skip to main content

Steroid-induced hyperglycaemia — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

HardDiabetesSteroid-induced hyperglycaemiaSCE Endocrinology

A 71-year-old man with type 2 diabetes is prescribed prednisolone 40 mg each morning for organising pneumonia. His pre-breakfast glucose is 6–8 mmol/L, but pre-evening-meal readings are 17–23 mmol/L. He is eating normally and has no ketones. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Add morning isophane insulin titrated to afternoon glucose

Once-daily morning prednisolone typically drives afternoon and evening hyperglycaemia, which is pharmacodynamically matched by morning isophane insulin. Bedtime rapid-acting insulin would miss the steroid peak and may cause nocturnal hypoglycaemia. The clinical pearl is to match insulin profile to glucocorticoid timing.

Reference: JBDS steroid hyperglycaemia guideline, BNF