Diabetes (steroid induced)

Inpatients on steroid therapy at a dose of ≥ prednisolone 20mg or equivalent (see below) should have once daily glucose monitoring prior to evening meal, increasing to four times daily if one reading above 12mmol/l (consider reducing to once or twice daily in palliative circumstances)

Outpatients screening and monitoring pathway

Note: HbA1c should be repeated every 3 months if continuing on steroids

If readings of 12mmol/l twice in 24 hours then refer to on-call diabetes/endocrine registrar or diabetes specialist nurse for advice on treatment.

Contact:

RIE: #6800

WGH: via switchboard

SJH: diabetes specialist nurse 01506 523856/01506 523859

• Prior to commencing on sulfonylurea (SU) or insulin therapy, patients should be equipped with home blood glucose monitoring (HBGM) and relevant education regarding hypoglycaemia management and driving responsibilities. Treatment should be tailored on an individual basis. This will require the local diabetes service.
• Glucose target is 6-10 mmol/l (4mmol-12mmol/l is acceptable) Patients who are elderly, frail, at risk of falling, eating variably or with impaired hypoglycaemia awareness may require a higher target.

Treatment algorithm

Treatment cessation and follow up

• Gradual reduction in insulin or SU therapy will be required following cessation of steroids. This should be guided by HBGM readings with particular emphasis on the avoidance of hypoglycaemia.
• If the diagnosis of underlying T2DM is uncertain (i.e. normal HbA1c, with isolated hyperglycaemia on steroids) oral glucose tolerance test (not HbA1c) should be done 6 weeks post cessation of diabetes treatment. Fasting BG should be done annually thereafter to screen for underlying T2DM.

Full NHS Lothian steroid induced diabetes guideline available on the NHS Lothian intranet.