PM&R
Volume 1, Issue 4 , Pages 340-345, April 2009

The Effects of Epidural Betamethasone on Blood Glucose in Patients with Diabetes Mellitus

  • Peter Gonzalez, MD

      Affiliations

    • University of Colorado Denver, School of Medicine, Department of Physical Medicine and Rehabilitation, PO Box 6511, Mail Stop F-493, Aurora, CO 80045†
    • Corresponding Author InformationAddress correspondence to: P.G.
    • ,
  • Scott R. Laker, MD

      Affiliations

    • University of Washington, School of Medicine, Department of Rehabilitation Medicine, Seattle, WA‡
    • ,
  • William Sullivan, MD

      Affiliations

    • University of Colorado Denver, School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, CO§
    • ,
  • Jeri E.F. Harwood, PhD

      Affiliations

    • University of Colorado Denver, School of Medicine, Department of Pediatrics, Aurora, CO
    • ,
  • Venu Akuthota, MD

      Affiliations

    • University of Colorado Denver, School of Medicine, Department of Physical Medicine and Rehabilitation, Aurora, CO∥

Received 20 February 2008; accepted 17 December 2008.

Objective

To determine the effects of lumbosacral transforaminal and caudal epidural betamethasone injections on blood glucose levels in diabetic subjects. The hypothesis is that epidural steroid injections result in transient elevation of blood glucose levels in diabetic subjects.

Design

This is a prospective, observational cohort. Twelve diabetic subjects (6 non–insulin-dependent and 6 insulin-dependent) receiving lumbosacral or caudal epidural betamethasone injections for neurogenic claudication or radicular pain were studied. Spinal level and approach were decided based on symptoms, pathology, and magnetic resonance imaging findings. Subjects recorded their finger stick blood glucose levels twice daily for 3 days before the injection, the day of the injection, and 3 days after the injection.

Setting

A tertiary, university-based, spine center.

Participants

Inclusion criteria included diabetic subjects (age 18 years) with the ability and willingness to monitor and report their blood glucose. Exclusion criteria included epidural steroid injections (ESIs) within the previous 2 months or peripheral corticosteroid injections within the previous 2 weeks. Nineteen subjects initially enrolled, and 12 successfully completed the study.

Interventions

After informed consent was obtained, subjects underwent fluoroscopically guided lumbosacral transforaminal ESIs (TFESIs) or caudal ESIs, using contrast to confirm targeted needle placement and to rule out vascular uptake.

Main Outcome Measures

Subjects recorded morning and evening blood glucose (mg/dL) via glucometer.

Results

There was a 106 mg/dL average elevation in blood glucose level on the evening of the injection day. The blood glucose elevation remained statistically significant for 3 days after the injection (P < .002). Blood glucose remained elevated through postinjection day 2, though these elevations were not statistically significant.

Conclusions

Lumbosacral transforaminal and caudal epidural betamethasone injections are associated with statistically significant elevations in blood glucose levels in diabetic subjects. This effect peaked on the day of the injection and lasted approximately 2 days.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(08)00082-8

doi:10.1016/j.pmrj.2008.12.007

PM&R
Volume 1, Issue 4 , Pages 340-345, April 2009

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