How does a steroid medication impact blood glucose?

Does anyone out there have experience using prednisolone? I need some info on what it will do to BG. My 3-year-old son was just diagnosed with bronchitis after having weeks of coughing, sometimes bad enough to make him throw up. The pediatrician was going to give him just an antibiotic but when he heard that Eric would cough till he puked (which of course sent his BG plummeting), he decided to be more aggressive. He did warn us though that the prednisolone would affect Eric's BG, but he wasn't sure how. Any info would be helpful.

Tags: bronchitis, prednisolone, steroid

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Permalink Reply by Serena on November 10, 2010 at 7:50am

In general, it can raise blood glucose levels. But, as with everything else, everyone's different. So, keep an eye on your son, but don't be surprised if he needs more insulin. Hope he feels better soon!

Permalink Reply by MelissaBL on November 10, 2010 at 8:32am

I stay in the 300-400s for up to 3-5 days after having prednisone and become very insulin resistant. I don't know what your son's doc would recommend in such a young diabetic, but I have to increase my basal rates by about 20% until I see my first low and then I reduce them back to my regular rates.

Permalink Reply by Elizabeth on November 10, 2010 at 10:14am

I bumped Eric's up by 16% for a 3-hour period and it appeared to hold him steady (at 400+, not what I wanted) but the correction didn't seem to touch the high BG at all. Endo sez I probably have to beef up all of his rates -- carb ratios, correction factor, and basal too. I knew he'd go high, but I had no idea he'd go THIS high.

Permalink Reply by daneenm on November 10, 2010 at 10:00am

Yep, lots of it, sadly. My son runs VERY high on it. Always has. So, as with everything else, YDMV (your Diabetes my vary) so keep an eye out and see his reaction, but do not be surprised if he runs quite high. My son's highs remain for a day or two even after we have tapered off.

Permalink Reply by Elizabeth on November 10, 2010 at 10:09am

So far we're seeing BGs in the 400s. I bumped his basal up a little but clearly not enough -- going to have to get aggressive with it from the looks of things. Any of you guys get ketones on it? Eric had 0.6 blood ketones the last time his BG got tested and we changed the site just to be safe, but I felt pretty confident that it's not the site because his BG held steady at 408/410 over the two hours between his snack and his lunch -- if he wasn't getting any insulin, he'd be a whole lot higher than 410, IMHO. So I'm going to assume that the ketones are related to insulin resistance from the prednisone and just hit him with bigger boluses and higher basals for the duration. Guess we won't be participating in the Big Blue Test this year after all... he's going to be on this stuff till Monday.

Permalink Reply by daneenm on November 10, 2010 at 10:13am

We have not seen ketones, but my son is very slow to develop them (he has only had them twice that we know of and they were low both times). I would say it is an excellent thing to watch for because it is hard to be ultra aggressive in the basal/ratio adjustments in a toddler, since they can go from highs to lows so fast. He will likely run out of normal range while on the pred even with your adjustments, so Ketones could easily develop.

Permalink Reply by Elizabeth on November 10, 2010 at 10:18am

Good to know -- thanks for the info! Eric seems to develop ketones fairly quickly, he has a pretty high metabolism. Good thing I just refilled the ketone strip script :)

Permalink Reply by Laura on November 12, 2010 at 5:02am

I wish I had seen this earlier. My T1 daughter got one shot of steroids when she was 3. She was having a procedure done at the hospital where they knocked her out. Well, the stupid anesthesiologist didn't know not to give a steroid to a diabetic. They gave her a shot so she didn't vomit after coming out of anesthesia, which was just a precautionary measure because most people don't. When I complained they said we only gave her a little bit, and look, she's fine. She was fine ... until a few hours later when she got home. BG in the 300's and 400's for the next 24 hours which would not come down no matter what I did. And the high BG caused her to develop a serious and painful infection that she needed antibiotics for. Also she needed almost double her normal dose of Lantus for a month afterward. Probably insulin resistance as Melissa said.

IMHO any doctor who gives any diabetic a steroid to cure an infection needs to go back to school. There are enough diabetics these days that doctors should know that steroids can hurt them badly.

Permalink Reply by MelissaBL on November 12, 2010 at 8:01am

We can receive steroids safely - I've had them for tonsillitis, for sinus infections, for laryngitis, for a problem with my foot, but we need to make sure we are being followed closely for the highs in the aftermath.

After an ENT gave me 4x the recommended dosage of a steroid when I had tonsillitis, I was on the phone with my endo several times that evening. She said they'd given me the amount they'd have given someone with an inoperable brain tumor. Regardless, her advice was the same: Monitor, Massive basal rate changes (Lantus is like basal rate), Aggressive adjustments. My BG went up into the 570s.

It sounds like your daughter's secondary infection was a horrible experience though and you'd be right to be skeptical of steroid use in the future for her when there might be other options.

Permalink Reply by Elizabeth on November 12, 2010 at 9:56am

I'm definitely on board with that, Melissa -- Eric's bronchitis has improved markedly with the steroid, but oh boy, those highs are nasty. So far, we've been floating back and forth between the 200's and 400's -- he seems to be a lot higher in the 3 or 4 hours after his dose, then gradually comes back down. I was dismayed today to find that after I bumped up his basal rate by 20% across the board, AND lowered his correction scale by 1/3 and dropped all his carb ratios by anywhere from 15% to 25%, he was STILL above 400 at lunchtime. I thought I was being aggressive with those changes, but apparently not aggressive enough.

Permalink Reply by Roxanne on February 4, 2011 at 11:50am

My son had his first dose of Orapred last night. WOW! His blood sugars have been in the 400's and he's had ketones. Even when I correct him with a syringe, the blood sugar will not come down. I have changed his site, but I feel that it has more to do with the insulin resistance, as well. It's gonna be a long weekend!

Permalink Reply by helen on February 4, 2011 at 1:48pm

My son is on long term steroids as he has cystic fibrosis. He now has to take them daily instead of alternate days to keep blood sugars level. If he has to take extra for infections he does rise and it takes us a couple of days to stabilize him again