Current inpatient management of status asthmaticus employs continuous inhaled beta-adrenergics and high dose parenteral corticosteroids, both of which cause hyperglycemia. To determine the effects of asthma management on glucose homeostasis, we measured the glucose and insulin responses in patients that were admitted from the emergency room to the asthma care unit. Serial glucose and insulin samples were drawn at time 0, 1, 6, 12, 24, 36, and 48hrs. Methylprednisolone(8mg/kg/day with maximum of 240mg/day) was given intravenously every six hours beginning at time zero. Patients were weaned from therapy as tolerated. Ten subjects(ages 2-15yrs) completed the study. Seven patients were on continuos albuterol for at least 85% of the time. Three patients were weaned to q3-4hr nebs by the end of the 48 hour study period. One obese patient was found to have significant insulin resistance and is excluded from the below analysis. Paired t-test analysis was performed compared to initial concentrations; data from 24,36, and 48hrs was grouped together; and all insulin concentrations were log transformed for analysis. At time 0, the mean glucose was 135±25.4mg/dL. Peak glucose was reached at 6hrs with mean of 254±74.8mg/dL(p<0.01). By 24hrs glucose returned to just above baseline with the mean of 24,36, and 48hr levels being 148±34.6mg/dL(p>0.10). The mean initial insulin was 43.6μ U/ml. The insulin peak was at 12hrs and broader than that of glucose with a value of 138μ U/ml(p<0.01). Insulin secretion leveled off above baseline values by 24hrs., with the mean insulin concentrations 24-48 hrs being 83μU/ml(p<0.001). The marked hyperglycemia observed during high dose methylprednisolone administration resolved by 24 hours. The mild hyperglycemia observed at 24-48 hours is accompanied by increased insulin secretion. In only 1 of our 10 patients was this clinically significant. The combination of continuous inhaled beta-agonists and high dose glucocorticoids, as employed in present management of status asthmaticus is a significant stress to normal glucose homeostasis. However, the majority of children appear to tolerate this challenge with only a brief period of significant hyperglycemia but sustained hyperinsulinemia.
