THE EFFECT OF INTRA-ARTICULAR STEROID ON BLOOD GLUCOSE LEVEL IN INSULIN DEPENDANT DIABETICS

Abstract

Steroids are known to have an adverse effect on the blood glucose levels in diabetics. Intra-articular steroids are commonly used in Orthopaedic and Rheumatology practice. However we have failed to identify any studies to date that have been carried out on the short-term effect of intra-articular steroids in diabetics who are taking insulin. This study was carried out to establish the effects of intra-articular (IA) steroid injections on the blood glucose levels and insulin requirements for insulin dependant diabetic patients treated for a “Frozen Shoulder”.

Methods: Insulin-dependant diabetic patients suffering from a “Frozen Shoulder” who were referred to our out patient clinics were recruited prospectively for this study. Each patient received 40 mg of long acting steroid plus 9 mls of 0.5% Marcain injected intra-articularly into the glenohumeral joint. They were each asked to record their subsequent blood glucose levels and insulin requirements on a form, four times a day for seven days post injection. Each patient was seen again at 6 weeks and, when appropriate, they were offered a second intra-articular injection according to the recommendations of Jacobs et al¹ (1991).

Results: Fifteen patients were recruited into the study. All patients reported a disturbance of their blood glucose control in the post injection period lasting for a variable period up to seven days. Approximately one third of patients found it necessary to increase their daily insulin requirements during the first two days after the injection.

Conclusion: IA steroid injections cause disturbance of the blood glucose control in insulin dependant diabetics. Patients must be warned regarding this side effect when IA steroid injections are given.