Pilot study of using neutral protamine Hagedorn insulin to counteract the effect of methylprednisolone in hospitalized patients with diabetes.

Patients and Methods We conducted a pilot study in 20 patients with cystic fibrosis–related diabetes (CFRD), after bone marrow or solid organ (liver, kidney, or lung) transplantation, who received methylprednisolone intravenously (10-60 mg) during admissions to the University of Colorado Hospital, Denver, Colorado. All patients received basal glargine and premeal lispro insulins. A total of 10 patients (randomized 1:1) received neutral protamine Hagedorn (NPH) insulin at the time of administration of methylprednisolone between 8 and 11 am (Group 1). The dose of NPH insulin was selected as follows: 1 unit (U) for 1 mg methylprednisolone for the first 20 mg of steroid; 0.5 U of insulin for 1 mg of methylprednisolone for the next 20 mg of steroid; and 0.25 U of insulin for each subsequent milligram of steroid. The average dose of NPH was 23 6 5 U. In the remaining 10 patients, the doses of glargine and lispro were increased according to the University of Colorado Hospital’s standard protocols for use of subcutaneous insulin to achieve the best possible control (Group 2). Point-of-contact glycemia immediately prior to initiation of steroids and for the 3 days of methylprednisolone administration was compared. Results are expressed as mean 6 standard deviation and compared using the Student t test with P value < 0.05 considered significant.