Endocrine Abstracts

There are no established guidelines on the management of steroid induced diabetes (SID) in children. 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.

Insulin remains the main stay of treatment and has three components; basal, prandial and supplemental insulin requirements. As hyperglycaemia mainly occurs after meals; the prandial insulin is the primary need. Careful adjustment of insulin doses would then be required alongside calculation of carbohydrate-to-insulin ratios.

Administration of steroids may result in secondary adrenocortical insufficiency. The degree and duration of adrenocortical insufficiency produced is variable among patients and depends on the dose, frequency, time of administration and duration of therapy. This would have implications for the choice of insulin preparations and the timing of administration and the weaning schedule.

If the BG remains persistently uncontrolled i.e.>10 mmol/l, i.v. insulin can be used. The use of i.v. insulin can also provide an estimate of the patient’s 24-h insulin requirements. I.v. insulin should only be used on a temporary basis and need for continued use should be reviewed on a daily basis.

Patients will need to be monitored carefully if discharged on steroids. The discharge plan needs to include strategies to interpret BG trends and how to adjust the insulin dose with weaning schedule of steroids.

East of England Paediatric Diabetes Network has established guidelines on how to manage SID in the East Anglian region. Clinicians and health care professions should be aware of timely and appropriate management of SID.