From the Guidelines
Steroid injections can significantly increase blood glucose levels, especially in people with diabetes or prediabetes, by increasing insulin resistance and stimulating glucose production in the liver, and this effect can last for several days to weeks after the injection. The increase in blood glucose levels is a result of the steroid's counteractive effect on insulin, making it harder for cells to absorb glucose from the bloodstream, as well as the stimulation of the liver to release more glucose into the bloodstream 1.
Key Considerations
- The type and duration of action of the glucocorticoid must be considered in determining insulin treatment regimens 1.
- Daily-ingested intermediate-acting glucocorticoids such as prednisone reach peak plasma levels in 4–6 h but have pharmacologic actions that last through the day 1.
- Patients on morning steroid regimens have disproportionate hyperglycemia during the day, but they frequently reach target blood glucose levels overnight regardless of treatment 1.
- For diabetic patients receiving steroid injections, blood glucose monitoring should be increased for 1-2 weeks after the injection, and diabetes medications may need temporary adjustment 1.
Management Strategies
- Administration of intermediate-acting (NPH) insulin is a standard approach for subjects on once- or twice-daily steroids 1.
- NPH is usually administered in addition to daily basal-bolus insulin or in addition to oral glucose-lowering medications 1.
- For long-acting glucocorticoids such as dexamethasone and multidose or continuous glucocorticoid use, long-acting basal insulin may be required to manage fasting blood glucose levels 1.
- Adjustments based on anticipated changes in glucocorticoid dosing and POC glucose test results are critical 1.
Monitoring and Adjustments
- Blood glucose monitoring should be increased for 1-2 weeks after the injection 1.
- Diabetes medications may need temporary adjustment 1.
- Adjustments based on anticipated changes in glucocorticoid dosing and POC glucose test results are critical 1.
The most recent and highest quality study, 1, provides guidance on the management of diabetes and hyperglycemia in the hospital, including the use of glucocorticoids and insulin therapy. This study recommends that the type and duration of action of the glucocorticoid be considered in determining insulin treatment regimens, and that adjustments be made based on anticipated changes in glucocorticoid dosing and POC glucose test results.
From the FDA Drug Label
Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. Because corticosteroids may increase blood glucose concentration, dosage adjustments of antidiabetic agents may be required.
The steroid injections can increase blood glucose levels. This is due to the effect of corticosteroids on glucose metabolism.
- Key points:
From the Research
Physiology of Steroid Injection Raising Blood Glucose Levels
The physiology behind steroid injections raising blood glucose levels can be understood through the effects of corticosteroids on glucose metabolism.
- Corticosteroids are known to affect the metabolism of glucose, leading to abnormal blood glucose levels in diabetic patients 4.
- The exact mechanism involves the stimulation of gluconeogenesis and the inhibition of glucose uptake in peripheral tissues, resulting in increased blood glucose levels.
Effects of Steroid Injections on Blood Glucose Levels
Studies have consistently shown that steroid injections can cause a significant increase in blood glucose levels in patients with diabetes.
- A systematic review of seven studies found that all studies showed a rise in blood glucose levels following intra-articular steroid injection, with peak values reaching as high as 500 mg/dL 4.
- Another study found that blood glucose levels significantly elevated 1 day after steroid injection, but not 2 days after injection, in patients with type 2 diabetes mellitus 5.
- The degree of blood glucose increase was found to be associated with the level of hemoglobin A1c (HbA1c), with higher HbA1c levels resulting in greater elevations in blood glucose 5, 6.
Factors Affecting Blood Glucose Elevation
Several factors can affect the degree of blood glucose elevation after steroid injection, including:
- HbA1c level: Higher HbA1c levels are associated with greater elevations in blood glucose 5, 6.
- Steroid dose: A higher dose of triamcinolone was found to increase fasting blood glucose (FBG) and postprandial blood glucose (PBG) levels more than a lower dose 7.
- Type of diabetes: Type 1 diabetic patients were found to have a greater increase in blood glucose levels after corticosteroid injection than type 2 diabetic patients 8.
Clinical Implications
The clinical implications of steroid injections on blood glucose levels are significant, particularly for patients with diabetes.
- Patients should be warned of the potential for hyperglycemia after steroid injection and advised to regularly monitor their blood glucose levels for up to a week after injection 4.
- Healthcare providers should consider the potential effects of steroid injections on blood glucose levels when managing patients with diabetes, particularly those with poorly controlled diabetes 5, 6.