Changing Insulin Doses when Taking Prednisone

I am having some severe back pains and my Orthopedic Dr. prescribed Prednisone. The pain is greatly reduced while on the Prednisone, but it is a challenge to get my BG below 300.

My Endo doesn’t work Fridays and Monday is a holiday according to their answering machine. I’ll be off the Prednisone on Tuesday.

So, unable to ask my Endo before I end the Prednisone treatment, and I know that dosing recommendations is discouraged here for good reason, but I would like to know if anyone else has been here.

What I would ask the endo- How should I cover the Prednisone-induced high BG? I currently take both Novolog and Lantus. Applying my high BG overage calculation with my mealtime Novolog injection might bring me down to the low 300’s, but by the next mealtime I am over 400 again.

Should I increase my Lantus or my mealtime Novolog or both?


I haven’t had to deal with steroids, but when I’m sick I just keep bolusing until I get to normal range. Then continue to watch BG and bolus as needed. If that means every two hours, so be it.

That should deal with your BG while you’re awake, so all but 8 hours of the day. If you find you rise significantly over that eight hours of sleep, then you can increase your basal, and that is easier if you inject Lantus twice a day. Personally I would not increase basal more than a modest amount unless I had prior experience with Prednisone and had a sense for how long the increase would be needed. If this is your first time, then use this as a learning experience for next time.

NOTE: just noticed you are Type 2, not Type 1. Type 1’s are used to managing BG and insulin as needed in the way I described. If this is not something you are comfortable with as a T2, then probably best to get some professional advice.

(You might want to change the title of your thread, since it is highly misleading :slight_smile:

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Was your dosages changed at all when you started the steroid treatment? If no, I would probably just wait it out until Tuesday when you go off the steroid. If you dosage was changed when you started on Prednisone, you might need to go back to your old dosing as the steroid gets out of your system.

I edited your title, feel free to re-edit if I didn’t do it justice.

When I’m on oral prednisone, I increase my basal across the board by 15% for every 5 mg, whether on MDI or pumping.

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When I started my Prednisone treatment, the BG shot from the low 100’s to over 400 within a day.

I reached out to my Endo’s trainer who contacted the Endo who called me. (That’s a first).
The Endo said to not adjust the Lantus (is that what you call basal?) and to chase it with Novolog at meal times.My normal sliding scale is 1:4 (1 iu of Novolog for each 4 g of carbs). She directed me to change to 1:2 , and if that doesn’t bring it down to increase it overall by 10-20%)

What was wrong with my post title?

The original title was talking about having trouble with an electronic watch, and your post was around the effect of steroids. I edited it, hope you don’t mind.

So, the advice your endo gave you is pretty conservative. i.e. we would have probably doubled our basal and increased our bolus. And yes, Lantus is your long acting Basal insulin and Novolog is your fast acting meal insulin. With that said, until you are comfortable with being more aggressive with your insulin therapy you should follow the advice of your medical team. At some point, you will likely have enough experience to control things in a tighter range. Do you have a CGM? If not, it was this tool that taught us the most and allows us to be very aggressive with my son’s insulin therapy.

As as side note, steroid therapy is one of the most difficult things to manage while taking insulin, so don’t feel bad about how you managed it. Hopefully your back heals and you won’t need the steroid treatments.

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Don’t rely only on mealtime shots to bring it down. You will have to keep doing that over and over and keep chasing it all the time.

Do both. Increase your mealtime dose as needed and also raise your basal.

It goes away after a couple of days, so the worst is probably behind you.

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@SteveMann When I have Lupus flare-ups prednisone is the drug of choice. Over the years I’ve found a couple of days of IV prednisone (Methylprednisolone / Solu-Medrol) is far easier to handle from a T1D blood glucose point of view than the oral Prednisone, which takes weeks to months to wean off of.

Either way, with prednisone on board your BG control is literally shot and I’ve found times when IR increases to the point where you just shrug your shoulders and keep bolus’ing (often at triple to quadruple your normal correction doses).

I’d rather only fight it for 3-5 days (IV) than weeks on end.

Good luck with the battle - let us know how it’s going.


Agree with Eric. Increasing basal makes a big difference but, with MDI, one has to be careful!

For us, when on MDI, if we need to increase basal for a short number of days (for instance sick days), we have had good success with a small number (about 4) of daily N-insulin (Walmart) injections.

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Now I am confused. Maybe I hijacked another thread? At any rate, I am new to the group and appreciate any nudges in the proper direction.


No worries at all, we are happy to have you @SteveMann