[Management of diabetes during corticosteroid therapy]

Corticosteroids are generally contraindicated in diabetic patients due to the risk of disrupting glucose control leading to acute decompensation. In some cases however, corticosteroid therapy can be beneficial if given early with a well-controlled regimen. Glucose disequilibrium after withdrawal can be anticipated with proper knowledge of the pharmacokinetics of the glucocorticoid used.

Ketose acidosis is a real risk in these patients. Insulin dose must be increased and the administration scheme optimized.

Whether oral drugs should be continued is a question of debate, excepting cases where the underlying disease might cause acute decompensation requiring insulin. Outside this situation, oral drugs can be continued at a higher dose if the fasting serum glucose is below 2 g/L. Finally, it is important to recognized steroid-induced diabetes in order to initiate proper antidiabetic measures.

The glucose curve is reproducible. Basically, the postprandial level rises, warranting repeated insulin injections. Rapid-release analogs and alpha-glucosidase inhibitors appear to be promising; biguanides affect insulin resistance.