Can 80 mg of daily steroids cause hyperglycemia (Blood Glucose >500 mg/dL)?

Steroid-Induced Hyperglycemia and Blood Glucose Levels Above 500 mg/dL

Yes, 80 mg of daily steroids can absolutely cause blood glucose levels to exceed 500 mg/dL, particularly in patients with pre-existing diabetes or risk factors for diabetes. 1, 2

Mechanism and Prevalence

• Glucocorticoids induce hyperglycemia through multiple mechanisms: impaired beta cell insulin secretion, increased insulin resistance, and enhanced hepatic gluconeogenesis 1
• Steroid-induced hyperglycemia occurs in 56-86% of hospitalized patients with and without pre-existing diabetes 1
• The degree of hyperglycemia directly correlates with the steroid dose - higher doses (such as 80 mg) cause more significant elevations in blood glucose 1, 2
• In patients receiving high-dose steroids, 70% of subjects had at least one blood glucose reading ≥10 mmol/L (180 mg/dL), and many had significantly higher readings 3

Pattern of Hyperglycemia

• The hyperglycemic effect is most pronounced during the day (particularly afternoon and evening) and often normalizes overnight 1
• Peak hyperglycemic effects typically occur 6-9 hours after administration of morning steroids 1, 4
• The highest glucose concentrations are typically detected on the 3rd day of steroid therapy 4
• For once-daily morning steroid regimens, glucose levels peak in the afternoon and often return to baseline by the next morning 3

Severity of Hyperglycemia

• For higher doses of glucocorticoids (like 80 mg), increasing doses of prandial and correctional insulin, sometimes in extraordinary amounts, are often needed in addition to basal insulin 5
• Patients with pre-existing diabetes are at particularly high risk, with mean maximal changes in serum glucose being significantly greater than in those without diabetes 6
• Severe hyperglycemia (including levels >500 mg/dL) can occur, especially in patients with:
  • Pre-existing diabetes 1
  • Higher steroid doses (80 mg is considered a high dose) 2
  • Longer duration of steroid therapy 7
  • Multiple daily steroid doses 5

Management Considerations

• Blood glucose monitoring should be performed four times daily (fasting and 2 hours after each meal) when on high-dose steroids 1
• For significant hyperglycemia with high-dose steroids, NPH insulin at 0.3-0.5 units/kg/day is recommended, with higher doses needed for higher steroid doses 1, 2
• For long-acting glucocorticoids or continuous use, long-acting insulin may be required to control fasting blood glucose 5, 1
• Monitor for hyperosmolar hyperglycemic state, a life-threatening complication of severe steroid-induced hyperglycemia that can present with extremely high glucose levels 1

Risk Stratification

• Patients with pre-existing diabetes are at highest risk for severe hyperglycemia 8
• Even patients with prediabetes have double the incidence of steroid-induced hyperglycemia compared to those with normal glucose tolerance 8
• Patients without known glucose abnormalities can still develop significant hyperglycemia on high-dose steroids 3

In conclusion, 80 mg of daily steroids represents a high dose that can certainly cause blood glucose levels to exceed 500 mg/dL, particularly in patients with underlying diabetes or risk factors for diabetes. This severe hyperglycemia requires aggressive monitoring and treatment to prevent complications.