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Mixing Glucocorticoids WITH DIABETES

By: Tamara R Meier, MS, APRN, CCNS. Mixing Glucocorticoids WITH DIABETES. OBJECTIVES. Analyze medications used to treat diabetes mellitus Determine therapy for treatment of glucocorticoid induced hyperglycemia Develop treatment plan for diabetics requiring glucocorticoid therapy.

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Mixing Glucocorticoids WITH DIABETES

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  1. By: Tamara R Meier, MS, APRN, CCNS Mixing Glucocorticoids WITH DIABETES

  2. OBJECTIVES • Analyze medications used to treat diabetes mellitus • Determine therapy for treatment of glucocorticoid induced hyperglycemia • Develop treatment plan for diabetics requiring glucocorticoid therapy

  3. DIABETES • TYPE 1 • TYPE 2 • INSULIN RESISTANCE • PREDIABETES • GLUCOCORTICOID INDUCED DIABETES

  4. RANGES • HGA1C • Prediates= 5.7-6.4% • DM= >6.5% • FASTING • <100 mg/dl • BEFORE MEALS • <100 mg/dl • 2 HR AFTER MEALS • <140 mg/dl

  5. GLUCOCORTICOIDS • HYDROCORTISONE • SOLU-MEDROL • SOLU-CORTEF • PREDNISONE • MEDROL DOSE PACK • PREDNISOLONE

  6. DISEASES TREATED WITH GLUCOCORTICOIDS • COPD • BRONCHITIS • TRANSPLANT • CANCER • CYSTIC FIBROSIS • GOUT • PAIN

  7. MEDICATIONS FOR DIABETES • ORAL AGENTS • INSULIN SENSITIZERS • SULFONUREAS • INJECTIONS • INSULINS • BASAL • BOLUS • INCRETIN MIMETICS • BYETTA • VICTOZA

  8. GLUCOCORTICOID INDUCED DIABETES • NO PRIOR HISTORY OF DIABETES • PATIENT IS STRESSED • SURGERY • TRAUMA • ILLNESS • HYPERGLYCEMIA • PRE-MEAL • POST MEAL

  9. GLUCOCORTICOID INDUCED DIABETES • MAY BE LIFE LONG • MAY ONLY NEED DIABETES MEDICATIONS WHILE ON GLUCOCORTICOIDS • HIGHER RISK OF HYPERGLYCEMIA AND REQUIRING MEDICATION LATER IN LIFE

  10. GLUCOCORTICOID THERAPY IN PATIENTS WITH DIABETES • PATIENT WITH PRIOR DIAGNOSIS OF DIABETES • INCREASE IN INSULIN RESISTANCE • DIABETES MEDICATIONS • INCREASE • CHANGE • HIGHER RISK OF COMPLICATIONS • SIDE EFFECTS

  11. FACTORS • OUTPATIENT SETTING • WHAT DRUG IS GIVEN • ROUTE GIVEN • TIME GIVEN • DOSE OF DRUG • HOW LONG IS THE TREATMENT • SHORT-TERM • LONG-TERM • UNKNOWN

  12. WHERE TO BEGIN? • TIME GLUCOCORTICOID IS GIVEN • WHEN IS HYPERGLYCEMIA OCCURING • FASTING • PRE-MEAL • POST MEAL • BEDTIME • DO CARBOHYDRATES/MEALS INCREASE HYPERGLYCEMIA

  13. WHAT MEDICATION TO GIVE? • ALWAYS DEPENDS ON THE PATIENT!! • USUALLY BEST TREATED WITH INSULIN • IF ALL BLOOD SUGARS (FSBS) ARE HIGH – BASAL INSULIN • IF ONLY POST MEAL FSBS ARE HIGH – BOLUS INSULIN • IF THERE IS A COMBINATION – BASAL & BOLUS INSULIN

  14. HOW MUCH? • ONCE AGAIN – DEPENDS ON PATIENT • START LOW DOSE • CAN ALWAYS INCREASE • DO NOT FEAR HYPOGLYCEMIA – TEACH PATIENT HOW TO TREAT AND RESPOND • HAVE PATIENT SEND IN FSBS RECORD

  15. AS THERAPY CONTINUES….. • GLUCOCORTICOIDS ARE TAPERED OR STOPPED = DIABETES MEDICATIONS NEED TO BE TAPERED OR STOPPED • BASE CHANGES ON MORE THAN ONE READING • STAY IN TOUCH WITH YOUR PATIENTS

  16. IMPORTANT! • Tell your patients to ALWAYS tell their provider who manages their diabetes about glucocorticoid therapy!!! Especially when started, stopped, or changed!!! • Depending on the patient, the provider may or may not make any changes. • Better to be safe than sorry! • EVERY PATIENT IS DIFFERENT!!

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