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Steroid induced hyperglycaemia

Patient information A-Z

Who is the leaflet for?

This leaflet is for haematology patients who have developed steroid-induced hyperglycaemia following treatment with steroids.

Introduction:

Effective control of blood sugars can usually be achieved with diet and medications. It is important to keep an up-to-date diary of your sugar levels to allow doctors to adjust your medication if needed. Your blood sugars may be increased by infection, medication or a diet high in sugary foods and drinks.

If you experience any fevers or feel unwell, please contact the Addenbrooke’s haematology emergency triage line on the Haematology emergency triage number immediately on 01223 274225

It is particularly important to monitor blood glucose levels regularly, particularly when steroid doses are altered, this will be performed at clinic appointments and, if needed, you may be supplied with a glucose meter for self-monitoring of blood glucose levels with finger-prick testing. We also recommend that your blood pressure is checked at least once per week when taking steroids and medications such as tacrolimus or ciclosporin, this may be performed when you attend clinic or by using a blood pressure monitor at home. The chart attached is for you to record these readings. Please bring this chart and your glucose meter to your clinic and hospital appointments for review.

Dietary recommendations include the following:

  • Aim to eat balanced nutritious meals
  • Avoid simple carbohydrates (sweets, sugary drinks/fruit juice, biscuits and cakes) and instead take complex carbohydrates (bread, cereal, grains and vegetables)
  • Aim to drink two to three litres daily and avoid sugary drinks such as fruit juice.
  • Further information is available from the hospital dietician or community diabetes specialist nurse (via your GP).

Self-monitoring of blood glucose

You have been advised to monitor blood glucose levels at home as they are above the recommended range of 4-12mmol/L. In general, these checks should be made before a meal and two hours after a meal. If your glucose levels are stable and between 4-12mmol/L over 7 days, testing can be reduced to twice per week. We advise you to vary the time of day you self-test.

Glucose levels should be checked three to four times a day in the following circumstances:

  • Illness/infection
  • Changes in steroid dose
  • Varying glucose levels or levels persistently greater than 12mmol/L.

It is also important to rotate the test sites on your fingers. Avoid testing the thumb and index fingers. Always prick the sides of your fingers to avoid nerve endings.

Please ensure you check your blood glucose levels before driving and continue to do so every two hours if on a long drive.

Further information for driving recommendations can be found on the Diabetes.org website.

To test your blood glucose levels you will require the following equipment:

  • A blood glucose meter
  • Finger pricking device - to hold lancet
  • Lancets- needle for finger prick
  • Safety device for safe disposal of lancets
  • Testing strips compatible with the meter

Table 1 shows the recommended range for glucose levels. Please remember to wash your hands with warm water before testing as this helps to increase blood flow and will ensure that any surface sugars are removed prior to testing.

Blood Glucose Level Ranges and Actions Required
Blood Glucose Range Potential Symptoms Action Required
Less than 4mmol/L Potential Symptoms Lightheadedness, dizziness, confusion, sweating, shaking, fast or pounding heartbeat Action Required Take a sugary drink or two glucose tablets followed by toast/sandwich/biscuits and milk. Call your GP/community diabetic team in working hours or Addenbrooke's Haematology emergency triage number (out of hours) if symptoms persist. If this happens on two or more occasions, contact your GP for review.
4 - 12mmol/L Potential Symptoms Acceptable range Action Required Continue with current plan
12 - 20 mmol/L Potential Symptoms Headache, lack of energy, thirst, frequent urination. Action Required If you feel unwell, please contact your Haematology doctors at Addenbrooke's. Otherwise please contact your GP if levels fall within this range on four or more readings. Avoid sugary foods/drinks and drink plenty of water.
HIgher than 20mmol/L Potential Symptoms Excessive thirst, frequent urination, fatigue, headache and blurred vision Action Required Contact your GP/community diabetic team within working hours, or the emergency triage number at Addenbrooke's (out of hours) even if you do not notice any symptoms. Avoid sugary food/drinks and drink plenty of water.

Contact Numbers:

BMT Nurse Practitioners Number (for advice)

01223 217224

Haematology Emergency 24 hour Triage

01223 274225

Monitoring Form
Date / Time Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)
Steroid Dose Blood Glucose Level Blood Pressure e.g. 135 / 85 Action Taken (if any)

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