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Glucocorticoid-induced hyperglycaemia — SCE Endocrinology MCQ

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HardDiabetes mellitusGlucocorticoid-induced hyperglycaemiaSCE Endocrinology

A 72-year-old man with type 2 diabetes is started on prednisolone 40 mg each morning for giant cell arteritis. Fasting glucose is 7 mmol/L but pre-evening-meal glucose is 18 mmol/L. He eats reliably and eGFR is 70 ml/min/1.73 m2. What is the most appropriate management?

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Correct answer: A — Target afternoon hyperglycaemia with a daytime-acting insulin strategy and steroid-dose review

Target afternoon hyperglycaemia with a daytime-acting insulin strategy and steroid-dose review is best because morning prednisolone typically causes afternoon and evening hyperglycaemia, requiring treatment matched to the steroid profile. The alternatives are less appropriate because overnight basal escalation risks nocturnal hypoglycaemia; fasting glucose misses the abnormal period; bedtime sulfonylurea is poorly matched; stopping steroids may be clinically unsafe. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: JBDS-IP steroid hyperglycaemia guideline