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February 27, 2000

Other Medications

Question from New Brunswick, Canada:

I am a community health nurse having just lately been involved with Type 2 diabetics who have been started on prednisone [a medication in a class called steroids] for unrelated problems. This of course plays havoc with their glycemic control. Could you direct me to information on the effects of steroids in these situations? I am interested in knowing the expecting time of blood sugar increases in relation to timing of doses, the mechanism of the effect, best measures to level the control, etc.

Answer:

You have noticed correctly that prednisone plays havoc with glucose in people with diabetes. In my experience, NPH insulin nicely covers the increase in glucose from a dose of steroids in the A.M. Interestingly, I have seen a normal blood glucose in the A.M. go to 300-400 by 5:00 P.M. A dose of NPH in the A.M. can control that glucose and they will not need NPH in the evening to wake up with a normal blood glucose. I don’t know where to research this other than the school of experience.

VV
Additional comments from Dr. Bill Quick:

If the patient will be on the steroids long-term, adding more pills, especially the insulin sensitizers or “glitazones,” seems to work very well.

WWQ