CME INDIA Presentation by Admin.
DEXAMETHASONE – Important in COVID.
But Steroid induced Diabetes is being seen at large.
Three things to ponder:
- Insult of dexamethasone-induced impaired glucose metabolism, COVID-19-induced insulin resistance, and COVID-19 impaired insulin production.
- Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial showed that dexamethasone reduced deaths in patients with COVID-19 on ventilators or receiving oxygen therapy. The dose used in RECOVERY — 6 mg daily for 10 days — is five- to six-fold greater than the therapeutic glucocorticoid replacement dose.
- High glucocorticoid doses can exacerbate hyperglycaemia in people with established diabetes, unmask undiagnosed diabetes, precipitate hyperglycaemia or new-onset diabetes, and can also cause hyperglycaemic hyperosmolar state (HHS).
What to do?
- The guidance recommends a target glucose of 108-180 mg/dL and up to 216 mg/dL is “acceptable.”
- Use of once or twice-daily NPH insulin is recommended for patients whose glucose has risen above 216 in some cases with the addition of a long-acting analog.
- Those patients already taking premixed insulin formulations can continue using them while increasing the dose by 20% to 40%.
How Long/How to modify?
- Steroid induced high sugar is often post meals.
- Give repaglinide 1 mg or 2 mg sublingual before meals
- Add 0.3 units insulin per kg in divided doses
- In high risk cases steroids may have to be started on day 1 itself so adjust dose accordingly
- In post Covid illness steroids may have to continue for weeks together like in any immunological illness
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