Diabetes control in patients given corticosteroids

Background: Corticosteroids are generally contraindicated in diabetic patie nts due to the risk of disrupting glucose control leading to acute decompen sation. In some cases however, corticosteroid therapy can be beneficial if given early with a well-controlled regimen. Glucose disequilibrium after wi thdrawal can be anticipated with proper knowledge of the pharmacokinetics o f the glucocorticoid used. For patients with type I diabetes: Ketose acidosis is a real risk in these patients. Insulin dose must be increased and the administration scheme opti mized. For patients with type II diabetes: Whether oral drugs should be continued is a question of debate, excepting cases where the underlying disease might cause acute decompensation requiring insulin. Outside this sitution, oral drugs can be continued at a higher dose if the fasting serum glucose is bel ow 2 g/L. Finally, it is important to recognized steroid-induced diabetes i n order to initiate proper antidiabetic measures. For all patients: The glucose curve is reproducible. Basically, the postpra ndial level rises, warranting repeated insulin injections. Rapid-release an alogs and alpha-glucosidase inhibitors appear to be promising; biguanids af fect insulin resistance.