Exogenous steroids beyond the physiologic dose can result in hyperglycemia, increased infection, fluid retention, and hypertension.7

When managing hyperglycemia secondary to high-dose exogenous steroid therapy, it is important to note that although the overall glucoses are likely to increase, the postprandial glycemic response is more affected. Therefore, patients should be instructed to monitor their fasting and postprandial glucose to direct appropriate medication management.


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The extent of hyperglycemia is proportional to the dose of steroids given, a significant factor when tapering steroid dose. Hyperglycemia usually persists beyond discontinuation of steroids for several days.

In conclusion, preoperative glycemic optimization for patients with diabetes can significantly reduce risks of perioperative and postoperative complications.

In establishing a preoperative antihyperglycemic regimen, the provider must differentiate between the patient’s basal and prandial glycemic management needs and account for other factors that can potentially complicate perioperative glycemic management such as use of high dose exogenous steroid therapy and stress-induced glycemic response.

Annie D. Lu, ANP-BC, ADM-BC, practices at the NYULMC-Hospital for Joint Diseases Diabetic Foot and Ankle Center

References

  1. Duncan AE et al. Hyperglycemia and perioperative glucose management. Current Pharmaceutical Design. 2012; 18 (38): 6195-6203
  2. Goshi, GP et al. Ambulatory Anesthesia. 2010; doi: 10.1213/ANE.0b013e3181f9c288
  3. Gandhi, GY et al. Annals of Internal Medicine. 2007; 146 (4):  233-243
  4. American Society of Clinical Endocrinologist. Management of Hyperglycemia in the Noncritical Care Setting. AACE Diabetes Resource Center. Retrieved 9/13/14 from http://inpatient.aace.com/management-of-hyperglycemia-in-the-noncritical-care-setting
  5. American Diabetes Association. Diabetes Care. 2014; doi: 10.2337/dc14-S014.
  6. American Society of Clinical Endocrinologist. Retrieved 9/14/14 from http://inpatient.aace.com/sites/all/files/Pre-Operative_Instructions_for_Patients_with_Diabetes.pdf.
  7. Garcia, JE et al. American Society of Anesthesiologist. 2013; 77 (11). Retrieved 9/14/14 from http://www.asahq.org/For-Members/Publications-and-Research/Newsletter-Articles/2013/November-2013