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May 6, 2007

Insulin, Other Illnesses

Question from Hollywood, Florida, USA:

I have cystic fibrosis and just recently started on pump therapy, a MiniMed 722. I was diagnosed about one and a half years ago with diabetes. The pump has made such a difference in my blood sugars! I've noticed that any time I take albuterol and Pulmozyme and test, my sugar tends to rise about 30 to 40 mg/dl [1.7 to 2.2 mmol/L]. Why is this? If I ever need I.V. antibiotics, how will it effect my sugars? Would an increase in basal most likely be needed? Would bolus doses for food change for a bit? Also, I haven't really ever found out "why" I got diabetes. I have never been on any steroids or antibiotics, or other medication that would cause diabetes. My CF has always be very stable. The diabetes just popped up. I lost a lot of weight, was thirsty, etc. declined PFTS (pulmonary function tests), and, bam, I was in the hospital next to a diabetes educator. I've read somewhere it's because the pancreas secretes the enzymes, but they're blocked up because of the CF and they begin to kind of eat the pancreas' beta cells away. Is this true? I don't have any history of diabetes in my family either.

Answer:

The albuterol acts a lot like adrenaline, which is a hormone that works against insulin. You may find that the effect is only short-lived. It may not require a lot of treatment. I do not think there is any negative to the enzymes. If you ever need I.V. antibiotics, it is likely you have had a pulmonary exacerbation and have gotten sicker. It is known that intercurrent illnesses can transiently make your blood sugars higher. Again, they increase the stress hormones in your body that antagonize insulin. Yes, you probably have to increase your basal insulin and your bolus may also have to be increased. The best way to follow the adequacy of your bolus is with the two hour post-meal glucose determination.

It is known that the endocrine pancreas, another name for the cells that make insulin, are an inadvertent target of the CF. It is clear the exocrine pancreas that makes the enzymes is damaged. The insulin producing cells, known as beta cells live in islands of cells called islets. These islets are interspersed throughout the pancreas and are damaged when the rest of the pancreas is damaged. The timing is such that the endocrine pancreas is damaged to such an extent that diabetes occurs only after over 90% of the exocrine pancreas is damaged. The symptoms of diabetes consist of frequent urination, thirst, weight loss, and poor visual acuity. Most people who have CF long enough get diabetes.

It sounds like you are getting good information. Keep up the good work.

JTL

[Editor’s comment: For more information on CFRD (Cystic Fibrosis Related Diabetes), see Diabetes mellitus, Cystic Fibrosis Related Diabetes, and Paediatric cystic fibrosis related diabetes.

BH]