The Effect of Oral Methylprednisolone Pulse on Blood Sugar

Barathi, M (2011) The Effect of Oral Methylprednisolone Pulse on Blood Sugar. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION : Systemic corticosteroids are one of the commonly prescribed drugs for dermatological conditions. Conventional corticosteroids was associated with many side effects like hypertension, hyperglycemia, eye changes like cataract, glaucoma, bone changes like osteoporosis, avascular necrosis. Corticosteroids in the form of intravenous pulse therapy are used to treat autoimmune disorders like pemphigus1, bullous pemphigoid, vitiligo, alopecia areata. Oral steroid minipulse has been tried in conditions like vitiligo, alopecia areata. Corticosteroids steroids like betamethasone, prednisolone and methylprednisolone has been used for minipulse therapy. Oral methylprednisolone has been used safely in pediatric age group3 also. The side effects of steroids are minimal when given in the form of pulse therapy compared to daily conventional dose. Hyperglycemia is one of the many known side effects of corticosteroid therapy, particularly when these drugs are administered in high doses6.The pattern of steroid induced hyperglycemia is post-prandial hyperglycemia. Acute hyperglycemia and ongoing high blood glucose levels have been linked to increased risk for infection, poor cardiovascular outcome, thrombosis, inflammation, endothelial cell dysfunction and enhanced neuronal damage after ischaemic brain injury. One of our patient who was on oral methylprednisolone minipulse met with a road traffic accident. after hospitalization it was found that his blood sugar was more than 450mg/dl. He required emergency measures to bring down the blood sugar levels. We initiated this study to know the effects of oral methylprednisolone minipulse on blood sugar. AIMS AND OBJECTIVES : 1. To determine post-prandial blood sugar before and after giving oral methylprednisolone minipulse. 2. To observe for hyperglycemic symptoms. MATERIALS AND METHODS : A. Inclusion Criteria : Patients with alopecia areata, vitiligo, lichen planus were included. B. Exclusion Criteria : Patients with diabetes mellitus, associated infections, pregnant women were excluded from the study. Total of 22 patients were studied. The study was conducted over a period of 12 months at the Department of Dermatology, Venereology and Leprology, PSG Hospitals, Coimbatore, Tamil Nadu. Patients were hospitalized for 2 days. On the first day, baseline fasting blood sugar was done and 2 hours later post prandial blood sugar was done. Estimation of Blood sugar : The estimation of blood sugar was done by calorimetric method. The values were calculated in mg/dl. The normal fasting blood sugar and post prandial blood sugar levels were 70 – 110 mg/dl and <140 mg/dl, respectively. On day 2 methylpredinisolone 1.7 mg/kg was administered to the patients as a single morning dose and patients had breakfast. After 2 hours post – prandial blood sugar was measured by calorimetric method. The results were tabulated. Details of hyperglycemic symptoms were noted in the last 10 patients since a patient started on oral steroid minipulse had developed hyperglycemic symptoms (dryness of mouth). The presence or absence of the following hyperglycemic symptoms were noted: Increased frequency of urination, Excessive thrist, Dehydration – Dry mouth, Nausea, vomiting, Fatigue, Confusion, Lack of Concentration. STATISTICAL ANALYSIS : Data were analyzed by paired “t” test. Data were expressed as mean. The chosen level of significance was p<0.05. RESULTS : A total of twenty two patients were studied. The age of the patients ranged between 12 years and 56 years with a mean age of 31.18 years. Of the twenty two patients eight were men and fourteen were women. Out of the twenty two patients nine patients were diagnosed with Vitiligo, ten patients with alopecia areata, one patient with Lichen planus and two patients with chronic severe pruritus. The mean value of the fasting blood sugar (83.51) and post- parandial blood sugar before and after giving oral methyl prednisolone (112.77 and 112.40 respectively) is shown in Table 1.The statistical analysis is shown in Table 2. The details of hyperglycemic symptoms which were noted in the ten patients is shown in Table 3. The mean value of post prandial blood sugar before and after giving steroid was 112.77 mg/dl and 142.41 respectively. The difference was statistically significant (P value was 0.000782). The standard deviation of the fasting blood sugar, post prandial blood sugar levels (7.04, 21.66 and 31.23 respectively) showed that there is a wide range of post - prandial blood sugar levels after giving oral methyl predinisolone. Out of ten patients who were enquired about hyperglycemic symptoms two patients had excessive thirst and two had symptoms of dehydration like dry mouth. CONCLUSION : We suggest that all the patients treated with either steroid pulse or oral minipulse should undergo fasting blood sugar and post prandial blood sugar before and after steroids. And the physician should be alert regarding the symptoms associated with hyperglycemia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Oral Methylprednisolone Pulse ; Blood Sugar.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 16:35
Last Modified: 03 Mar 2018 06:27

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