Successful management of a glucocorticoid-induced hyperglycemia in hospitalized patient with use of novel protocol

Abstract

Glucocorticoids can potentially cause hyperglycemia in otherwise normoglycemic individual or worsen the glycemic control in a patient having pre-existing diabetes mellitus. Management of glucocorticoid-induced hyperglycemia (GCIH) in hospitalized patients is a significant challenge. A recently published novel insulin protocol proposes the use of insulin neutral protamine Hagedorn (NPH) along with prednisolone to negate the hyperglycemic effect of prednisolone in a patient who develops GCIH. Here we report a case of an obese pre-diabetic female who developed GCIH following the use of prednisolone. The patient was initially managed with basal-bolus insulin protocol which leads to high glycemic variability. The use of single dose of insulin NPH along with the prednisolone as proposed by the novel protocol leads to excellent glycemic control while reducing glycemic variability. This case illustrates the use of the novel protocol in successful management.