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August 6, 2000

Diagnosis and Symptoms

Question from Elmhurst, Illinois, USA:

My son was diagnosed with type 1 diabetes a few months after being hospitalized with "pneumonia". Upon review, we learned that it was not pneumonia, but severe asthma. He was 18 months old at the time and was not given nebulizer treatments. Four months later, he was diagnosed with diabetes. The hospital told us that it was probably because of the "pneumonia" as there is no family history of diabetes. But we have been advised that this was never a case of pneumonia. Is it possible that this was the result of too much prednisone or prolonged use while in the hospital for undiagnosed asthma? They never monitored his blood sugars while administering high doses of steroids. Since then we have become painfully aware of how strongly prednisone affects his blood sugars. Also is there any information available for parents of children with asthma and diabetes regarding management of the diabetes during an asthma flare?

Answer:

It is more than probable that the stress of the first asthma attack together with the use of prednisone hastened the conversion of pre-diabetes to the insulin dependent stage.

For diabetes management during an attack it might help to review sick day management. This is not specifically oriented to asthma, but the principles are the same. You need to be guided by your son’s doctors on the details, but the first priority is to do whatever is required to relax the airway. It would probably be better to be using Humalog rather than Regular for the short acting insulin all of the time because it gives more flexibility especially in situations when appetite and blood sugar may be unexpectedly out of line, but check with the diabetes doctor on this.

Then you need to develop a profile of what blood sugars are likely to do during an asthma attack where stress, diminished appetite, diminished activity and possibly steroids will have conflicting impacts on blood sugar. Both short and long acting insulin doses may have to be adjusted. You also need to monitor the urine for ketones and to have a clearly defined back up plan if it looks as though ketoacidosis is developing.

DOB