Drug selection and the management of corticosteroid-related diabetes mellitus.

Glucocorticoid use is associated with the risk of hyperglycemia in patients without known diabetes mellitus and worsened glycemic control in diabetic patients. The effects are greater in the fed than fasting state. Management includes use of diet and exercise (as appropriate for the individual) in all patients. Mild hyperglycemia can often be managed with oral agents, especially those with rapid onset of action. Marked hyperglycemia, especially in diabetic patients or patients with liver or renal disease, requires insulin. Adjustments in insulin can be done both in anticipation of the glucocorticoid effect and based on home glucose monitoring. The effects of glucocorticoids on hyperglycemia usually remit within 48 hours of discontinuation of oral administration.