Asthma attack and blood sugars, and asthma vs KA

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I'm a student nurse and we are studying insulin/glucose and all that right now.

I was just curious-- if a person came in with an asthma attack (stress would release glucose right?) and they were given albuterol SVN and probably a corticosteriod (which would release more glucose), are they at risk for hyperglycemia during the crisis? Or does their natural insulin keep them from getting beyond a normal value even in this crisis, and even with the glucose-raising drugs?

Do you even test for blood glucose routinely when a person comes in for a non-diabetic type situation? Say, you think it's asthma because of pt hx of asthma, the breathing pattern and low O2, but it could actually be ketoacidosis (Kusmmauls would "look" a lot like asthmatic breathing and the acidosis would cause low O2 sats).

Finally,

If a person is on long-term steriods for any reason, do they ever get tested for glucose routinely?

Thanks! :-)

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Specializes in Cardiac, ER.

This is a whole semester worth of questions you are asking..:) You will learn this. Remember that the pt who is in ketoacidosis is breathing fast to blow off C02,..not because his airway is restricted. You'll learn more about this when you start studying ABG's. Two totally different things with different treatments.

You are correct in that anyone under stress will produce more glucose. It is common for a diabetic pt who is normally controlled on PO meds to need insulin while ill or on steroids. Non diabetic pts will compensate well without intervention.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

great questions!

i'm a student nurse and we are studying insulin/glucose and all that right now.

if a person is on long-term steriods for any reason, do they ever get tested for glucose routinely?

thanks! :-)

prudent physicians, np's and pa's do monitor glucose levels periodically, especially adults with

copd and ms/neurological disorders who are on steroids long term.. readmitted patients needing sliding scale insulin in hopital often are referred to homecare for teaching re glucometer use + sliding scale insulin to prevent hyperglycemia.

management of steroid-induced diabetes in patients with copd

steroid-induced diabetes mellitus and related risk factors ...

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Specializes in home health, dialysis, others.

I have steroid-induced Diabetes. Had a massive asthma attack, the usual Medrol dose pack barely touched me - so I was put on a 'big' bolus and wean. Took that 60 mg of prednisone, and on the 3rd day I couldn't drink enough or pee often enough. Yup - my blood sugar was nearly 300.

That was over 9 years ago, and my life has never been the same. I take as many as 5 shots a day. And my heart loves all of the stents that help support it!

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Specializes in Acute rehab, LTC, Community Health.

I had one patient who was end stage kidney/liver disease who was on high dose steroids and we routinely tested blood sugars and sometimes administered low doses of insulin, depending on sliding scale results. Good questions! I bet you are someone that does great, considering how inquisitive you are! Good luck to you in finding your answers.

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Specializes in Hospital Education Coordinator.

unfortunately, I have seen MD's not order BS checks in people taking steroids because "the reason the BS is up is due to the steroids". DUH! What difference does it make WHY the BS is up? Fix it. So no, not everyone gets routine BS evals in the out-pt setting. In-patient is not much better. Everyone gets a basic metabolic panel when they are admitted (could be some who don't but I have never come across them). This lab work shows the glucose level. If it is high (over 130) the MD should a Hemaglobin A1C to rule out diabetes and BS checks to determine if hyperglycemia is present and should be treated, even if only short-term.

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Thanks for your detailed replies! Lots to think about.

Today in sim lab it was a real eye opening experience. We were practicing ER work. I have a real respect for you ER workers, seriously! You never know what's going to walk in, and it takes awhile to see the whole patient, not just the presenting problem. Whew!

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Specializes in Trauma/ED.

Just another note...you don't need a bedside BS to get your glucose level...it is included in the CMP. For someone who is non-diabetic, having an asthma exacerbation, you would probably not check a blood sugar but may get a CMP.

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Specializes in Emergency & Trauma/Adult ICU.

Good info for you given here ...

One other noted: Kussmaul respirations, in my experience, really do look and sound pretty different than acute asthma. You'll learn the difference and be able to easily differentiate the two.

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Specializes in LTC.

I searched the internet high and low to see if I could find an audio or video example of kussmaul respirations. Unfortunately I couldn't find any. I've seen both a couple of times and they are very different.

I would see if you can continue my search and maybe find something. It always helps to have a visual example.

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