What should a patient with diabetes mellitus type 2 (DM2) on Farxiga (dapagliflozin) do about elevated blood sugar levels after taking prednisone for bronchitis?

Managing Elevated Blood Sugar in a Type 2 Diabetes Patient on Farxiga After Prednisone Use

For a patient with type 2 diabetes on Farxiga (dapagliflozin) experiencing elevated blood sugar after taking prednisone for bronchitis, the patient should temporarily increase blood glucose monitoring to 4-6 hours after prednisone administration and may need additional short-term insulin therapy while continuing Farxiga.

Understanding Glucocorticoid-Induced Hyperglycemia

Prednisone commonly causes hyperglycemia in patients with diabetes. This occurs because:

• Glucocorticoids like prednisone reach peak plasma levels in 4-6 hours and can significantly increase blood glucose throughout the day 1
• The typical glycemic pattern shows normal or mild fasting hyperglycemia with increasing hyperglycemia during the afternoon, peaking in the evening 1
• Prednisone can induce hyperglycemia in 56-86% of individuals with and without pre-existing diabetes 1, 2

Immediate Management Steps

1. Increase blood glucose monitoring:

   • Monitor blood glucose every 4-6 hours after prednisone administration, when steroid effect peaks 3
   • Target blood glucose range should be 100-180 mg/dL 1
   • Continue monitoring for several days after completing prednisone course

2. Continue Farxiga (dapagliflozin):

   • Maintain current Farxiga therapy as it helps with glycemic control 4
   • Farxiga has a low risk of hypoglycemia, making it suitable during steroid therapy 4
   • Be aware that a study showed dapagliflozin alone may not be sufficient to control prednisone-induced hyperglycemia 5

3. Consider short-term insulin supplementation:

   • If blood glucose remains >250 mg/dL despite continued Farxiga use, short-acting insulin may be needed temporarily
   • For prandial coverage, consider starting at 4 units per meal or 10% of basal insulin dose 3
   • Adjust insulin by increasing 1-2 units or 10-15% twice weekly based on postprandial readings 3

4. Hydration and ketone monitoring:

   • Maintain adequate hydration to prevent dehydration 6
   • Monitor for symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain) 6
   • If ketones are present in urine or blood, seek immediate medical attention 6

Adjusting Treatment Based on Prednisone Duration

For Short-Term Prednisone (typical for bronchitis)

• Most patients will see blood glucose normalize spontaneously within 2-8 weeks after completing prednisone 2
• Continue monitoring blood glucose until it returns to baseline
• No permanent medication changes are typically needed

For Longer-Term Prednisone

• If prednisone therapy extends beyond 2-4 weeks, more aggressive insulin supplementation may be required
• Consider a systematic approach to tapering both prednisone and supplemental insulin based on 3-day average blood glucose 3

Common Pitfalls to Avoid

1. Inadequate monitoring: Failure to check blood glucose frequently enough during steroid therapy
2. Not aligning insulin with steroid effect: Peak insulin action should match peak steroid effect 3
3. Overbasalization: Relying too heavily on basal insulin rather than addressing postprandial spikes
4. Delayed adjustments: Not responding quickly enough to hyperglycemia patterns
5. Dehydration: Neglecting fluid intake, which can worsen hyperglycemia 6

When to Seek Medical Help

The patient should contact their healthcare provider immediately if:

• Blood glucose consistently exceeds 250 mg/dL despite adjustments 1
• Any reading is too high for the glucometer 1
• Symptoms of ketoacidosis develop (nausea, vomiting, abdominal pain) 6
• Signs of dehydration appear (dizziness, lightheadedness, weakness) 6

Long-Term Considerations

After completing the prednisone course, the patient should:

• Return to their regular blood glucose monitoring schedule
• Follow up with their healthcare provider to assess if any adjustments to their diabetes management plan are needed
• Continue their usual diabetes care including diet, exercise, and medication adherence 1

By following these steps, the patient can effectively manage the temporary blood glucose elevation caused by prednisone while continuing their Farxiga therapy for long-term diabetes control.