[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"menu":3,"$fkW7DM6JbGjvuJR5raO1wFb4_Vl-Wdt7ZyxisVmEqrA0":210},{"main":4,"mainTranslated":17,"footer":45,"footerTranslated":109},[5,8,11,14],{"title":6,"url":7},"Course library","https:\u002F\u002Fwww.medmastery.com\u002Fcourse-library",{"title":9,"url":10},"Pricing","https:\u002F\u002Fwww.medmastery.com\u002Fpricing",{"title":12,"url":13},"Earn credits","https:\u002F\u002Fwww.medmastery.com\u002Fcme-credits",{"title":15,"url":16},"Institutions","https:\u002F\u002Fwww.medmastery.com\u002Finstitutions",{"de":18,"es":27,"fr":36},[19,21,23,25],{"title":20,"url":7},"Kurse",{"title":22,"url":10},"Preise",{"title":24,"url":13},"CME-Punkte",{"title":26,"url":16},"Organisationen",[28,30,32,34],{"title":29,"url":7},"Biblioteca de cursos",{"title":31,"url":10},"Precios",{"title":33,"url":13},"Gana créditos",{"title":35,"url":16},"Instituciones",[37,39,41,43],{"title":38,"url":7},"Cours",{"title":40,"url":10},"Tarifs",{"title":42,"url":13},"Obtenir des crédits",{"title":44,"url":16},"Établissements",[46,59,79,97],{"title":47,"group":48,"menu":49},"Company",true,[50,53,56],{"title":51,"url":52},"Our teachers","https:\u002F\u002Fwww.medmastery.com\u002Fteachers",{"title":54,"url":55},"About us","https:\u002F\u002Fwww.medmastery.com\u002Fabout-us",{"title":57,"url":58},"Work with us","https:\u002F\u002Fwww.medmastery.com\u002Fwork-with-us",{"title":60,"group":48,"menu":61},"Product",[62,64,67,70,73,76,78],{"title":63,"url":7},"Courses",{"title":65,"url":66},"Magazine","https:\u002F\u002Fwww.medmastery.com\u002Fmagazine",{"title":68,"url":69},"Podcast","https:\u002F\u002Fwww.medmastery.com\u002Fpodcasts",{"title":71,"url":72},"Webinars","https:\u002F\u002Fwww.medmastery.com\u002Fwebinars",{"title":74,"url":75},"Guides","https:\u002F\u002Fwww.medmastery.com\u002Fguides",{"title":15,"url":77},"https:\u002F\u002Fwww.medmastery.com\u002Finstitutions\u002F",{"title":9,"url":10},{"title":80,"group":48,"menu":81},"Legal",[82,85,88,91,94],{"title":83,"url":84},"Imprint","https:\u002F\u002Fwww.medmastery.com\u002Fimprint",{"title":86,"url":87},"Newsletter policy","https:\u002F\u002Fwww.medmastery.com\u002Fnewsletter-privacy-policy",{"title":89,"url":90},"Privacy policy","https:\u002F\u002Fwww.medmastery.com\u002Fprivacy-policy",{"title":92,"url":93},"Cookie Policy","https:\u002F\u002Fwww.medmastery.com\u002Fcookie-policy",{"title":95,"url":96},"Terms","https:\u002F\u002Fwww.medmastery.com\u002Fterms",{"title":98,"group":48,"menu":99},"Customer support",[100,103,106],{"title":101,"url":102},"FAQs","https:\u002F\u002Fwww.medmastery.com\u002Ffaqs",{"title":104,"url":105},"Contact","https:\u002F\u002Fwww.medmastery.com\u002Fcontact",{"title":107,"url":108},"support@medmastery.com","mailto:support@medmastery.com",{"de":110,"es":143,"fr":177},[111,118,128,137],{"title":112,"group":48,"menu":113},"Unternehmen",[114,116,117],{"title":115,"url":52},"Unsere Dozentinnen und Dozenten",{"title":54,"url":55},{"title":57,"url":58},{"title":119,"group":48,"menu":120},"Produkt",[121,122,123,124,125,126,127],{"title":20,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":26,"url":77},{"title":22,"url":10},{"title":129,"group":48,"menu":130},"Rechtliches",[131,133,134,135,136],{"title":132,"url":84},"Impressum",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":138,"group":48,"menu":139},"Kundenservice",[140,141,142],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[144,151,162,171],{"title":145,"group":48,"menu":146},"Empresa",[147,149,150],{"title":148,"url":52},"Nuestros profesores",{"title":54,"url":55},{"title":57,"url":58},{"title":152,"group":48,"menu":153},"Producto",[154,156,157,158,159,160,161],{"title":155,"url":7},"Cursos",{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":35,"url":77},{"title":31,"url":10},{"title":163,"group":48,"menu":164},"Información legal",[165,167,168,169,170],{"title":166,"url":84},"Aviso legal",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":172,"group":48,"menu":173},"Atención al cliente",[174,175,176],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[178,185,196,204],{"title":179,"group":48,"menu":180},"Entreprise",[181,183,184],{"title":182,"url":52},"Nos enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":266,"meta":332,"internal":342},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":252,"author":254,"readDuration":264,"readDurationFormatted":265},"Treating steroid-induced diabetes","In this video, from our Diabetes Mellitus Essentials course, you'll find out how to treat steroid-induced hyperglycemia and diabetes.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,247],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},266,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Treating steroid induced diabetes","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=TZvs_9ti7ak",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},13.333333333333334,"\u003Cp>Prescribing steroid medications to patients with an existing diabetes diagnosis can create quite a minefield. In this video, from our \u003Ca href=\"https:\u002F\u002Fapp.medmastery.com\u002Fcourse\u002Fdiabetes-mellitus-essentials\">Diabetes Mellitus Essentials\u003C\u002Fa> course, we take a look at the main considerations when prescribing steroids to this population. You'll find out when (and how long) you need to monitor hyperglycemia and why you should prescribe insulin alongside the steroid.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},11.466666666666667,"Join our Diabetes Mellitus Essentials course today!","\u003Cp>Learn how to manage diabetes with confidence! With our \u003Ca href=\"https:\u002F\u002Fapp.medmastery.com\u002Fcourse\u002Fdiabetes-mellitus-essentials\">\u003Cstrong>Diabetes Mellitus Essentials\u003C\u002Fstrong>\u003C\u002Fa> course, you'll learn how to fine-tune your patient's treatment plans, confidently initiate, adjust, and manage insulin regimes, and screen for diabetic complications with total ease.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245,"teachIllustration":246},3.7333333333333334,"Start the first chapter of our Diabetes Mellitus Essentials course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Fdiabetes-mellitus-essentials","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9fe1dd99-6a02-4702-9c27-0af1632a7380",{"type":230,"data":248},{"readDurationInSeconds":249,"title":250,"text":251},138.13333333333333,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>Steroids present a particular challenge for managing blood sugars, especially for patients with underlying diabetes because of increased insulin resistance, which can lead to significant hyperglycemia. The effect of steroids on blood sugars usually occurs about four hours after the dose, that is if patients are taking steroids with breakfast as they're often given, they'll experience hyperglycemia post-lunch. For patients on prednisone, which has a duration of action of 12 hours, the effects will typically wear off\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30] \u003C\u002Fstrong>several hours after dinner so fasting blood sugars are not often affected. For patients on long-acting steroids such as dexamethasone, the hyperglycemia can last for up to 36 hours. When diabetic patients are started on steroids, they should be advised to check their blood sugars one to two hours after dinner for the first few days. If blood sugars are less than 180 mg \u002F dL, they can discontinue monitoring. If blood sugars are elevated above 200 mg \u002F dL, however, they should increase testing to four times daily\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>before meals and at bedtime, and you should consider starting treatment for hyperglycemia if blood sugars are consistently elevated throughout the day.The hyperglycemia associated with steroids is primarily post-meal and due to an increase in insulin resistance. For patients without prior diabetes or those with diabetes treated with lifestyle modification only, this can often be managed with oral medications. Metformin can improve insulin resistance and decrease hepatic glucose output. It carries a low risk of hypoglycemia\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30] \u003C\u002Fstrong>so it's safe to continue during steroid tapers. DPP-4 inhibitors and GLP-1 receptor agonists are also reasonable options to consider, as they can decrease post-meal hyperglycemia and are unlikely to cause hypoglycemia. Insulin is the best option for managing steroid-induced hyperglycemia in patients with a previous diagnosis of diabetes. For patients new to insulin, starting a basal-bolus insulin regimen can be complicated and difficult. So, a simple regimen for managing steroid-induced\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00] \u003C\u002Fstrong>hyperglycemia is to add a dose of once-daily basal insulin with breakfast. For patients already on insulin, you can simply increase their basal insulin dose. What insulin should you use? Well, choosing which insulin to use depends on the steroid that the patient is getting. As mentioned earlier, prednisone has a 12-hour duration of action, thus, for patients getting once daily prednisone, their hyperglycemia is best controlled with NPH with breakfast. The peak of NPH is approximately four hours, which corresponds\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30] \u003C\u002Fstrong>to the post-lunch hyperglycemia seen with prednisone. The duration of action also matches the effect of prednisone, which minimizes the risk of overnight hypoglycemia. Patients on longer acting steroids like dexamethasone or twice daily prednisone will need more prolonged coverage than what they would get with NPH. They'll require a 24-hour basal insulin like glargine to cover the effects of the steroids. The dose of insulin can be estimated based on the patient's body weight and the dose of steroids. An initial insulin dose\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00] \u003C\u002Fstrong>would be 0.1 unit \u002F kg per day for every 10 mg of prednisone, or equivalent, up to a maximum of 0.4 unit \u002F kg per day. For example, an 80 kg patient is taking 30 mg of prednisone daily for one week. We would calculate his insulin dose as 0.1 unit for every 10 mg of prednisone, so 0.3 units times his body weight, 80 kg, giving us 24 units of NPH every morning. If you're already on\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30] \u003C\u002Fstrong>insulin, we would simply add this to his home regimen.\u003C\u002Fp>\u003Cp dir=\"ltr\">It's important to recognize that as steroid doses are tapered, you will need to decrease the insulin dose to minimize the risk of hypoglycemia. A good rule of thumb is to decrease the basal insulin by 0.1 unit \u002F kg per day for every 10 mg decrease in steroid dose. Steroid- induced hyperglycemia can be a significant problem for patients on long-term steroid treatment. Be sure to monitor blood sugars for these patients and intervene to treat their\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:00]\u003C\u002Fstrong> hyperglycemia, if needed, to prevent complications from high blood sugars.\u003C\u002Fp>",{"courses":253,"showAwardsBelow":48},[],{"id":255,"name":256,"image":257,"profession":258,"relativeUrl":261,"specializations":262},3748,"Tracy Tylee, MD","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-88e6-4632-a711-cf90c6d98c24",{"name":259,"description":260},"Endocrinologist","Tracy is an Associate Professor of Endocrinology at the University of Washington, and Program Director for the Endocrinology Fellowship Program.","\u002Fteachers\u002Ftracy-tylee-md",[263],"Endocrinology",173,"3m",[267,295,313],{"id":268,"title":269,"text":270,"image":271,"author":279,"path":288,"readDuration":289,"readDurationFormatted":290,"internal":291},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":272,"title":273,"size":274,"location":276},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle","",{"width":275,"height":275},660,{"bucket":277,"key":278},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(2)_magazine image.png",{"id":280,"title":281,"relativeURL":282,"image":283,"professionLong":284,"profession":285,"weight":287},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":286},"Internist",4,"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,"4m",{"created":292,"updated":293,"published":294},1778960150,1779196374,1778961827,{"id":296,"title":297,"text":298,"image":299,"author":305,"path":307,"readDuration":308,"readDurationFormatted":265,"internal":309},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":300,"title":273,"size":301,"location":303},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":302,"height":302},1200,{"bucket":277,"key":304},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":280,"title":281,"relativeURL":282,"image":283,"professionLong":284,"profession":306,"weight":287},{"name":286},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":310,"updated":311,"published":312},1778115738,1778799792,1778118255,{"id":314,"title":315,"text":316,"image":317,"author":323,"path":325,"readDuration":326,"readDurationFormatted":327,"internal":328},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":318,"title":273,"size":319,"location":321},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":320,"height":320},600,{"bucket":277,"key":322},"\u002F2026-04\u002FC121_magazine image.png",{"id":280,"title":281,"relativeURL":282,"image":283,"professionLong":284,"profession":324,"weight":287},{"name":286},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":329,"updated":330,"published":331},1777403036,1777572381,1777412421,{"seo":333,"og":335},{"title":334,"description":213},"Treating steroid-induced diabetes | Medmastery",{"title":334,"description":213,"image":336},{"alt":273,"title":273,"size":337,"location":340},{"width":338,"height":339},758,388,{"bucket":277,"key":341},"\u002Fmigrated-images\u002FScreen Shot 2018-11-15 at 10.59.18 am.png",{"id":343,"created":344,"updated":345,"published":344},277,1543932147,1773664636]