In the case of basal insulin therapy or multiple daily injections (MDI) therapy, adjusting them may in some cases suffice to treat the rise in blood sugar resulting from cortisone treatment. In most cases, a treatment involving a morning injection of intermediate-acting NPH insulin is started in addition to the previous insulin therapy.
Cortisone tablets with insulin therapy in diabetes
Cortisone tablets taken in the morning particularly raise blood sugar levels in the afternoon. Often, a supplementary dose of intermediate-acting NPH insulin is initiated as a morning injection as treatment.
If the basal insulin is a long-acting insulin analog (degludek, detemir, glargine), the dose is not increased; instead, an NPH insulin injection is started alongside in the morning. The typical starting dose is often 10 units. The dose of NPH insulin is increased every 2-3 days according to blood sugar levels and the dose of cortisone.
If the basal insulin is detemir insulin in the morning or morning and evening, the increase in insulin needs caused by cortisone can be managed by increasing the morning dose and decreasing the evening dose if necessary.
Before lunch and dinner, blood sugar can be adjusted if necessary with rapid-acting insulin correction doses.
Before a snack at bedtime or before going to sleep, high blood sugar is generally not corrected, as it increases the risk of too low blood sugar at night as the effect of cortisone wanes.
In pump therapy, basal dosing is adjusted based on glucose sensor monitoring.
In Type 1 diabetes, it is often advisable to divide the dose of cortisone into two parts. In this case, two-thirds of the total dose of cortisone is taken in the morning and one-third in the afternoon. Insulin doses are increased based on blood sugar self-measurements or glucose sensor monitoring.
Sometimes long-acting cortisone treatment (dexamethasone) is used, which has an around-the-clock elevating effect on blood sugar. Usually, all insulin doses need to be increased. Dosage adjustments are planned individually.
A single dose of cortisone in the morning
If the basal insulin is a long-acting insulin analog (degludek, detemir, glargine), the dose is not increased; instead, an NPH insulin injection is started alongside in the morning. The typical starting dose is often 10 units. The dose of NPH insulin is increased every 2-3 days according to blood sugar levels and the dose of cortisone.
If the basal insulin is detemir insulin in the morning or morning and evening, the increase in insulin needs caused by cortisone can be managed by increasing the morning dose and decreasing the evening dose if necessary.
Before lunch and dinner, blood sugar can be adjusted if necessary with rapid-acting insulin correction doses.
Before a snack at bedtime or before going to sleep, high blood sugar is generally not corrected, as it increases the risk of too low blood sugar at night as the effect of cortisone wanes.
In pump therapy, basal dosing is adjusted based on glucose sensor monitoring.
Cortisone in two doses
In Type 1 diabetes, it is often advisable to divide the dose of cortisone into two parts. In this case, two-thirds of the total dose of cortisone is taken in the morning and one-third in the afternoon. Insulin doses are increased based on blood sugar self-measurements or glucose sensor monitoring.
Long-acting corticosteroid
Sometimes long-acting cortisone treatment (dexamethasone) is used, which has an around-the-clock elevating effect on blood sugar. Usually, all insulin doses need to be increased. Dosage adjustments are planned individually.
Updated 2.12.2025