From San Antonio, Texas, USA:
My mother, who has had type 2 for over 10 years, was diagnosed with pulmonary fibrosis and placed on prednisone. She takes an oral medication and takes Lantus insulin at night. I heard NPH is the only effective insulin to be on while taking prednisone (or steroids). Is this true? How do steroids, especially prednisone react with insulin and diabetes? If blood sugar is high, can this delay healing or accelerate the disease process?
Prednisone is a drug that is also a synthetic hormone. It has anti-inflammatory effects, but it also antagonizes blood sugars. In large doses, it will aggravate blood sugars in those already diagnosed with diabetes. In some without a previous diagnosis, but genetically susceptible, it may bring the diabetes out. In this situation, the underlying pulmonary fibrosis is a difficult problem to treat and prednisone or a similar type of steroid is reasonable to use. Knowing you have to use the prednisone, you have to make sure you can treat the blood sugars. This often requires treatment with insulin. There are several types of insulin that can be used. If the blood sugars are high enough, especially when they are over 200 mg/dl [11.1 mmol/L], you are talking about having to use both a basal insulin and a bolus insulin. Basal insulin helps keep blood sugars down between meals and over the night. Bolus insulin work on lowering blood sugars after meals. NPH is not necessarily superior to all other insulins in this case. It is a form of basal insulin. However, other basal insulins can be used. The key is to monitor the glucose carefully and adjust the insulin doses to the dose that treats the high blood sugars without low values.
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