Endocrine Abstracts

Aims
To present a case of steroid induced diabetes and use this opportunity to review the diabetic resources we provide to other speciality teams in our hospital.

Case
A fifteen year old patient was diagnosed with acute lymphoblastic leukaemia from a full blood count and bone marrow biopsy following a short history of lymph node swelling. He was started on a treatment regime that included dexamethasone at a dose of 6mg/m²/day. 

Later that week the endocrine team were asked to review after random blood sugars of up to 18.6 mmol/l and a fasting sugar of 13.4 mmol/l were noted in the previous 24 hours along with glucose in the urine dip. Ketones had been checked and were low throughout. He did not complain of any osmotic symptoms.  He was fasting pre-theatre at the time of diagnosis of steroid induced diabetes so he required variable rate intravenous insulin infusion initially.  Following this he was commenced on subcutaneous insulin with Tresiba and set doses of Novorapid with corrections using ACDC guidance¹.  During the rest of his inpatient stay his management was reviewed daily and both he and his parents received education via the paediatric diabetic nursing team.

Follow up
Diabetic team reviews were provided at further haematology appointments and guidance given for peri-operative care.

When steroids were due to be weaned off we provided a complimentary regime for the reduction of insulin until both were stopped.  His blood sugars remained within the normal range thereafter.

Conclusions
Using ACDC guidance¹ we were able to manage this patient through his transient diabetes without complication. Following this case we have produced a quick reference guide on the identification and management of steroid induced diabetes. 

There is an increased risk of cancer with the use of Lantus. Some units prefer to use Levemir in preference to Lantus in patients with malignancy or post-transplant¹. Tresiba is the preferred choice in our unit for older patients whilst Levemir is mainly reserved for very young children. Risk of cancer with Tresiba requires further research. 

References:

1-Assocation of Children’s Diabetes Clinicians’.  A Practical Approach to the Management of Steroid, Chemotherapy or Transplant Induced Hyperglycaemia or Diabetes in Children and Young People Under 18 years in the Acute or Inpatient Setting.  Available at http://www.a-c-d-c.org/endorsed-guidelines/. 

2-British Society for Paediatric Endocrinology and Diabetes.  BSPED Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis – 2021.  Available at https://www.bsped.org.uk/clinical-resources/bsped-dka-guidelines/.