From the FDA Drug Label
DOSAGE AND ADMINISTRATION General NOTE: CONTAINS BENZYL ALCOHOL (see PRECAUTIONS). The initial dose of KENALOG-40 Injection and KENALOG-80 Injection may vary from 2. 5 mg to 100 mg per day depending on the specific disease entity being treated In the treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of triamcinolone for a week followed by 64 mg every other day for one month are recommended For adults, doses up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient. The suggested initial dose is 60 mg, injected deeply into the gluteal muscle
The FDA drug label does not provide specific guidance for the use of Kenalog (triamcinolone) in a type 1 diabetic patient with hives, already taking Benadryl (diphenhydramine) and hydrocortisone cream. Key considerations for the use of corticosteroids in diabetic patients include:
- Monitoring of blood glucose levels: Corticosteroids can cause hyperglycemia, which may require adjustments to diabetes management.
- Dose and duration: The use of corticosteroids should be optimized to minimize the risk of adverse effects, including hyperglycemia. However, the label does provide general dosing information for Kenalog, including an initial dose of 60 mg injected deeply into the gluteal muscle. It is essential to consult with a healthcare professional to determine the appropriate dose and treatment plan for this patient, taking into account their specific medical condition and concurrent medications 1.
From the Research
A type 1 diabetic patient with hives who is already taking Benadryl and hydrocortisone cream should not receive a Kenalog (triamcinolone) injection without careful medical evaluation first, considering the potential risks of disrupting glucose control and the possibility of an allergic reaction to the carboxymethylcellulose component of Kenalog 2. The decision to administer a Kenalog injection to a type 1 diabetic patient with hives requires careful consideration of the potential impact on blood glucose levels, as corticosteroids like Kenalog can significantly raise blood glucose levels in diabetic patients, persisting for several days to weeks after injection, and necessitating adjustments to insulin dosing 3. Additionally, the combination of multiple antihistamines and corticosteroids needs professional assessment to avoid overtreatment. The underlying cause of the hives should also be determined, as persistent hives might indicate a condition requiring different treatment. If a Kenalog injection is administered, the patient should monitor blood glucose levels more frequently, be prepared to increase insulin doses as needed, and watch for signs of infection since corticosteroids can suppress immune function. Alternative treatments with less impact on blood glucose might be preferable, such as non-sedating antihistamines or mast cell stabilizers. It is also important to note that there is a risk of anaphylaxis induced by the carboxymethylcellulose component of injectable triamcinolone acetonide suspension (Kenalog) 2, which should be considered when evaluating the patient's suitability for a Kenalog injection. Given the potential risks and the availability of alternative treatments, a thorough medical evaluation is necessary to determine the best course of treatment for the patient's hives, taking into account their type 1 diabetes and current medications.