An Old Theme and New Technology: Marked Glucocorticoid-Induced Hyperglycemia in a Hospitalized Patient Uncovered Retrospectively by Her Flash Glucose Monitoring

Abstract

Abstract Background  Glucocorticoid-induced hyperglycemia is a problem-facing endocrinologists and internal medicine specialists in hospital wards. Case History  A 63-year-old woman with type 2 diabetes was admitted to the hospital with acute exacerbation of chronic obstructive airway disease. She was treated with a short course of intravenous hydrocortisone followed by oral prednisolone. On discharge, she attended her regular diabetes consultation. Throughout the period, she had her flash glucose monitoring (FGM) sensor in place, and she was monitoring her blood glucose regularly. As part of her diabetes clinic routine, the meter data uploaded and ambulatory glucose profiles were examined. These revealed three distinctly different blood glucose levels before, during, and after glucocorticoid therapy. Glucocorticoid therapy resulted in a marked rise in blood glucose that lasted for a further week before it returned to the pre-treatment levels. This old phenomenon has yet to be demonstrated using the new FGM technology. Conclusions  The story (1) asserts the significant impact of glucocorticoid therapy on glycemic control, (2) demonstrates the prolonged impact on glycemic control following discontinuation of glucocorticoids, (3) suggests a lack of adequate monitoring and timely recognition of hyperglycemia in the hospital, and poor management glucocorticoid-induced hyperglycemia either due to failure of conventional monitoring methods or a degree of complacency to appreciate its magnitude.