Covid case

1. As the patient is a non- diabetic, can the use of steroids cause transient rise in blood glucose?

Yes, Increase in the blood glucose might be due to the use of steroids, in this case Dexamethasone

2. If yes, can this transient rise lead to long term complication of New-onset diabetes mellitus? 

High blood glucose levels whilst taking steroids may subside after one stop taking steroids, however, some people may develop type 2 diabetes which will need to be managed for life.

Type 2 diabetes is more likely to develop following longer term usage of steroids, such as usage of oral corticosteroids for longer than 3 months.

3. How can this adversely affect the prognosis of the patient?

 The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes

4. How can this transient hyperglycemia be treated to avoid complications and bad prognosis?

At admission: pre-meal BG: 150 to 180 mg/dl and/or post-meal BG 200 to 250 mg/dl)

If there is an anticipated delay in consulting endocrinologist/physician, initiate on Tab Metformin (either immediate or sustained release) 500 mg BD and a Gliptin (Tab Vildagliptin 50 mg BD or Tab Sitagliptin 100 mg OD or Tab Linagliptin 5 mg OD or Tab Teneligliptin 20 mg OD)

Indication: At admission: pre-meal BG: ≥180 mg/dl or post-meal BG ≥250 mg/dl

A. Total daily dose (TDD) = 0.4 units/kg/day (age > 65 yr, nephropathy or liver disease, use 0.2 units/kg/day)

B. Total daily dose is divided equally into 4 doses (25% each): 3 doses are for bolus insulin (Regular insulin 30 min before breakfast, before lunch and before dinner) and 1 dose for basal insulin (Inj. NPH insulin at bed time/ 2 hours after dinner)

 If pre-meal BG value is 140 to 180 mg/dl and/or post-meal BG value is 180 to 250 mg/dl → consult endocrinologist/physician for OAD optimization

B. If pre-meal BG value ≥180 mg/dl and/or post-meal BG value ≥250 mg/dl despite being on OAD → start basal-bolus insulin regimen using calculation mentioned in section 3A (Kindly note that in this particular scenario, OADs apart from Metformin and Gliptins need to be stopped).

5. What is thrombophlebitis fever? 

Thrombophlebitis is when a blood clot Any veins and slows the blood flow in the vein. It may be due prolonged use of IV cannula.

This causes fever 

6. Should the infusion be stopped inorder to control the infusion thrombophlebitis? What are the alternatives?

There is no need to stop infusion to control Theombophlebitis. Instead change the IV cannula to opposite or another site. If there is pain at that site use aspirin or ibuprofen