Steroids & Blood Sugar Management

Quick Overview: Why Steroids Raise Blood Sugar

Steroids (also called glucocorticoids) can significantly increase blood sugar levels.

Here’s how and why:

• They reduce insulin sensitivity, especially in the liver and muscles, meaning your body needs more insulin to keep glucose in check.
• At higher doses, steroids can also suppress insulin production.
• The effect on glucose depends on:
  • Type of steroid (e.g., prednisone, dexamethasone, medrol)
  • Dosage (low vs. high)
  • How often it’s taken (once daily vs. multiple times per day)

Steroid Timing = Blood Sugar Pattern

Different steroids work differently in the body. Here’s how they typically behave with blood glucose: Example: If prednisone is taken once in the morning, you might see a spike in glucose after breakfast, a bigger rise after lunch, and then a gradual drop overnight. Fasting glucose can still look fairly normal by morning.

Before Making Insulin Adjustments, Assess the Following with your physician:

• When will the steroid start?
• What’s the name of the steroid? (Prednisone, Medrol, or Dexamethasone)
• What dose and how often is it given?
• How long is the course? When is the last dose scheduled?

When to Adjust Insulin

• Start adjustments: ~6 hours after the first steroid dose
• Stop adjustments: When the steroid is discontinued

Insulin Adjustments Differ by Steroid Type & Dose

Prednisone (Once Daily in the AM)

• Low Dose (10–30 mg/day)

• High Dose (>30 mg/day)

Medrol Dose Pack (Taken 2–3 Times Daily)

If Medrol is taken once daily, follow the Prednisone once-daily plan

Dexamethasone

• Low Dose (<2 mg/day)

• High Dose (>2 mg/day)

Steroid Injections

• You will likely require different adjustments for basal vs bolus insulin

Extra Tip:

Need to calculate steroid potency or compare types? Use the GlobalRPH corticosteroid equivalency tool online for conversions.

Feel free to share this with your physician and develop a plan to management your diabetes while under steroid therapy.