Diabetes · For patients and their doctors

Steroid high sugar planner

Steroids such as prednisolone and dexamethasone raise blood sugar, even in people who have never had diabetes. Enter the steroid and a few details. The planner shows when to test, what the readings mean, how to adjust gliclazide or insulin, and how to bring them down safely as the steroid is reduced.

Built by Dr. Khizer Hussain Junaidy · Diabetologist & Bariatric Physician · Telangana State Medical Council 04937 · Reviewed September 2026

A plan to use with your doctor, not a prescription. Any dose shown here must be confirmed by the doctor treating you. For adults. Not for steroids given in pregnancy to help the baby's lungs; the obstetric team manages those. Nothing you enter leaves this device.

1. The steroid

Steroid

How it is given

Dose each time mg

How often

First day at this dose

The plan for the steroid

Number of days

2. About you

Age years

Weight kg

Height cm, optional

Diabetes

Latest HbA1c %, optional

Kidney function, eGFR optional

Where

At home In hospital

Eating

Diabetes in a parent, brother or sister Diabetes during a past pregnancy High sugar on steroids before Frail, or often unsteady or confused Advanced liver disease (cirrhosis) Receiving end-of-life care

3. Sugar readings on the steroid (optional)

The last 24 hours, in mg/dL. Leave blank if you have not started testing.

Fasting

Before lunch

Before dinner

At bedtime

Had a reading below 72, or symptoms of low sugar

4. Your plan

Book a review

Caspian Healthcare reception: 89193 41154.

Steroid equivalents and duration

Steroid	Equal to prednisolone 5 mg	Duration of action
Hydrocortisone	20 mg	8 hours
Prednisolone	5 mg	16 to 36 hours
Methylprednisolone	4 mg	18 to 40 hours
Deflazacort	6 mg	about 24 hours
Triamcinolone	4 mg	12 to 36 hours
Dexamethasone	0.75 mg	36 to 54 hours
Betamethasone	0.75 mg	36 to 54 hours

Equivalents and durations from JBDS 2023 (deflazacort and triamcinolone from their product information). Dexamethasone 6 mg is about prednisolone 40 mg.

Rules worth keeping in view

Treat when two readings in 24 hours are above 216 mg/dL (12 mmol/L). Target 108 to 180 mg/dL, up to 216 acceptable; 108 to 270 at the end of life (JBDS 2023).
Morning intermediate steroid: morning gliclazide or morning NPH, titrated daily by the reading before the evening meal. Dexamethasone, evening or divided doses: basal insulin or NPH twice a day, or gliclazide twice a day (JBDS; ADA 2026).
Weight-based NPH: 0.1 units/kg for each 10 mg of prednisolone equivalent, up to 0.4 units/kg at 40 mg or more (Indian consensus 2022). JBDS starts insulin-naive patients on 10 units and titrates by 10 to 20% a day.
Reduce glucose-lowering treatment in step with the steroid. JBDS example: prednisolone 20 to 15 mg needs about 20 to 25% less insulin, or 40 mg less gliclazide.
No taper is needed for courses under 3 to 4 weeks. Longer courses above about 5 mg prednisolone a day need a taper and a steroid emergency card (ESE/Endocrine Society 2024).
Metformin has no proven benefit for acute steroid highs; the evidence for gliptins, GLP-1 receptor agonists and gliflozins is limited. Stop gliflozins during acute illness.
New steroid hyperglycaemia: HbA1c 3 months after the steroid stops; fasting glucose or OGTT earlier if needed.

Sources

Joint British Diabetes Societies for Inpatient Care. Management of hyperglycaemia and steroid (glucocorticoid) therapy. JBDS 08, January 2023 revision. ABCD
Shah P, Kalra S, Yadav Y, et al. Management of glucocorticoid-induced hyperglycemia. Diabetes Metab Syndr Obes 2022;15:1577-88. Indian expert consensus. DOI
American Diabetes Association. Standards of Care in Diabetes 2026: section 16, Diabetes care in the hospital; section 9, Pharmacologic approaches. Diabetes Care
Korytkowski MT, et al. Management of hyperglycemia in hospitalized adult patients in non-critical care settings: an Endocrine Society guideline. J Clin Endocrinol Metab 2022;107:2101-28. PubMed
Beuschlein F, Else T, et al. European Society of Endocrinology and Endocrine Society guideline on glucocorticoid-induced adrenal insufficiency, 2024. Endocrine Society
Effect of steroid injections on blood glucose level. Am Fam Physician 2023 (FPIN clinical inquiry). AAFP

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