Insulin management in hospitalized patients with diabetes mellitus on high-dose glucocorticoids: management of steroid-exacerbated hyperglycemia
Open accessAbstract
Background: Glucocorticoid (GC)-exacerbated hyperglycemia is prevalent in hospitalized patients with diabetes mellitus (DM) but evidence-based insulin guidelines in inpatient settings are lacking. Methods and findings: Retrospective cohort study with capillary blood glucose (CBG) readings and insulin use, dosed with 50% basal (glargine)-50% bolus (lispro) insulin, analyzed in hospitalized patients with insulin-treated DM given GC and matched controls without GC (n = 131 pairs). GC group (median daily prednisone-equivalent dose: 53.36 mg (IQR 30.00, 80.04)) had greatest CBG differences compared to controls at dinner (254±69 vs. 184±63 mg/dL, P<0.001) and bedtime (260±72 vs. 182±55 mg/dL, P<0.001). In GC group, dinner CBG was 30% higher than lunch (254±69 vs. 199±77 mg/dL, P<0.001) when similar lispro to controls given at lunch. Bedtime CBG not different from dinner when 20% more lispro given at dinner (0.12 units/kg (IQR 0.08, 0.17) vs. 0.10 units/kg (0.06, 0.14), P<0.01). Despite receiving more lispro, bedtime hypoglycemic events were lower in GC group (0.0% vs. 5.9%, P = 0.03). Conclusions: Since equal bolus doses inadequately treat large dinner and bedtime GC-exacerbated glycemic excursions, initiating higher bolus insulin at lunch and dinner with additional enhanced GC-specific insulin supplemental scale may be needed as initial insulin doses in setting of high-dose GC.
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Surgical stress and counterregulatory hormone release increase the risk of hyperglycemia as well as mortality, infection, and length of stay.
“Surgical stress and counterregulatory hormone release increase the risk of hyperglycemia as well as mortality, infection, and length of stay (131,132).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [131]
The Introduction (page unavailable) associates hyperglycemia in hospitalized patients with mortality, infection, and longer hospital stays, and describes glucocorticoids as a cause of hyperglycemia. It does not attribute those effects to surgical stress or counterregulatory hormone release; the mechanisms it discusses concern glucocorticoid treatment. (LLM, conf=0.87)
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- Authors
- Cheng, Y.-C., Guerra, Y., Morkos, M., Tahsin, B., Onyenwenyi, C., Fogg, L., & Fogelfeld, L.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Guerra, Yannis
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-09-16
- Volume
- 16
- Issue
- 9
- Pages
- e0256682
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8445406
- OpenAlex
- W3201075387
- Cited by
- 12
- References
- 28
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 2
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- 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 Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- glucocorticoid-induced hyperglycemia, diabetes mellitus, insulin management, hospitalized patients, high-dose glucocorticoids, multiple daily insulin injections, insulin lispro, insulin glargine, capillary blood glucose, glycemic excursions, insulin dose adjustment
- MeSH terms
- Aged, Blood Glucose, Chicago, Diabetes Mellitus, Drug Administration Schedule, Female, Glucocorticoids, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Retrospective Studies
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