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Steroid-induced hyperglycaemia — SCE Endocrinology MCQ

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ModerateDiabetesSteroid-induced hyperglycaemiaSCE Endocrinology

A 39-year-old woman has polyuria, polydipsia and glucose 15 mmol/L three months after starting prednisolone 40 mg each morning for vasculitis. Fasting glucose is 6.8 mmol/L but late-afternoon readings are 18–22 mmol/L. What is the most appropriate treatment pattern?

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Correct answer: A — Morning intermediate-acting insulin titrated to afternoon hyperglycaemia

Morning glucocorticoids often cause afternoon and evening hyperglycaemia, and morning intermediate-acting insulin matches this profile. Bedtime basal insulin may miss the steroid glucose peak and increase nocturnal hypoglycaemia. Steroids should not be stopped abruptly when clinically required.

Reference: JBDS Steroid Hyperglycaemia Guideline; BNF