Management of Steroid-induced Hyperglycemia

Sunghwan Suh; Mi Kyoung Park

doi:10.4093/jkd.2016.17.3.174

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Suh and Park: Management of Steroid-induced Hyperglycemia

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J Korean Diabetes 2016;17(3):174-184.

Published online: 10 January 2016

DOI: https://doi.org/10.4093/jkd.2016.17.3.174

Management of Steroid-induced Hyperglycemia

Sunghwan Suh, Mi Kyoung Park

Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea

Corresponding author: Mi Kyoung Park Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea, E-mail: pmk02@dau.ac.kr

Received 30 July 2016 Accepted 1 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Steroids are widely used as potent anti-inflammatory and immunosuppressive drugs to treat a wide range of diseases. However, they are also associated with a number of side effects including new-onset hyperglycemia in patients without a history of diabetes mellitus or severely uncontrolled hyperglycemia in patients with known diabetes mellitus. This negative effect is believed to be caused by a variety of factors, including increased insulin resistance, increased glucose intolerance, reduced beta-cell mass from beta-cell dysfunction, and increased hepatic insulin resistance leading to impaired suppression of hepatic glucose production. Steroid-induced hyperglycemia is important in clinical practice because it has been associated with deleterious effect on prognosis. However, there is no scientific evidence regarding the consequences of corticosteroid-induced hyperglycemia and clinical studies investigating the effects of prevention and correction of the condition are lacking. Similar to non-steroid-related diabetes, the principles of early detection and risk factor modification apply. Challenges in the management of steroid-induced diabetes stem from wide fluctuations in post-prandial hyperglycemia and the lack of clearly defined treatment protocols. Together with, or after, life style measures, hypoglycemic drug with important insulin sensitizer effects is indicated. Other oral hypoglycemic drugs or insulin therapy can be considered as the drug of choice. These treatments may provide additional long-term survival benefit and improve glycemic control.

Keywords: Corticosteroids, Diabetes mellitus, Hyperglycemia

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Table 1.

Predictors of steroid-induced hyperglycemia

Higher dose of steroid treatment (prednisolone >20 mg, hydrocortisone > 50 mg, dexamethasone > 4 mg)

Longer duration of steroid treatment

Advanced age

High body mass index

Previous glucose intolerance, impaired glucose tolerance

Personal history of gestational diabetes or previous steroid-induced hyperglycaemia

Family history of diabetes mellitus

estimated glomerular filtration rate < 40 mL/min/1.73 m²

Table 2.

Estimation of the initial dose of insulin in steroid-induced hyperglycemia, according to the type and dose of steroid

Prednisone dose (mg/day)	Insulin NPH dose (IU/kg per day)	Dexamethasone dose (mg/day)	Insulin glargine/detemir dose (IU/kg per day)
≥ 40	0.4	≥ 8	0.4
30	0.3	6	0.3
20	0.2	4	0.2
10	0.1	2	0.1

NPH, neutral protamine Hagedorn.

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