Canterbury DHB

Context

Ward Management

This topic provides guidance on how to manage glucose in Haematology patients who have been admitted to hospital and are starting to take corticosteroid medication.

Goals

About steroid induced hyperglycaemia

Corticosteroids and their effects

Steroid

Physiological equivalent dose

Potency

Effect on glucose recordings after a single dose

Hydrocortisone

25 mg

Low to moderate

Over a few hours

Prednisone

5 mg

Moderate to high

12 to 36 hours

Methylprednisolone

4 mg

Moderate to high

12 to 36 hours

Dexamethasone

0.75 mg

High

24 hours to several days

Steroids usually affect blood glucose levels after food.

Example

Prednisone given at breakfast time tends to cause the highest blood sugars in the afternoon and evening but usually has less or no effect on waking blood glucose levels.

Example

Dexamethasone is a very potent steroid, particularly at doses given according to Haematology protocols. The effect on plasma glucose may be prolonged (more than 24 hours after a single dose).

Management for all patients starting corticosteroids

Check finger prick glucose regularly for the first 24 hours after starting steroids:

Depending on blood glucose levels, seek medical review

Blood glucose (mmol/L)

Action

< 11.0

No specific action. Review at next ward round.

11.0 - 15.0

Intervention may be needed in some but not all cases. Seek advice at next medical ward round.

> 15.0

Intervention likely needed. Seek advice from medical team before next glucose check.

Actions

Intervention will depend on a number of factors which must be considered by the treating physician, including:

Treatment options

Refer to HealthPathways for guidance or contact the Diabetes Registrar on call (if needed).

Provided the patient is eating, insulin doses should be administered at regular times. ‘PRN’ dosing of rapid-acting insulin (e.g. NovoRapid q4hrly) should be avoided.

Patients not already on insulin

Patients already on insulin

Discharge planning

Record the diagnosis of steroid-induced hyperglycaemia in the Discharge Summary.

This will alert the GP and other medical staff to the problem and allow anticipatory planning for any future courses of steroids

Encourage patients to self-monitor glucose

Make sure they have a glucose meter and testing strips. Testing should be done before breakfast and bed.

Ensure adequate follow-up arranged

If the steroid or insulin regimen is complex, request inpatient advice from a Diabetes Nurse Educator or the Diabetes Registrar on call.

All patients should be advised to see their own GP for review following discharge.

About this Canterbury DHB document (284655):

Document Owner:

Not assigned (see Who's Who)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 284655