It's not a problem with nasal inhalation of steroids, or with small doses of steroid creams when applied to the skin. However, moderate or severe elevation of blood sugar should be expected if the patient gets shots containing steroids, or steroid-containing pills.

The blood sugar will go up within a half a day or so after starting steroid medications. Sometimes insulin doses need to be increased to twice what the previous dose was, or if the patient has Type 2 diabetes, the patient may need to add additional medications to get the diabetes back under control. Fortunately, when the steroid is gone, the steroid effect should also disappear.

Should people with diabetes get steroid medications? Yes, if

• there's no other therapy that's likely to work, and
• if the patient has been informed of the probable increase of blood sugar level, and
• the doctor and the patient have a plan on how to cope with the increased blood sugar levels.

• Ask the treating physician how long the steroid therapy will be needed (which is a pretty good guide to how long the elevated blood sugars will persist).
• Ask the treating physician to have their staff call or fax the diabetes doctor, and advise the diabetes doc of the medication, the dose, and the anticipated duration of therapy.
• Start checking four blood sugar tests daily, and to plan to increase their diabetes medications within a half-day of starting steroid therapy.
• Phone us as soon as possible, and doublecheck what to do with the diabetes medications. (Don't wait till 10 P.M. at night, when the bedtime blood sugar is suddenly higher than usual!)

-- WWQ