperglycaemia does occur, follow your hospital protocol. The Joint British Diabetes Societies for inpatient care has produced an algorithm for this clinical scenario and a separate one for patients with diabetes who have COVID-19.
Aim for a target blood glucose of 6 to 10 mmol/L (108 to 180 mg/dL), with an acceptable range 6 to 12 mmol/L (108 to 216 mg/dL)
If your patient has type 1 diabetes, check daily for ketones if their capillary blood glucose is >12 mmol/L (>216 mg/dL).
When you taper the corticosteroid dose, glycaemic control will likely improve, which may require weaning of titrated diabetic medication back to the pre-corticosteroid regimen.
The duration of action for a particular corticosteroid will determine the period of effect on glycaemic control.
Intravenous corticosteroids (e.g., hydrocortisone) typically have shorter half-lives, which means glycaemic control returns to pre-corticosteroid levels within 24 hours.
Oral corticosteroids (e.g., prednisolone) may take a few days.