Glycemic targets for most patients[38]: | |||
---|---|---|---|
A1C: ≤7.0 % | FPG: 4.0–7.0 mmol/L | 2-hr PPG: 5.0–10.0 mmol/L | |
Management: | |||
  Lifestyle interventions: | |||
   • Initiate nutrition therapy and physical activity; if BG targets not met, initiate pharmacotherapy | |||
  Pharmacotherapy: | |||
If BG < 15 mmol/L: | Non-insulin therapies → | • Metformin |  |
 |  | • Insulin secretagogues | → If using once-daily prednisone, use shorter-acting agents (e.g., glyburide, gliclazide, repaglinide) dosed once-daily with prednisone |
 |  |  | → If using dexamethasone or shorter-acting agents > once/day, use longer-acting agents (e.g., gliclazide MR, glimepiride) |
 |  | • DPP-4 inhibitor | |
 |  | • GLP-1 agonist | |
If BG < 15 mmol/L vs. >15 mmol/L | Insulin | → Starting dose: 0.15-0.3 units/kg/day | |
→ If using once-daily prednisone in the morning, FPG less affected but BG will be higher later in the day: | |||
 • Initiate intermediate-acting insulin (N or NPH) or a premixed combination of intermediate- and fast-acting insulin, administered in the morning | |||
 • Add evening insulin if FPG is elevated | |||
→ If using dexamethasone or shorter-acting agents > once/day, BG likely to be affected throughout the entire day: | |||
 • Use intermediate-acting insulin twice daily or long-acting insulin (detemir, glargine) | |||
 • Fast-acting insulin at mealtimes can be used in combination with intermediate- and long-acting insulin | |||
Metformin | → Often recommended in combination with insulin | ||
Caution: If reducing the GC dose, adjust diabetes medications to avoid hypoglycemia |