title: Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics.
abstract: Shoulder pain is very common in diabetic patients and often treated with steroid injections, with subsequent increases in blood glucose levels or the need for additional insulin being questioned. We report a case of significant and prolonged elevation of blood glucose levels and resultant insulin requirement in a type 1 diabetic man after a single 40 mg injection of triamcinolone for shoulder pain. Within 48 h, the shoulder pain as assessed by a visual analogue scale (0-10) was reduced to zero, but the elevated insulin requirements continued for 4 weeks after the injection. This finding suggests that steroid injections for shoulder pain in diabetics may not always be as safe as previously thought. We propose that medical practitioners advise their patients to monitor their glucose levels more carefully after such injections and that caution is exercised when considering administrating these injections to those who have poorly controlled blood glucose levels preinjection to avoid ketoacidosis.
authors.affiliation: London Hand Clinic, London, UK.
authors.forename: Bo
authors.initials: B
authors.lastname: Povlsen
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Povlsen
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007270:Injections, Intra-Articular; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use; D014221:Triamcinolone / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D007328:Insulin; D013256:Steroids; D014221:Triamcinolone