I think I’ve posted this tip before but it’s such good information I wanted to do so again. I recently had a cortisone shot and my blood sugar started rising a few hours after. I immediately thought to dose more rapid acting insulin (I’m on MDI), but I remembered, when I’d had this situation a year ago, I reached out to diabetes educator extraordinaire, Gary Scheiner, and searched back for the email where he’d advised me. His advice was opposite what I’d thought to do.

Rather than raise your rapid-acting insulin, except of course for correcting an ordinary high blood sugar from food, raise your basal.

Gary says: Most people need to raise their basal insulin by 50% starting about 6 hrs post injection, then double their basal on days 2 and 3, then taper down.  Some need to triple their basal.  The Humalog doses (rapid-acting) can remain as-is (correct any highs and cover meals as usual); the extra basal takes care of the insulin resistance caused by the steroid.  

I take 6 units of Tresiba in the morning and one unit before bed. The day of the shot, which I’d gotten at 2 pm, I saw my blood sugar rising around 6 pm. I took extra Humalog for the rise, but also took 3 units of Tresiba before bed. That’s the 50% extra.

The next day I took 10 units of Tresiba in the morning and nothing at night because it looks like I wasn’t rising. Stead overnight around 93 mg/dl, the second day I took 8 units of Tresiba and nothing at night. Today, the third day, I took my normal 6 unit dose.

I think because I tend to be insulin sensitive eating a low carb diet and walking every day, I didn’t have to take the higher doses Gary suggested. But you may need too. As everything diabetes, it’s trial and error – but knowing it’s the basal insulin to raise is key.

Sorry folks on pumps, I can’t tell you how to translate this.