In this section : Discharge
Discharging Patients on High Dose Steroids
C4 Predischarge Beds Handover
Immediate Discharge Letter
Discharging Patients on High Dose Steroids
Last updated 21st June 2023
Introduction
The following advice is for discharging a patient taking corticosteroids ≥ 20mg Prednisolone Daily for 2 Weeks or More:
Patients without diabetes and people with type 2 diabetes who do not have a blood glucose meter:
- Ensure an HbA1c test has been taken. This should be performed as close to the start of treatment as possible but ideally within the first 2 weeks.
- Provide a blood glucose meter at discharge. These will be supplied from Pharmacy. Ensure the ward team are aware of the need to provide the meter, lancets and sharps container, and if necessary the ward team should train the patient to use the meter. The meter comes with 10 test strips which should be sufficient for most patients for the first week.
- Prescribe “blood sugar check” on the discharge prescription. This flags up to the primary care team that a meter has been provided.
- Give patients the following advice:
- A daily capillary glucose should be done before the main meal of the day.
- If capillary glucose > 12mmol/l recorded, the patient should move to four x daily testing.
- If capillary glucose > 12mmol/l on two occasions in 24 hours, the patient should contact their GP as they are likely to need treatment.
- It may be possible to stop or reduce testing to 1-2 times weekly if BG is persistently < 12mmol/l after 2 weeks on steroid therapy
- Remind patients to stop testing when oral steroids are discontinued.
People with diabetes who have their own meter:
- Capillary glucose levels should be checked more frequently – before each meal and at bedtime.
- If capillary glucose > 12mmol/l on two occasions in 24hrs, insulin/oral diabetes therapy may need to be adjusted. Tell patients to contact their usual diabetes care provider (GP / practice nurse / diabetes team) for advice on treatment adjustment.
End of Life Care
- Please note that the above advice also applies to palliative patients prescribed dexamethasone.
- See below for dose equivalences.
Short Course High Dose Steroids
- Pharmacy will provide a patient safety card which highlights the signs of hyperglycaemia for patients prescribed short courses of high dose steroids of less than two weeks duration.
Steroid Equivalence (Approximate)
Prednisolone 5mg | Dexamethasone 750 micrograms | Budesonide 1.2mg |
Prednisolone 20mg | Dexamethasone 3mg | Budesonide 4.7mg |
Summary Flowchart

Content by Dr Fiona Green