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KMID : 0948920100090020082
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Clinical Pain
2010 Volume.9 No. 2 p.82 ~ p.89
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Effect of Three Consecutive Steroid Injection on Blood Glucose and Cortisol Level in Diabetic Patients with Hemiplegic Shoulder Pain
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Byun Seung-Deuk
Park Dong-Hwi
Jo Dong-Hyun
Choi Won-Duck
Lee Zee-Ihn
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Abstract
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Objective : To investigate the changes of serum glucose, cortisol, insulin and HbA1c levels after three consecutive steroid injections in diabetic patients with hemiplegic shoulder pain.
Materials and Methods: 10 non-insulin dependent diabetes mellitus patients with hemiplegic shoulder pain were included. All patients underwent a musculoskeletal examination and sono-guided injection of hemiplegic shoulder. As a result of evaluation, 5 patients were treated with intra-articular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg (1 ml) once a week for 3 weeks, and 5 patient were treated with intra-bursal injection with a mixture of 0.5% lidocaine 5 ml and triamcinolone 40 mg (1 ml). The serum glucose, insulin, HbA1c and cortisol levels were measured before the 1st injection, at 24 hours, 3 days, 5 days, 6 days after 1st injection, at 24 hours, 1 week after 2nd and 3rd injection, and at 2 weeks injection after 3rd injection.
Results:: (1) Serum glucose level was increased after three consecutive steroid injection, but statistically not significant (p＞0.05). (2) HbA1c levels showed no significant change after three consecutive steroid injection(p＞0.05). (3) Insulin levels significantly increased at 24 hours after 2nd & 3rd injection(p＜0.05), and normalized at 1 week after 2nd & 3rd injection. These changes of insulin level were observed only in intra-bursal injection group, not in intra-articular injection group. (4) The cortisol level was decreased at 24 hours, 3 days, 5 days after 1st injection, and at 24 hours, 1 week after 2nd injection and 3rd injection (p＜0.05), but normalized at 6 days after 1st injection and 2 weeks after 3rd injection. These changes were observed in both groups.
Conclusion: Three consecutive shoulder injections with triamcinolone 40 mg at 1 week interval in diabetes patients did not elevate the glucose and HbA1c level, but affected on cortisol levels and elevated the insulin level at 24 hrs after 1st, 2nd & 3rd intra-bursal injection. So we think the repeat steroid injection should be done with careful monitoring of glucose and hormone levels.
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KEYWORD
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Cortisol, Serum glucose level, Hemiplegic shoulder pain, Three consecutive steroid injection
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