From the Guidelines
To prevent hypoglycemia during prednisone withdrawal, gradually taper the medication rather than stopping abruptly, and monitor blood glucose levels regularly, especially if you have diabetes or are at risk for hypoglycemia. A typical tapering schedule might reduce the dose by 5-10% every 1-2 weeks, with slower reductions at lower doses (below 10mg daily) 1. It is essential to maintain consistent carbohydrate intake across meals and snacks, avoiding long periods without food. Keep fast-acting glucose sources (like glucose tablets, juice, or hard candy) available for emergency treatment of hypoglycemia.
Key Considerations
- Hypoglycemia risk during corticosteroid withdrawal occurs because prednisone increases blood glucose by promoting gluconeogenesis in the liver and causing insulin resistance 1.
- When the medication is reduced, your body needs time to restore normal glucose regulation as the hypothalamic-pituitary-adrenal axis recovers.
- If you experience symptoms of hypoglycemia (shakiness, sweating, confusion, or weakness), check your blood glucose if possible and consume 15 grams of fast-acting carbohydrates, then recheck levels after 15 minutes 1.
- For those with diabetes, work closely with your healthcare provider to adjust insulin or other diabetes medications during the tapering process.
Emergency Treatment
- In cases of hypoglycemia, treatment with 15-20 grams of oral glucose is recommended, with repeated treatment at 15-minute intervals until blood glucose levels return to normal (70 mg/dl) 1.
- It is crucial to have a plan in place for emergency treatment, including access to glucose tablets or other glucose-containing foods, and to educate individuals on the recognition and treatment of hypoglycemia 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Preventing Hypoglycemia during Prednisone Withdrawal
To prevent hypoglycemia during prednisone (corticosteroid) withdrawal, several strategies can be employed:
- Gradual tapering of the prednisone dose to allow the body's natural cortisol production to recover, as suggested by 2
- Close monitoring of the patient's condition, including blood glucose levels, to quickly identify any potential issues, such as those described in 3
- Patient education on recognizing the signs and symptoms of hypoglycemia and adrenal insufficiency, as emphasized in 4
- Consideration of alternative-day drug regimens or "superpotent" topical preparations to minimize the risk of hypocortisolism, as mentioned in 4
Managing Adrenal Insufficiency
In patients with adrenal insufficiency, such as those with Addison's disease, the risk of hypoglycemia can be mitigated by:
- Using a continuous glucose monitoring system (CGMS) to detect nocturnal hypoglycemia, as demonstrated in 3
- Adjusting the hydrocortisone replacement scheme to prevent unphysiological low cortisol levels in the early morning, as discussed in 3
- Employing a novel hydrocortisone dual-release formulation to provide a more physiological exposure-time cortisol profile, as investigated in 5
Reducing the Risk of Steroid Withdrawal Syndrome
To minimize the risk of steroid withdrawal syndrome, which can include symptoms similar to those of adrenal insufficiency, despite acceptable cortisol levels, the following approaches can be taken: