“It is important to understand the risk benefit ratio and learn how to manage rising blood glucose when steroids are used,” the advisory reads
Diabetes India, the Indian task force on diabetes, has released an advisory document for doctors on the various strategies to manage hyperglycemia (high blood sugar levels) in Covid patients on steroids.
Published in the journal Diabetes and Metabolic Syndrome: Clinical Research & Reviews, the document provides “awareness on steroids and hyperglycemia, adverse outcomes of elevated blood glucose levels and, advice at the time of discharge.”
Highlighting the impact of steroids, the advisory reads, “While it is lifesaving in several individuals with Covid-19 infection (from moderate to severe), its pharmacological action increases blood glucose and poses additional challenges in the management.”
“There is also an ongoing concern on inappropriate timing, dosing and duration of steroid use in COVID-19 among certain sections of the medical fraternity. Hence it is important to understand the risk-benefit ratio and learn how to manage rising blood glucose when steroids are used,” it adds.
While many people with diabetes have been infected with COVID, health experts have also pointed that uncontrolled diabetes, coupled with Covid is the reason behind the spike in mucormycosis. AIIMs director Dr Ranadeep Guleria also linked the rise in infections to the “irrational use of steroids” in treatment.
“Those who are diabetic and Covid positive and being treated with steroids will see a surge in their sugar and may need to go onto insulin (if they are taking tablets),” Dr Danendra Sahu, associate consultant, endocrinology, Fortis Hospital Shalimar Bagh, told ModernMediHealth .
“Similarly non-diabetic Covid patients who are treated with steroids will see a surge in their sugar and may need to be put on insulin for some time or given oral medicines. In this case also, good modification is very important,” the doctor added.
Steroids can increase blood sugar levels in various ways:
*Increase the hepatic gluconeogenesis or production of glucose from the liver by enhancing the effect of counter-regulatory hormones.
*Block the action of insulin and increase insulin resistance.
*Reduce uptake of glucose by the muscles and adipose tissue.
*May even reduce the action of Beta cells directly.
The advisory suggested that treatment of blood glucose is “necessary and must be immediate” to avoid complications and improve recovery rate. It gives detailed guidelines for a physician on diagnosis and treatment of hyperglycemia, including management of blood glucose levels and adjustment of insulin, based on various scenarios.
As for the advice at the time of discharge, here’s what experts recommended:
*Comprehensive diabetes management including diet and lifestyle advice.
*Risks associated with hyperglycemia and hypoglycemia.
*Blood glucose monitoring at home and dosage adjustment as per patient requirement.
*Self-Injection technique and site rotation.
*Foot care and sick day rules.
*Advice on reducing insulin as Steroid dosage gets tapered.
*Those with ‘stress-induced diabetes’ to continue monitoring and to seek the help of the physician for future prevention of diabetes.
“The COVID-19 pandemic has opened our eyes to the importance of controlling hyperglycemia. The focus of diabetes management over the years has moved towards an individualized approach towards reduction of cardiovascular disease, kidney disease and micro vascular complications,” the document further states.
