Episode Details

Intimate Partner Violence.  

Dr Yomi discusses how to screen for intimate partner violence (IPV), she shares statistics, risk factors, and how to prevent it. Introduction about steroid injections and hyperglycemia with Dr Kooner.

Today is January 18, 2022.

Introduction: Intra-Articular Corticosteroid Injections and Hyperglycemia
By Gagan Kooner, MD, Government Medical College of Amritsar, India.

There is a physiologic association between hyperglycemia and corticosteroids. Do intra-articular steroids induce hyperglycemia? According to the Spine Intervention Society’s Patient Safety Committee, the answer is yes. These researchers reviewed studies done on both diabetic and non-diabetic patients.

In non-diabetic patients, transient and self-limited hyperglycemia was reported following peripheral intraarticular injections. The increase in blood glucose was less than 40 mg/dl, and levels returned to near baseline by 24 hours. The hyperglycemia in patients with diabetes is more significant. In patients with well-controlled diabetes (hemoglobin A1C of <7), glucose levels rose to the 300s at 1-2 days after administration. Less significant elevations persisted for up to 5-7 days! This effect was evidenced with injections into different joints, with different preparations such as methylprednisolone and betamethasone. 

The effects of epidural steroid injections vs injections in other joints were compared in patients with and without diabetes. Three consecutive injections were given. On day 1 following the injection, there was a significant increase in post-prandial glucose in all groups. However, on day 7, only patients who had received intra-articular injections, did not return to baseline. The hyperglycemia is likely to happen because the steroid spreads in a larger area when injected in a large joint. Also, a caveat is that the group of patients who received intra-articular steroid injections had a higher proportion of diabetic patients. 

Spine Intervention Society recommendations: 

All patients with diabetes should have a provider to contact if their glucose levels become difficult to control.

The informed consent process should include the potential for hyperglycemia after the procedure. Patients with diabetes should check their glucose consistently for at least two days before the procedure. A rule of thumb is to cancel the procedure if the glucose is above 200 mg/dl.

The number of joints and the total amount of steroid given should be considered. 

If the procedure is only a diagnostic block; only local anesthetic should be used (avoid unnecessary steroids).

After the procedure, patients should monitor their glucose until levels return to baseline and adjust their treatment accordingly.

In conclusion, it appears there is a definite correlation between intra-articular steroid injections and hyperglycemia. Although the risk may be minimal, in my opinion, following these recommendations would ensure we are providing adequate healthcare to our patients, especially those more vulnerable, such as diabetic patients. 

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

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Intimate Partner Violence. 
By Timiiye Yomi, MD. Discussion with Hector Arreaza, MD.

INTRODUCTION

The CDC defines domestic violence (also called Intimate Partner Violence or IPV) as physical violence, sexual violence, stalking, and psychological aggression by a current or former intimate partner (spouse, boyfriend/girlfriend, sexual partner, etc.). According to the National Coalition Against Domestic Viole