Abstract
Glucocorticoids can potentially cause hyperglycemia in otherwise normoglycemic individual or worsen the glycemic control in a patient having pre-existing diabetes mellitus. Management of glucocorticoid-induced hyperglycemia (GCIH) in hospitalized patients is a significant challenge. A recently published novel insulin protocol proposes the use of insulin neutral protamine Hagedorn (NPH) along with prednisolone to negate the hyperglycemic effect of prednisolone in a patient who develops GCIH. Here we report a case of an obese pre-diabetic female who developed GCIH following the use of prednisolone. The patient was initially managed with basal-bolus insulin protocol which leads to high glycemic variability. The use of single dose of insulin NPH along with the prednisolone as proposed by the novel protocol leads to excellent glycemic control while reducing glycemic variability. This case illustrates the use of the novel protocol in successful management.
Similar content being viewed by others
References
Liu X, Zhu X, Miao Q, Ye H, Zhang Z, Li Y-M. Hyperglycemia induced by glucocorticoids in nondiabetic patients: a meta-analysis. Ann Nutr Metab[Internet]. 2014;65(4):324–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25402408
Lakhani O, Kumar S, Tripathi S, Desai M, Seth C. Comparison of two protocols in the management of glucocorticoid-induced hyperglycemia among hospitalized patients. IJEM[Internet]. 2017;21(6):836. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29285445
Sandhiya S, Vikneswaran G, Nishanthi A, Alphienes S, Xavier SS, Kamalanathan SK, et al. Systematic review on vitamin D level in apparently healthy Indian population and analysis of its associated factors. IJEM. 2017;21(2):765–75.
Burt MG, Roberts GW, Aguilar-Loza NR, Frith P, Stranks SN. Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab. 2011;96(6):1789–96.
Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab[Internet] . 2012 Jan 1 [cited 2018 Jan 2];97(1):16–38. Available from: doi: https://doi.org/10.1210/jc.2011-2098
Grommesh B, Lausch MJ, Vannelli AJ, Mullen DM, Bergenstal RM, Richter SA, et al. Hospital insulin protocol aims for glucose control in glucocorticoid-induced hyperglycemia. Endocr Pract [Internet]. 2016 Feb [cited 2018 Jan 12];22(2):180–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26492541
Management of hyperglycaemia and steroid (glucocorticoid) therapy. 2014 [cited 2018 Jan 12]; Available from: http://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Steroids.pdf
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Lakhani, O.J., Patel, S. Successful management of a glucocorticoid-induced hyperglycemia in hospitalized patient with use of novel protocol. Int J Diabetes Dev Ctries 38, 509–513 (2018). https://doi.org/10.1007/s13410-018-0649-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13410-018-0649-7