Drug selection and the management of corticosteroid-related diabetes mellitus

Glucocorticoid use may unmask hyperglycemia in patients without known diabetes mellitus and increase hyperglycemia in patients with known diabetes mellitus. This article summarizes possible mechanisms of glucocorticoid-induced hyperglycemia, the prevalence and magnitude of the hyperglycemic effect of glucocorticoids and the rationale for acute and chronic glycemic control. Strategies for the management of hyperglycemia are based on the glucose-lowering management in place before the use of glucocorticoids (diet, oral agents, or insulin), the glucocorticoid doses being given, and the degree of hyper,hyperglycemia are discussed.