Recommendations for Glycemic Treatment for Patients Receiving Dexamethasone for Treatment of COVID-19

Abstract

Abstract Introduction: SARS-CoV-2 infects not only cells of the upper respiratory system. Overproduction of proinflammatory cytokines results in cytokine storm, leading to hyper permeability, multiorgan failure, and death. The cytokine storm is more likely to develop in patients with uncontrolled diabetes. Dexamethasone reduces mortality in patients with COVID-19, but insulin resistance and hyperglycemia are common adverse effects which are also associated to worse outcomes. Methods: We analyze and recommend treatment with insulin in patients with hyperglycemia treated with dexamethasone. Articles for review were selected including information with hyperglycemia caused by steroids. After analyzing the information and adhering to endocrinology guidelines, we propose an algorithm for treating patients hospitalized with COVID-19 and hyperglycemia (with or without diabetes) and require steroid treatment. Results: It is important to consider the characteristics of each patient, specially weight, nutritional status, age, and renal function. Due to an increased insulin resistance, good control requires more bolus doses. A good approach is to start 50/50% of basal/bolus insulins. Discussion: Steroids are the best treatment for patients with important inflammation. There are important factors to consider in these hospitalized patients to start insulin treatment, but also for discharge. Hyperglycemia in these patients can be approached by provision of insulin via basal and bolus insulin. Keywords: COVID-19; dexamethasone; hyperglycemia; diabetes; insulin