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Type II and Steroids for Asthma

Question:

It sounds like you have been getting some sound advice from the other posts. This is a call your doctor situation. I am assuming (I know, assume+ass out of U and me) that the oral steroids are for an exacerbation of your asthma. Something has caused it to get seriously worse, and the oral steroids for a limited time are great for getting the asthma back under control. You are, I assume on a "prednisone taper" where the daily dose of prednisone is smaller than the previous day’s dose. Oral steroids, like prednisone. wreak havoc on the serum glucose levels. Your blood sugar daily readings will go UP. This is a fact of life. However, knowing that this will be happening, the doc can adjust your diabetes treatment regimen to cover for those increased glucose reading. This can include the temporary use of another type of insulin with your usual insulin or an adjustment to the doses you use, or the addition of a pill form med, like metformin. There are multiple tools in the doctor’s arsenal to deal with this elevated glucose problem. Many tools. Systemic steroids, like prednisone, work to decrease the inflammatory response going in the body. Inflammation is one of the two components in asthma. The other component is over-reactive and hypertrophied smooth muscle that is way too reactive and too easily narrows down the breathing passages. The predinose does nothing to help that smooth muscle part, but is works like magic on the inflammatory part of asthma. However, the symptomatic relief from the predinose commonly takes a day or two to be noticeable. Other asthma drugs, which I assume you are on, include a bunch of MDIs of "puffers". They include albuterol for fast or emergency relief, salmeterol (salbuterol is like albuterol – short acting, not long acting) that gives you the long acting relief (but not the immediate relief of albuterol) and some form of inhaled steroid (to work only locally, and not systemically like the prednisone pills) on the inflammation. Theophylline is an older drug that today is used typically for COPD and for really really bad asthma. It is a drug that has been moved to the bottom of a doctor’s bag of "tricks" because the newer drugs are better at attacking the problem and they have many fewer side effects. Theophylline, in a way, is a bit like oral steroids: both drugs are like sledge hammers– they hit a lot of systems in the body as well as the intended target. The mechanism of theophylline is very different than the steroids. Theophylline inhibits an enzyme that allows the adrenergic side of the autonomic system to get fired up. In English, theophylline really gets ya going, like drinking too much coffee. Well, one of the effects of firing up that part of the nervous system affects the liver and the whole sugar in the blood business. Theophylline’s effects ultimately tell the liver to release the sugar it has been storing and to start making more sugar. Theophylline can worsen diabetic control. Theophylline can also raise the blood pressure, increase heart rate, interfere with sleep patterns, etc. Like I said, it is a sledgehammer of a medicine. Unless the doc has you on it, stay away from theophylline. One thing theophylline does not do is act to damped the inflammation response. Predinose is the drug for that. If you have those 3 types of asthma/COPD puffers, and you are taking the oral steroids, ask if you can have a nebulizer at home. It will mix albuterol, another med called ipratropium (which helps the lungs secrete less mucous/fluid/gunk into the lungs) all in a nice steam that you breathe in via a mask. These "breathing treatments," as they are commonly referred to, are wonderfully effective and even soothing. In a case where asthma is very bad, this treatment modality is often used. CALL YOUR DOCTOR ABOUT THOSE ELEVATED GLUCOSE READINGS AND THOSE SYMPTOMS (blurred vision)!! (that’s s/he is there. That’s why s/he gets paid for.) Sorry to yell at you, but it was important enough for yelling. Do call the doc. The problems can be fixed. Good luck and take care! – Hide quoted text — Show quoted text – I have DMII, last HbA1c 6%. I also have asthma/COPD, and recently my asthma has been very bad. Due to that, I was put on a short course of 20mg Prednisone per day for five days. I took the first dose last night, and my blood sugar went up to 375 after eating a broiled pork chop with Worcestershire sauce. Within a few hours, I drank a gallon and a half of water, and my vision is blurry (even after I got my BG down to 125) and I have a terrible headache. Adding insult to injury, I’m still wheezing! I have a call into my doctor, but in the meantime, should I be overly concerned with these symptoms? (They’re in the "call doctor immediately" section of the warnings.) Prednisone is what made me diabetic in the first place (a much higher dosage for a longer period). I’ve taken low dose short courses since, and my BG got near 200 but I didn’t have the thirst, etc. I use QVar and albuterol inhalers regularly for the asthma. I used to take theophylline when it was OTC, and it worked like a charm without the awful side effects. I looked it up, and there doesn’t seem to be any reason why *I* shouldn’t take it (doesn’t cause elevated BG, doesnt interfere with any of my meds, and isn’t contraindicated by any of my conditions). Anyone know any different? In general, of course! I mean, reasons why theophylline in general may or may not be a better alternative to prednisone.

Response:

– Hide quoted text — Show quoted text – I have DMII, last HbA1c 6%. I also have asthma/COPD, and recently my asthma has been very bad. Due to that, I was put on a short course of 20mg Prednisone per day for five days. I took the first dose last night, and my blood sugar went up to 375 after eating a broiled pork chop with Worcestershire sauce. Within a few hours, I drank a gallon and a half of water, and my vision is blurry (even after I got my BG down to 125) and I have a terrible headache. Adding insult to injury, I’m still wheezing! I have a call into my doctor, but in the meantime, should I be overly concerned with these symptoms? (They’re in the "call doctor immediately" section of the warnings.) Prednisone is what made me diabetic in the first place (a much higher dosage for a longer period). I’ve taken low dose short courses since, and my BG got near 200 but I didn’t have the thirst, etc. I use QVar and albuterol inhalers regularly for the asthma. I used to take theophylline when it was OTC, and it worked like a charm without the awful side effects. I looked it up, and there doesn’t seem to be any reason why *I* shouldn’t take it (doesn’t cause elevated BG, doesnt interfere with any of my meds, and isn’t contraindicated by any of my conditions). Anyone know any different? In general, of course! I mean, reasons why theophylline in general may or may not be a better alternative to prednisone.

Hi, I`ve been ashtmatic for 47 years, dm LADA for 6 years ( and a bit ). My current regime for asthma is beclomethasone inhaler two puffs in the morning, two in the evening, and that`s basic maintenance. Two puffs of salbutamol when required, and I been having puffs (dirty grins all round) like that for approx 30 years, so I know beforehand when I`m going to need salbutamol. My diabetic regime is Beef Lente 14 units before bed for basal, as many Nopvorapid shots as I need (anywhere from 1 unit to 14) and my bg rarely goes above 7.6mmol, that`s 137 in America`s system. So, for me, I still got a trickle of endogenous insulin, my bg`s are under control except for the occasional blip at 12.4mmol to 13.7mmol, (223 to 247) and the asthma is only a little trouble. I think prednisone is big trouble, but depending on the individual, there may not be an alternative. Last, your 375 is going to give you more problems than anything you ever dreamed of if it stays there, and since those symptoms are in the *call doctor immediately*, I think you should do just that. — Al, Melton Mowbray, uk, LADA dx Jan97 Control basal/Beef lente bolus/Novorapid I do not experiment, I AM the experiment.

Response:

I have DMII, last HbA1c 6%. I also have asthma/COPD, and recently my asthma has been very bad. Due to that, I was put on a short course of 20mg Prednisone per day for five days. I took the first dose last night, and my blood sugar went up to 375 after eating a broiled pork chop with Worcestershire sauce. Within a few hours, I drank a gallon and a half of water, and my vision is blurry (even after I got my BG down to 125) and I have a terrible headache. Adding insult to injury, I’m still wheezing! I have a call into my doctor, but in the meantime, should I be overly concerned with these symptoms? (They’re in the "call doctor immediately" section of the warnings.) Prednisone is what made me diabetic in the first place (a much higher dosage for a longer period). I’ve taken low dose short courses since, and my BG got near 200 but I didn’t have the thirst, etc.

   Prednisone  is a known troublemaker for all diabetics.   It "orders" the liver to make and dump glucose into the blood. Diabetics have impaired glucose control mechanisms.  When the prednisone (and other steroids)  induce the dump, our sugars go wild. Some docs will counter the dump by prescribing metformin and insulin injections. Emergency rooms.  A 375 bG from prednisone is just as bad as a 375 from eating candy all day.  It is dangerous, it is damaging your body.   Yes you should call your doc. If you really need the steroid, then you may need a **temporary** course of insulin and/or metformin. Metformin "fights" the liver dump but almost always loses the battle. However for some folks, it works well enough that their impaired insulin systems can limp along and finish off the rest of the problem.   Others need the help of insulin injections. Regards   Old Al

Response:

I have DMII, last HbA1c 6%. I also have asthma/COPD, and recently my asthma has been very bad. Due to that, I was put on a short course of 20mg Prednisone per day for five days. I took the first dose last night, and my blood sugar went up to 375 after eating a broiled pork chop with Worcestershire sauce. Within a few hours, I drank a gallon and a half of water, and my vision is blurry (even after I got my BG down to 125) and I have a terrible headache. Adding insult to injury, I’m still wheezing! I have a call into my doctor, but in the meantime, should I be overly concerned with these symptoms? (They’re in the "call doctor immediately" section of the warnings.) Prednisone is what made me diabetic in the first place (a much higher dosage for a longer period). I’ve taken low dose short courses since, and my BG got near 200 but I didn’t have the thirst, etc. I use QVar and albuterol inhalers regularly for the asthma. I used to take theophylline when it was OTC, and it worked like a charm without the awful side effects. I looked it up, and there doesn’t seem to be any reason why *I* shouldn’t take it (doesn’t cause elevated BG, doesnt interfere with any of my meds, and isn’t contraindicated by any of my conditions). Anyone know any different? In general, of course! I mean, reasons why theophylline in general may or may not be a better alternative to prednisone.

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