FactFinders for patient safety: Hyperglycemia and steroid injections

This series of FactFinders presents a brief summary of the evidence and outlines recommendations regarding hyperglycemia and steroid injections. The evidence in support of the following facts is presented: (1) Corticosteroid injections can safely be administered to patients with Diabetes-Mellitus Type 2 (DM2) in most cases, including those with suboptimal management. Because there is a risk of hyperglycemia and related complications in these patients, a trial of conservative care before proceeding with a steroid injection is optimal. Patients with DM2 should be counseled on the signs, risks, and sequelae of hyperglycemia in the post-injection period and appropriate steps to take if significant hyperglycemia occurs. (2) No universally accepted “safe” pre-injection glucose cutoff exists, but expert consensus and studies provide some guidance, and physicians should engage in shared decision-making with patients to consider individualized thresholds to mitigate potential harms.