Adjusting Toujeo and Carb Ratio After Prednisone Treatment
After completing a 5-day course of prednisone 40mg, you should reduce your Toujeo dose by 20-25% (from 85 units to approximately 65-70 units) and adjust your carb ratio from 1:2.5 to approximately 1:3 or 1:3.5, with close blood glucose monitoring to guide further adjustments.
Understanding Steroid-Induced Hyperglycemia
- Prednisone significantly increases blood glucose levels, primarily affecting daytime glucose between midday and midnight, with less effect during nighttime 1
- Prednisone has an inhibitory effect on insulin response to glucose, requiring higher insulin doses during treatment 2
- After discontinuing prednisone, insulin sensitivity gradually returns, necessitating insulin dose reductions to prevent hypoglycemia 1
Specific Adjustments for Toujeo (Insulin Glargine U-300)
Basal Insulin Reduction
- Reduce your Toujeo dose by approximately 20-25% after completing prednisone therapy 3
- For your current dose of 85 units, this means decreasing to approximately 65-70 units 3
- Toujeo has a prolonged pharmacokinetic profile with duration exceeding 24 hours, so dose adjustments should be made cautiously 4
Monitoring and Further Adjustments
- Check fasting blood glucose levels daily for at least one week after reducing Toujeo dose 3
- If fasting glucose remains elevated (>180 mg/dL), consider smaller reductions (10-15%) 3
- If hypoglycemia occurs (<70 mg/dL), particularly overnight, further reduce basal insulin by an additional 10% 3
Adjusting Carbohydrate Ratio
- Increase your carbohydrate ratio from 1:2.5 to approximately 1:3 or 1:3.5 initially 3
- This means using less bolus insulin per gram of carbohydrate consumed 3
- Monitor postprandial glucose levels closely to determine if further adjustments are needed 3
Implementation Strategy
Day 1-3 After Prednisone
- Reduce Toujeo from 85 units to 65-70 units 3
- Change carb ratio from 1:2.5 to 1:3 or 1:3.5 3
- Monitor blood glucose before meals, 2 hours after meals, and at bedtime 3
Day 4-7 After Prednisone
- Assess patterns in blood glucose readings 3
- Make additional adjustments to Toujeo dose and carb ratio as needed based on monitoring 3
- If consistent hypoglycemia occurs, further reduce insulin doses 3
Important Considerations
- Toujeo (insulin glargine U-300) has a more stable and prolonged effect than standard insulin glargine U-100, which may affect how quickly you see changes after dose adjustments 4
- The return to pre-prednisone insulin requirements may take several days as the effects of prednisone gradually diminish 1
- For patients using insulin pumps, basal rates may need similar proportional reductions 3
Common Pitfalls to Avoid
- Avoiding too rapid reduction in insulin doses, which can lead to rebound hyperglycemia 3
- Failing to monitor both fasting and postprandial glucose levels when making adjustments 3
- Not accounting for the prolonged action profile of Toujeo when making dose adjustments 4
- Overlooking the need to adjust both basal and bolus insulin components 3