steroids and glucose management

I have a patient who has to have steroids post chemotherapy which is making her blood sugars go extremely high whilst on the steroids. She is increasing her ratio 4-fold but still not managing glucose levels. Has anyone got any experience in dealing with glucose management whilst on steroids?

I have experience but no simple solution. I have been on steriods a number of times and experienced insulin resistance as a result. The only solution I found was trial and error, however I also found that the larger the meal I ate, the harder it was to adjust for the resistance. It didn't seem to be linear i.e if I at 4 CP's and used a ratio of 2:1, if I ate 8 CP's then a 2:1 ratio was not enough. The only solution I found was to try and keep the CP's down and maybe eat more often and inject for each. Another important factor is to increase your BI accordingly as well. This will require acting like you are starting from scratch and try to get your BI right with carb free days. It won't 'fix' the issue but it will improve it by giving a better baseline to adjust the QA for.

Marke is right. Everyone responds differently to steroids but since they are very effective at turning the body's fat and muscle stores into glucose (in the liver) they will make glucose go up in everyone. Just increasing bolus and corrective doses may well not work if the doses are large enough and then background insulin has to be increased to bring the fasting, i.e. starting glucose of the day down. Morning BI also needs increasing by and large as Marke indicates. You also need to remember that when the steroids are reduced and this is normally gradually, then doses should begin to be wound down within 24 hours of a dose reduction. It is frustrating that there is no std formula so the secret is applying DAFNE principles very precisely as well as seeking help from a local DAFNE educator or doc. Simon

Simon made a very good point that I had forgotten about, which is surprising considering the circumstances. You need to be careful when you stop taking the steroids. They will taper them off slowly so that you body resumes production of 'natural' steroids. However my insulin requirements became a bit unpredictable for a week or two after I had finished the steroids completely. I had my only ever assisted hypo during this period. I was at work and apparently started behaving strangely then went to sleep at my desk. Sadly despite all my previous instructions to colleagues they called an ambulance. The operator told them to give me coca cola. I remember waking up and thinking oh there is an ambulance crew here, I wonder why. Oh sh*t it's for me !! I have been fine ever since.

Thanks guys for your help!