Modifying Type of Insulin to Manage Steroid-Induced Hyperglycemia: A Case Report

Steroid-induced hyperglycemia was diagnosed in an older hospitalized patient after he was treated with the intermediate-acting glucocorticoid methylprednisolone. Before hospital admission, the patient did not have a diagnosis of diabetes. His elevated admission glucose level of 167 mg/dL along with his significant hyperglycemia after glucocorticoid initiation prompted the medical team to obtain a hemoglobin A_1c result, 8.4%, which confirmed the diagnosis of type 2 diabetes. The capillary blood glucose level was elevated into the 200 to 399 mg/dL range for most of the patient’s hospital stay while he was receiving subcutaneous insulin therapy of glargine and aspart correction and prandial bolus dosing. When the patient’s subcutaneous insulin therapy was changed from glargine to neutral protamine Hagedorn insulin, the target glucose level range of 140 to 180 mg/dL was attained. From this case report, we determined that it is important to consider modifying subcutaneous insulin therapy by using another type of insulin when target glucose values are not achieved during the treatment of steroid-induced hyperglycemia.