More on home glucose monitoring

My patient had been doing very well with her home capillary blood glucose testing and had achieved fasting values of 120 mg/dL or below each morning. With one exception, her post-prandials had been 160 to180, her weight had come down a few pounds and she was feeling appropriately very satisfied.

Then she had an exacerbation of her asthma and she was placed on tapering doses of prednisone starting at 50 mg/day for five days and a taper planned for several weeks. She immediately recognized the impact of steroids on her glycemic control and was nearly in panic mode because diet modification clearly could not cope with this.

The solution I chose was tapering doses of glargine (Lantus; Sanofi Aventis) starting at 50 units once at bedtime each day and tapering by 10 units every time she dropped 10 mg/day on her prednisone. While the pens are more expensive than vials, needles and syringes, this seemed the quickest and easiest way for her to quickly become comfortable with injections short-term.