Endocrine Abstracts

Steroids are commonly used to treat many chronic illnesses and as part of chemotherapy regimen in children. The hyperglycaemia caused by steroids is poorly recognised and can lead to adverse outcomes. Early recognition and appropriate management of hyperglycaemia is therefore crucial. Fasting blood glucose (BG) levels can be normal and the most sensitive time to test BG is 2 h after lunch.

Steroids may also result in secondary adrenocortical insufficiency. In practice this means that steroids with shorter duration of action e.g. prednisolone given at breakfast may cause early morning hypoglycaemia the following day. This would have implications for the choice of insulin preparations and the timing of administration.

The increment of insulin dose is needed daily for several days until BG within the target range is achieved. With this approach in some patients BG levels remain outside the target range for many days. In others, severe insulin resistance secondary to steroids may demand more rapid increase in the insulin dose.

We report a child who was at high risk of developing SID and in whom tight BG control was desirable was commenced on sensor augmented insulin pump therapy (SAIPT). His BG levels were highest at lunch time. He was initially treated with prandial insulin but when commenced on longer duration of basal insulin analogue at breakfast, led to early morning hypoglycaemia the following day. SAIPT was useful in adjusting the dose of prandial and basal insulin and BG targets were achieved within 72 h with out subsequent hypoglycaemia.

This is the first case report of SAIPT in SID. We conclude that SAIPT can be used in patients at higher risk of developing SID, hyperglycaemia requiring rapid increase in insulin and who remain at higher risk of hypoglycaemia secondary to insulin treatment or adrenal suppression.