Which metabolic change is most likely to occur with prednisone therapy and should be monitored?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Hypokalemia
• D. Hyperglycemia

Answer: (D)

Prednisone acts like cortisol, boosting glucose production in the liver and reducing the body's sensitivity to insulin. This combination drives an increase in blood sugar, so hyperglycemia is the most likely metabolic change to monitor during therapy. In practice, check glucose levels (fasting and, if needed, postprandial) and watch for symptoms such as increased thirst, frequent urination, fatigue, or blurred vision. In long-term or high-dose use, this can lead to steroid-induced diabetes, so HbA1c may also be useful.

Other electrolyte or glucose problems aren’t the primary concern with prednisone in this context; hyperkalemia or hypokalemia aren’t the hallmark metabolic effects, and hypoglycemia would be unlikely with a glucocorticoid. The key monitoring focus is blood glucose elevation.