Prednisolone often causes hyperglycemia in hospitalized patients and complicates glycemic management. A study published in BMJ Open Diabetes Research & Care evaluated whether individualized basal–bolus insulin dosing could improve glucose control compared with standard weight-based regimens.

The study included 23 adults treated with individualized subcutaneous basal–bolus insulin derived from prior 24-hour intravenous insulin needs and 24 historical controls who received standard weight-based insulin. The primary endpoint was mean 24-hour point-of-care glucose on day one. Secondary outcomes included the proportion of readings within target range, glucose variability, and stress hyperglycemia ratio.

Mean glucose levels were comparable between groups (10.7 ± 3.4 mmol/L vs 11.9 ± 3.2 mmol/L; p = 0.07). However, individualized dosing increased the proportion of target-range glucose readings (52.0 ± 4.8% vs 37.0 ± 4.5%; p = 0.0007) and reduced day-one glucose variability (SD 3.1 ± 1.5 vs 4.0 ± 1.6; p = 0.04). Both groups showed higher variability after two days, but no major difference in mean glucose or stress hyperglycemia ratio.

These findings show that individualized basal–bolus insulin provides better short-term stability in glucose levels. It also achieves tighter glycemic control in hospitalized patients with steroid-induced hyperglycemia.