9.2.0.0 Glu­co­cor­ti­coid Ther­a­py

Glu­co­cor­ti­coid type and du­ra­tion of ac­tion must be con­sid­ered in de­ter­min­ing in­sulin treat­ment reg­i­mens. Once-‍a-‍day, short-‍act­ing glu­co­cor­ti­coids such as pred­nisone peak in about 4–8 h (67), so cov­er­age with in­ter­me­di­ate-‍act­ing (NPH) in­sulin may be sufficient. For long-‍act­ing glu­co­cor­ti­coids such as dex­am­etha­sone or mul­ti­dose or con­tin­u­ous glu­co­cor­ti­coid use, long-‍act­ing in­sulin may be used (32,66). For high­er doses of glu­co­cor­ti­coids, in­creas­ing doses of pran­di­al and cor­rectional in­sulin may be need­ed in ad­di­tion to basal in­sulin (68).

What­ev­er or­ders are start­ed, ad­just­ments based on an­tic­i­pat­ed changes in glu­co­cor­ti­coid dos­ing and POC glu­cose test re­sults are crit­i­cal.