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Diabetes

Diabetes and prednisone

12/28/2005

Question:

I am a type II diabetic and was just prescribed Prednisone for Pneumonia. The regimine is for 20mg a day x 3 days. Should I be overly concerned? I know that it can raise sugars.

Answer:

Prednisone is a synthetic version of cortisone, the hormone that comes from the outer part of the adrenal gland (the adrenal cortex).  Cortisone is essential for survival so people either need their own or may have it replaced with either synthetic cortisone or prednisone.  But prednisone also provides a more potent version of the anti-inflammatory effects of cortisone and is sometimes used in higher doses for that purpose as with the doses you mention.  Usually, prednisone is used for an acute inflammatory process including some forms of inflammation in the lung, most commonly periods of worsening of asthma or severe bronchitis or chronic obstructive lung disease.  It would not be used to treat MOST pneumonias in people without one of the above lung problems which are due to infectious agents like bacteria or viruses, so it is important to understand whether the problem is truly a pneumonia and, if so, what kind of pneumonia, as to whether prednisone is appropriate.   The other concern in people with diabetes is that one of the functions of this class of steroids is to raise the blood sugar or prevent it from falling.  In a person with type 2 diabetes, it may cause a severe rise in the blood sugar.  It is often difficult to predict which person will have a substantial blood sugar rise and which will not, and how high the rise will be.  You have to look at the options and the trade-offs in the individual situation about how to handle that:  In some situations, there may be no other option but to take the prednisone and either accept the rise in the blood sugar or use diabetes drugs to prevent the blood sugar from rising or to treat it once it happens.   Ideally, I would suggest monitoring the blood sugar more frequently when starting the prednisone and adding to the diabetes medicine promptly to counter-act the rise at the advice of your health care provider.  There are additional decisions that have to be made if one were to use prednisone in a person who is either not on diabetes medicines or is at the maximal dose of the medicine they use:  is an additional drug, including insulin, needed to use the prednisone safely?  In some people, one might judge that the benefits expected from the steroid are not sufficient to warrant these effects.  clearly, it takes good judgement and experience to sort out these alternatives.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati