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Diabetes

Prednisone and blood sugar

08/15/2008

Question:

Is there some kind of scale to determine the increased need of insulin for 60 mg tabs? My insulin pump currently delivers 1.1 units per hr. I have post radiation pneumonitis and have to take it. Anyway to avoid the vicious circle.?????

Answer:

The question is not clear but the inference I am drawing is that the question is about the effect of prednisone taken for a post-radiation therapy side effect of inflammation in the lungs and the need for increasing doses of insulin in a person with diabetes.  Unfortunately, there are some medical situations in which there are few options for treating an inflammatory disorder besides prednisone.  Further, unfortunately, one of the trade-offs to using high dose prednisone is that it tends to make blood sugars rise in people who have or are at risk for diabetes.  Depending on the duration of need for the prednisone, it may be helpful to have a diabetes specialist offer some other options to improve the effectiveness of blood sugar control.  There are a number of other drugs which may work to enhance the effectiveness of insulin in this situation.  While there are quite a number of new drugs for diabetes in the last 15 years, probably the ones that would work together with the insulin in the situation you are describing are metformin and two drugs in the thiazolidinedione or "glitazone" class.  Still ultimately the major option is very aggressive advancement of the insulin dose and then equally aggressive reduction of the insulin dose as the prednisone dose is reduced.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati