title: Management of hyperglycemia in diabetic patients with hematologic malignancies during dexamethasone therapy.
abstract: OBJECTIVE
  To compare the response to different insulin regimens for management of hyperglycemia in diabetic patients with hematologic malignancies who are receiving dexamethasone.
  
  
  METHODS
  A retrospective analysis was conducted to determine whether a basal bolus insulin (BBI) regimen with detemir and aspart is superior to a sliding scale regular insulin (SSI) regimen for management of hyperglycemia in hospitalized diabetic patients receiving dexamethasone.
  
  
  RESULTS
  Forty patients with hematologic malignancies were treated with intravenous (8 to 12 mg/day) or oral (40 mg/day) dexamethasone for 3 days. The average blood glucose (BG) level was 301 ± 57 mg/dL in the SSI group (n = 28) and 219 ± 51 mg/dL in the BBI group (n = 12) (P <.001). The BBI regimen resulted in an average BG reduction of 52 ± 82 mg/dL throughout the course of dexamethasone therapy, while the SSI regimen produced an increase in the mean daily BG level of 128 ± 77 mg/dL (P <.001). On the last day of dexamethasone administration, the insulin requirement was 49 ± 29 units/day in the SSI group and 122 ± 39 units/day in the BBI group (P <.001). Three patients in the SSI group developed diabetic ketoacidosis or hyperosmolar hyperglycemia during steroid therapy. No hypoglycemia was observed in either group. The length of stay and infection rates were similar between groups.
  
  
  CONCLUSIONS
  Basal and bolus insulin regimen is an effective and safe approach for managing dexamethasone-induced hyperglycemia in hospitalized patients with hematologic malignancies.
authors: Department of Medicine, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA. agosmano@uthsc.edu
authors: Aidar R
authors: AR
authors: Gosmanov
authors: Salil
authors: S
authors: Goorha
authors: Sundae
authors: S
authors: Stelts
authors: Limin
authors: L
authors: Peng
authors: Guillermo E
authors: GE
authors: Umpierrez
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D003907:Dexamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D061267:Insulin Aspart / Q000008:administration & dosage / Q000627:therapeutic use; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000627:therapeutic use; D061386:Insulin, Regular, Human / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010865:Pilot Projects; D012189:Retrospective Studies
chemical_list: D018931:Antineoplastic Agents, Hormonal; D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D061386:Insulin, Regular, Human; D000069057:Insulin Detemir; D003907:Dexamethasone; D061267:Insulin Aspart