Treatment of steroid-induced diabetes in hospitalized patients

INTERVENTION: Update Isophane insulin once daily and aspart insulin 3 times a day administered subcutaneously for up to 7 days. Subjects not treated with insulin prior to enrolment will initially receive a total daily insulin dose of 0.5 U/kg. Subjects receiving insulin prior to enrolment in the study will receive 130% of their current daily dose of insulin or 0.5 U/kg/day (whichever is greater). Insulin isophane will comprise 50% of the total daily dose and insulin aspart 50% of total daily dose with 20% of this dose administered before breakfast, 40% at lunch and 40% at dinner. Insulin dose adjustment will be carried out once daily by the study team using a designated protocol based on finger prick BGLs. Appropriate insulin doses will be increased by 2 units if BGL 10‐15 mmol/L, 4 units if BGL 15‐20 mmol/L and 6 units if >20 mmol/L. Insulin dose will be reduced by 2 units if the BGL is 2.8‐4 mmol/L and 4 units if the BGL is <2.8 mmol/L or there is symptomatic hypoglycaemia. If there is severe hypoglycaemia the study team may either reduce the insulin dose by 50% or cease insulin. Isophane doses will be adjusted if fasting glucose is not within the target range (4‐10 mmol/L). If individual blood glucose concentrations before lunch, dinner or at 21.00 are outside target, then the insulin aspart dose before the previous meal will be adjusted. CONDITION: Prednisolone‐induced hyperglycaemia PRIMARY OUTCOME: Time outside glucose concentration target range of 4‐10 mmol/L. Glucose concentration will be assessed using a continuous glucose monitoring system (iPro2, Medtronics). SECONDARY OUTCOME: Glucose < 2.8 mmol/L. Glucose concentration will be assessed using a continuous glucose monitoring system (iPro2, Medtronics). Glucose < 4 mmol/L. Glucose concentration will be assessed using a continuous glucose monitoring system (iPro2, Medtronics). Mean glucose concentration. Glucose concentration will be assessed using a continuous glucose monitoring system (iPro2, Medtronics). INCLUSION CRITERIA: 1. Prednisolone >20 mg/day for acute treatment of an inflammatory or autoimmune disease 2. Hyperglycaemia requiring institution of insulin therapy or higher insulin doses ‐ one finger prick BGL >15 mmol/L ‐ two finger prick BGLs >10 mmol/L within 24 hours 3. Expected to stay in hospital > 48 hours