Steroid-Induced Hyperglycaemia Management — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareSteroid-Induced Hyperglycaemia ManagementSCE Palliative Medicine

A 55-year-old woman with advanced breast cancer and symptomatic brain metastases has been started on dexamethasone 16 mg once daily. After 3 days she develops hyperglycaemia with a random plasma glucose of 22 mmol/L, accompanied by polyuria and polydipsia, and has no history of diabetes. What is the most appropriate management?

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Correct answer: B — Start insulin with proportionate glucose monitoring

High‑dose dexamethasone (> 16 mg OD) often causes severe hyperglycaemia through hepatic gluconeogenesis and insulin resistance, overwhelming oral hypoglycaemics. JBDS‑UK guidance advises insulin (basal isophane or analogue) for steroid‑induced hyperglycaemia when persistent >12 mmol/L or symptomatic. Metformin has delayed onset and is inadequate; reducing dexamethasone risks increased intracranial pressure; ICU and IV insulin are excessive. Thus B is correct. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: JBDS: Management of hyperglycaemia and steroid (glucocorticoid) therapy, 2021; NHS Lothian ‘Steroids and Diabetes – INPATIENTS’ guidance, https://www.mkuh.nhs.uk/wp-content/uploads/2021/04/JBDS-management-of-hyperglycaemia-and-steriod-therapy.pdf