Use of Continuous Glucose Monitoring to Estimate Insulin Requirements in Patients with Type 1 Diabetes Mellitus during a Short Course of Prednisone
Open accessAbstract
Background: Insulin requirements to maintain normoglycemia during glucocorticoid therapy and stress are often difficult to estimate. To simulate insulin resistance during stress, adults with type 1 diabetes mellitus (T1DM) were given a three-day course of prednisone. Methods: Ten patients (7 women, 3 men) using continuous subcutaneous insulin infusion pumps wore the Medtronic Minimed CGMS® (Northridge, CA) device. Mean (standard deviation) age was 43.1 (14.9) years, body mass index 23.9 (4.7) kg/m 2 , hemoglobin A1c 6.8% (1.2%), and duration of diabetes 18.7 (10.8) years. Each patient wore the CGMS for one baseline day (day 1), followed by three days of self-administered prednisone (60 mg/dl; days 2–4), and one post-prednisone day (day 5). Results: Analysis using Wilcoxon signed rank test (values are median [25th percentile, 75th percentile]) indicated a significant difference between day 1 and the mean of days on prednisone (days 2–4) for average glucose level (110.0 [81.0, 158.0] mg/dl vs 149.2 [137.7, 168.0] mg/dl; p = .022), area under the glucose curve and above the upper limit of 180 mg/dl per day (0.5 [0, 8.0] mg/dl·d vs 14.0 [7.7, 24.7] mg/dl·d; p = .002), and total daily insulin dose (TDI), (0.5 [0.4, 0.6] U/kg·d vs 0.9 [0.8, 1.0] U/kg·d; p = .002). In addition, the TDI was significantly different for day 1 vs day 5 (0.5 [0.4, 0.6] U/kg·d vs 0.6 [0.5, 0.8] U/kg·d; p = .002). Basal rates and insulin boluses were increased by an average of 69% (range: 30–100%) six hours after the first prednisone dose and returned to baseline amounts on the evening of day 4. Conclusions: For adults with T1DM, insulin requirements during prednisone induced insulin resistance may need to be increased by 70% or more to normalize blood glucose levels.
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(1970) · Cited by 24,983 · see citing works
Intensive insulin therapy in critically ill patients.
Van den Berghe, G., Wouters, P., Weekers, F., Verwaest, C., Bruyninckx, F., Schetz, M., Vlasselaers, D., Ferdinande, P., Lauwers, P., & Bouillon, R. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011300 · Cited by 9,977 · see citing works
A Syndrome produced by Diverse Nocuous Agents
Selye, H. (1936) · Nature · doi:10.1038/138032a0 · Cited by 3,967 · see citing works
Bodily Changes in Pain, Hunger, Fear, and Rage.
Washburn, M. F., & Cannon, W. B. (1917) · The Journal of Philosophy Psychology and Scientific Methods · doi:10.2307/2013624 · Cited by 1,912 · see citing works
Bodily Changes in Pain, Hunger, Fear and Rage
Cannon, W. B. (1929) · Southern Medical Journal · doi:10.1097/00007611-192909000-00037 · Cited by 1,359 · see citing works
Intensive Insulin Therapy in Mixed Medical/Surgical Intensive Care Units
den Berghe, G. V., Wilmer, A. P., Milants, I., Wouters, P. J., Bouckaert, B., Bruyninckx, F., Bouillon, R., & Schetz, M. (2006) · Diabetes · doi:10.2337/db06-0855 · Cited by 597 · see citing works
Clinical Pharmacokinetics of Prednisone and Prednisolone
Pickup, M. E. (1979) · Clinical Pharmacokinetics · doi:10.2165/00003088-197904020-00004 · Cited by 187 · see citing works
Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism
Qi, D., & Rodrigues, B. B. (2006) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00453.2006 · Cited by 162 · see citing works
Peirce, N. S. (1999) · British Journal of Sports Medicine · doi:10.1136/bjsm.33.3.161 · Cited by 156 · see citing works
Kinetics and Interconversion of Prednisolone and Prednisone Studied with New Radioimmunoassays
Meikle, A. W., WEED, J. A., & Tyler, F. H. (1975) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-41-4-717 · Cited by 87 · see citing works
Kramer, J., Ledolter, J., Manos, G. N., & Bayless, M. L. (2000) · Annals of Behavioral Medicine · doi:10.1007/bf02895164 · Cited by 77 · see citing works
Stress: an historical perspective
(2005) · Techniques in the behavioral and neural sciences · doi:10.1016/s0921-0709(05)80004-5 · Cited by 69 · see citing works
Riazi, A., Pickup, J. C., & Bradley, C. (2004) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2004.04.001 · Cited by 50 · see citing works
Glucocorticoid effect on insulin sensitivity: A time frame
Žarković, M., Beleslin, B., Ćirić, J., Penezić, Z., Stojković, M., Trbojević, B., Drezgić, M., & Savić, S. (2008) · Journal of Endocrinological Investigation · doi:10.1007/bf03345596 · Cited by 36 · see citing works
Landis, B., Jovanovlc, L., Landis, E., Peterson, C. M., Groshen, S. G., Johnson, K., & Miller, N. E. (1985) · Diabetes Care · doi:10.2337/diacare.8.6.624 · Cited by 28 · see citing works
Zisser, H., Bevier, W. C., & Jovanovic, L. G. (2007) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2007.0220 · Cited by 15 · see citing works
Self-citationCurrent controversy related to glucocorticoid and insulin therapy in the intensive care unit.
Klaff, L., & Wisse, B. E. (2007) · Endocrine Practice · doi:10.4158/ep.13.5.542 · Cited by 7 · see citing works
Glucose Monitoring of the Present and Future
Garg, S. K. (2006) · Clinical Diabetes · doi:10.1016/b978-1-4160-0273-4.50038-2 · Cited by 3 · see citing works
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Cited by
Sorted by citations
Challenges and recent progress in the development of a closed-loop artificial pancreas
Bequette, B. W. (2012) · Annual Reviews in Control · doi:10.1016/j.arcontrol.2012.09.007 · Cited by 182 · see citing works
The Relationship Between Diabetes Mellitus and Cancers and Its Underlying Mechanisms
Zhu, B., & Qu, S. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.800995 · Cited by 173 · see citing works
Pathways to Quality Inpatient Management of Hyperglycemia and Diabetes: A Call to Action
Draznin, B., Gilden, J. L., Golden, S. H., Inzucchi, S. E., & for the PRIDE investigators (2013) · Diabetes Care · doi:10.2337/dc12-2508 · Cited by 145 · see citing works
A practical guide for the management of steroid induced hyperglycaemia in the hospital
Aberer, F., Hochfellner, D. A., Sourij, H., & Mader, J. K. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10102154 · Cited by 110 · see citing works
Glucocorticoid-induced diabetes and adrenal suppression: How to detect and manage them
Lansang, M. C., & Hustak, L. K. (2011) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.78a.10180 · Cited by 103 · see citing works
Experimental Evaluation of a Recursive Model Identification Technique for Type 1 Diabetes
Finan, D. A., Doyle, F. J., Palerm, C. C., Bevier, W. C., Zisser, H., Jovanovic, L. G., & Seborg, D. E. (2009) · Journal of Diabetes Science and Technology · doi:10.1177/193229680900300526 · Cited by 64 · see citing works
Self-citationEffect of Inhaled Corticosteroids on Glycemic Status
Egbuonu, F., Antonio, F. A., & Edavalath, M. (2014) · The Open Respiratory Medicine Journal · doi:10.2174/1874306401408010101 · Cited by 46 · see citing works
Ruiz de Adana, M. S., Colomo, N., Maldonado-Araque, C., Fontalba, M. I., Linares, F., García-Torres, F., Fernández, R., Bautista, C., Olveira, G., de la Cruz, J. L., et al. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.09.015 · Cited by 45 · see citing works
Seggelke, S. A., Gibbs, J., & Draznin, B. (2011) · Journal of Hospital Medicine · doi:10.1002/jhm.874 · Cited by 42 · see citing works
Management of type 1 diabetes in the hospital setting
Mendez, C. E., & Umpierrez, G. E. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0919-7 · Cited by 34 · see citing works
Artificial Pancreas (AP) Clinical Trial Participants' Acceptance of Future AP Technology
Bevier, W. C., Fuller, S. M., Fuller, R. P., Rubin, R. R., Dassau, E., Doyle, F. J., Jovanovic, L. G., & Zisser, H. (2014) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2013.0365 · Cited by 25 · see citing works
Self-citationRasouli, N., Seggelke, S. A., Gibbs, J., Hawkins, R. M., Casciano, M. L., Cohlmia, E., Taylor‐Cousar, J. L., Wang, C., Pereira, R. I., Hsia, E., et al. (2012) · Journal of Diabetes Science and Technology · doi:10.1177/193229681200600507 · Cited by 24 · see citing works
Insulin Pump Use in Adults with Type 1 Diabetes—Practical Issues
Shetty, G. K., & Wolpert, H. A. (2010) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2010.0002 · Cited by 21 · see citing works
Bauerle, K. T., & Harris, C. A. (2016) · Europe PMC (PubMed Central) · Cited by 20 · see citing works
Nimri, R., Yakoob, H., Schoenberg, B. E., & Dassau, E. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.2504 · Cited by 18 · see citing works
Automatic Detection of Stress States in Type 1 Diabetes Subjects in Ambulatory Conditions
Finan, D. A., Zisser, H., Jovanovic, L. G., Bevier, W. C., & Seborg, D. E. (2010) · Industrial & Engineering Chemistry Research · doi:10.1021/ie901891c · Cited by 17 · see citing works
Self-citationContinuous glucose monitoring (CGM) in a non-Icu hospital setting: The patient's journey
Irace, C., Coluzzi, S., Cianni, G. D., Forte, E., Landi, F., Rizzo, M. R., Sesti, G., Succurro, E., & Consoli, A. (2023) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2023.06.021 · Cited by 16 · see citing works
Management of the Hospitalized Patient With Type I Diabetes Mellitus
Mendez, C. E., & Umpierrez, G. E. (2013) · Hospital Practice · doi:10.3810/hp.2013.08.1072 · Cited by 13 · see citing works
El Páncreas Artificial: Control Automático de Infusión de Insulina en Diabetes Mellitus Tipo 1
Bondía, J., Vehı́, J., Palerm, C. C., & Herrero, P. (2010) · Revista Iberoamericana de Automática e Informática Industrial RIAI · doi:10.1016/s1697-7912(10)70021-2 · Cited by 14 · see citing works
Self-citationGerards, M. C., Tervaert, E. C. C., Hoekstra, J. B. L., Vriesendorp, T. M., & Gerdes, V. E. A. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.05.040 · Cited by 12 · see citing works
Cheng, Y.-C., Guerra, Y., Morkos, M., Tahsin, B., Onyenwenyi, C., Fogg, L., & Fogelfeld, L. (2021) · PLOS ONE · doi:10.1371/journal.pone.0256682 · Cited by 12 · see citing works
Leverage biomaterials to modulate immunity for type 1 diabetes
Jing, Z., Li, Y., Ma, Y., Zhang, X., Liang, X., & Zhang, X. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.997287 · Cited by 11 · see citing works
Diabetes Technology Meeting 2021
Xu, N. Y., Nguyen, K. T., DuBord, A. Y., Pickup, J. C., Sherr, J. L., Teymourian, H., Cengiz, E., Ginsberg, B. H., Cobelli, C., Ahn, D. T., et al. (2022) · Journal of Diabetes Science and Technology · doi:10.1177/19322968221090279 · Cited by 9 · see citing works
Kaur, R. J., Deshpande, S., Pinsker, J. E., Gilliam, W. P., MCCRADY-SPITZER, S. K., Zaniletti, I., Desjardins, D., Church, M. M., Doyle, F. J., Kremers, W. K., et al. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0436 · Cited by 6 · see citing works
Self-citationAmadou, C., Franc, S., Huneker, E., Charpentier, G., & Penfornis, A. (2021) · Diabetes & Metabolism · doi:10.1016/j.diabet.2021.101294 · Cited by 4 · see citing works
Dassau, E., Hennings, T., Fazio, J. C., Atlas, E., & Phillip, M. (2013) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2013.1504 · Cited by 4 · see citing works
New Technologies for Glucose Monitoring and Insulin Administration
Horwitz, D. L., & Klonoff, D. C. (2016) · doi:10.1002/9781118924853.ch30 · Cited by 4 · see citing works
Katz, A., Shulkin, A., Housni, A., Roy‐Fleming, A., Rabasa‐Lhoret, R., Yale, J., Tsoukas, M. A., Peters, T. M., & Brazeau, A. (2026) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.70465 · Cited by 3 · see citing works
“Bevier et al. 35 administered 60 mg of prednisone for 3 days in 10 patients to stimulate stress response under monitored conditions.”
Co-Managing Patients with Type 1 Diabetes and Cancer
Best, C. J., Thosani, S., Ortiz, M. R., Levesque, C. A., Varghese, S. S., & Lavis, V. R. (2016) · Current Diabetes Reports · doi:10.1007/s11892-016-0766-y · Cited by 3 · see citing works
Best practices and rationale for expanding Medicaid access to continuous glucose monitoring
King, C. A., & Lilly, A. N. (2024) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2024.30.10-b.s40 · Cited by 2 · see citing works
New Technologies for Insulin Administration and Glucose Monitoring
Wolpert, H. A., & Shih, J. L. (2010) · doi:10.1002/9781444324808.ch28 · Cited by 2 · see citing works
Technology to Inform Insulin Dose Adjustments: Its Time Is Near
Zisser, H. (2012) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2012.0162 · Cited by 2 · see citing works
Self-citationVitebskaya, A. V., Владимировна, П. А., Afonina, E. Y., Kostina, Y. O., Aleksanyan, K. V., Грамматопуло, М. И., Yablokova, E. A., & Shpitonkova, O. V. (2019) · Diabetes Mellitus · doi:10.14341/dm10042 · Cited by 1 · see citing works
Ketaroonrut, N., Kiertiburanakul, S., & Sriphrapradang, C. (2024) · SAGE Open Medicine · doi:10.1177/20503121241238148 · Cited by 2 · see citing works
Apurva, Chaudhary, P., & Bahuguna, S. (2026) · Current Cancer Therapy Reviews · doi:10.2174/0115733947414188251210123952 · Cited by 1 · see citing works
Bondía, J., Sanz, A. J. L., Rossetti, P., Ampudia‐Blasco, F. J., & Vehı́, J. (2011) · IFAC Proceedings Volumes · doi:10.3182/20110828-6-it-1002.02006 · Cited by 1 · see citing works
Sarriyah, J. F., Alghamdi, A., Al-Otaibi, N. M., Abdulrahman, B. B., & Aljaed, K. M. (2024) · Cureus · doi:10.7759/cureus.54430 · Cited by 1 · see citing works
Continuous monitoring blood glucose level in clinical practice and new methods for its analysis
Dreval', A. V., Dreval, O., & Starostina, E. G. (2013) · Problems of Endocrinology · doi:10.14341/probl201359441-49
Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases
Ильшатовна, Н. Г. (2013) · Kazan medical journal · doi:10.17816/kmj1820
Zhuravlyova, L., Sokolnikova, N. V., & Pylov, D. (2016) · Shidnoevropejskij zurnal vnutrisnoi ta simejnoi medicini · doi:10.15407/internalmed2016.02.098
Amouyal, C., Benhamou, P., Carlier, A., Marchand, L., Smati, S., & Villard, O. (2026) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2026.06.008
- Authors
- Bevier, W. C., Zisser, H. C., Jovanovič, L., Finan, D. A., Palerm, C. C., Seborg, D. E., & Doyle, F. J.
- Affiliations
- Sansum Diabetes Research Institute (US)
- University of California, Santa Barbara (US)
- Sansum Diabetes Research Institute, Santa Barbara, California
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2008-07
- Volume
- 2
- Issue
- 4
- Pages
- 578-583
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC2769767
- OpenAlex
- W2012853114
- Cited by
- 41
- References
- 18
- Citations by year
- 2026: 3 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 3 · 2019: 1 · 2017: 1 · 2016: 5 · 2015: 2 · 2014: 2 · 2013: 5 · 2012: 3
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 1 diabetes, prednisone, glucocorticoid-induced insulin resistance, stress hyperglycemia, continuous glucose monitoring, total daily insulin dose, insulin pump therapy, basal insulin rate, prednisone withdrawal, hypoglycemia, glycemic variability, HbA1c
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