Table 2.

Insulin therapy in glucocorticoid-induced hyperglycaemia and diabetes mellitus

Insulin schedules	Onset of action	Duration	Advantages	Disadvantages	Suitable for type of glucocorticoid druga
Basal insulin (detemir or glargine)	1–4 h	Long acting, up to 24 h	Low risk of hypoglycaemia	Not specific to postprandial glucose	Intermediate-acting (2 or more daily doses), or long-acting glucocorticoids
Basal insulin (NPH)	1–2 h	Intermediate acting, ≥14 h	Activity profile closely resembles glucocorticoid-induced hyperglycaemia	Not specific to postprandial glucose	Intermediate-acting glucocorticoids
Prandial (bolus) insulin	15–60 min	Rapid and short acting, 3–8 h	Immediate onset of action; targets postprandial glucose; can be combined with basal insulin for severe glucocorticoid-induced hyperglycaemia	Limited flexibility in the timing of administration	Short-acting glucocorticoids
Basal-bolus	15–60 min for bolus	Rapid and long acting, up to 24 h	Flexibility in dose adjustment; useful for severe or persistent glucocorticoid-induced hyperglycaemia	Multiple daily injections	Use is based on severity of hyperglycaemia (not on type of glucocorticoid)

NPH, neutral protamine Hagedorn. ^aShort acting (for example, hydrocortisone, half-life of 8 h), intermediate acting (for example, prednisolone or methylprednisolone, half-life of 16–40 h), long acting (for example, dexamethasone or betamethasone, half-life of 36–54 h).