Intern Med J. 2023 Mar 7. doi: 10.1111/imj.16050. Online ahead of print.
BACKGROUND: Hyperglycaemia is a common side effect of prednisolone, although there are no widely accepted guidelines for management of glucocorticoid-induced hyperglycaemia (GIH). Our institution uses mixed insulin in a pre-breakfast or pre-breakfast and pre-lunch regimen, with the rationale that this profile of insulin action matches the physiological effect of prednisolone on blood glucose levels (BGLs).
AIM: Evaluate the use of the mixed insulin (NovoMix30®) in a pre-breakfast or pre-breakfast and pre-lunch regimen as management for GIH in a tertiary hospital setting.
METHOD: We retrospectively evaluated all inpatients co-prescribed prednisolone ≥7.5 milligrams and NovoMix30® for at least 48 hours over a 19-month period. BGLs were evaluated with repeated measures analysis within four time periods across the day, beginning from the day prior to NovoMix30® administration.
RESULTS: 53 patients were identified. NovoMix30® significantly reduced BGLs in the morning (mean 12.7±4.5 versus 9.2±3.9 mmol/L, p<0.001), afternoon (mean 13.6±3.8 versus 11.9±3.8 mmol/L, p=0.001) and evening (12.1±3.8 mmol/L versus 10.8±3.8, p=0.01). With up-titration of insulin over three days, 43% of all BGLs were within the target range, compared to 23% on day 0 (p<0.001). The final median dose of NovoMix30® was 0.15 (0.10-0.22) units/kilogram bodyweight, or 0.40 (0.23-0.69) units/milligram of prednisolone, which is lower than our hospital guideline recommends. One overnight hypoglycaemic event was observed.
CONCLUSION: Mixed insulin as a pre-breakfast or pre-breakfast and pre-lunch regimen can target the hyperglycaemic pattern induced by prednisolone and minimise overnight hypoglycaemia. However, higher doses of insulin than used in our study are likely required for optimal BGL control. This article is protected by copyright. All rights reserved.
PMID:36880383 | DOI:10.1111/imj.16050