Prednisone therapy is most likely responsible for the patient’s loss of glucose control. Glucocorticosteroids have a common adverse effect of stimulating the increase of blood glucose by facilitating overall glucose production, especially in the liver (Yasir et al., 2022). In patients with diabetes mellitus, when the level of insulin is reduced and the sensitivity of tissues to it is impaired, the body is not able to neutralize the effect of steroids on glucose metabolism. Therefore, while taking corticosteroids, blood glucose levels may increase and the need for insulin or oral antidiabetic drugs may arise.
The patient should contact her healthcare provider if there are any signs of infection manifesting in her organism. Corticosteroids act as anti-inflammatory agents, decreasing the body’s acute response to the inflammation and thus reducing symptoms of conditions such as asthma (Yasir et al., 2022). However, they also subsequently have an immunosuppressive effect by reducing the number of immune system cells like lymphocytes, eosinophils, basophils, and macrophages in the organism (Yasir et al., 2022). This causes the body to be more receptive to various infections as its immune system is impaired. Therefore, the patient needs to watch her organism closely to be able to counter the infection with additional therapy in time.
The patient is now at risk of developing Cushing syndrome. It is the most common condition associated with long-term glucocorticoid therapy (Yasir et al., 2022). Cushing syndrome is characterized by overabundance of glucocorticoid hormones in the body. These hormones are normally produced in the body by the adrenal cortex of the adrenal glands. However, patients who take long-term glucocorticoid therapy are at risk of increasing their glucocorticoid hormones to a level at which the Cushing syndrome occurs.
The patient should start taking insulin as needed according to her blood glucose levels. This is due to the fact that lower doses of Prednisone helped reduce the symptoms of asthma only for a short time, and then the patient needed an increase to a second lowest dose. Currently, the patient is stable, but she would be at risk of her asthma returning if her Prednisone dose is decreased or the therapy is stopped altogether. Moreover, her blood glucose level is in the higher range now due to glucocorticoid therapy. Thus, she needs acute treatment in form of insulin rather than waiting for her blood glucose to drop over time with lower dose of Prednisone.
Reference
Yasir, M., Goyal, A., & Sonthalia, S. (2022). Corticosteroid adverse effects. StatPearls Publishing, Treasure Island.