Published: 1 March 2018

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The Risk of Hyperglycaemia with Systemic Glucocorticoids

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Prescriber Update 39(1): 3
March 2018

Medsafe was recently notified of a case where a patient was treated with high dose dexamethasone who developed diabetic ketoacidosis requiring hospitalisation.

Healthcare professionals are reminded that systemic glucocorticoids, including dexamethasone, can cause hyperglycaemia (severe enough to cause ketoacidosis) in both diabetic and non-diabetic patients^1,2.

In non-diabetics, effects on blood glucose levels are dose-dependent usually with a mild increase in fasting glucose levels and a greater increase in postprandial values². It is important to ask non-diabetic patients if they are experiencing any symptoms of hyperglycaemia during treatment with systemic glucocorticoids.

Diabetic patients may experience difficulties with glycaemic control while taking glucocorticoids². Regular monitoring of blood glucose levels is important during treatment with glucocorticoids, and dose adjustments for insulin or oral hypoglycaemic agents may be required.

Medsafe is working with pharmaceutical companies to ensure all data sheets for systemic glucocorticoids include information on the risk of hyperglycaemia. Please continue to report any adverse reactions to medicines to CARM.

References

1. Tamez-Perez HE, Quintanilla-Flores DL, Rodriguez-Gutierrez R, et al. 2015. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World Journal of Diabetes 6: 1073–81.
2. 2. UpToDate. 2017. Major side effects of systemic glucocorticoids 15 June 2017. URL: www.uptodate.com/contents/major-side-effects-of-systemic-glucocorticoids (accessed 12 January 2018).