Mechanisms of Abnormal Glucose Metabolism During the Treatment of Acute Severe Asthma

Twenty-five patients with acute severe asthma were treated withoxygen, corticosteroids and either salbutamol or aminophyllineby intravenous infusion. Blood glucose, plasma insulin and glucagonwere measured during the first 24 hours of treatment. Salbutamoland aminophylline rapidly caused hyperglycaemia, accompaniedby a rise in insulin and a fall in plasma glucagon. At firstthe increase in plasma insulin was insufficient to restore normoglycaemia,but by 24 hours homeostasis was restored. The early submaximalinsulin response was attributed to the fasting caused by breathlessness.There was no evidence of an increase in hormone secretion causedby direct ß₂-adrenergic stimulation of the pancreaticislets. The effect of corticosteroids on blood glucose overthe period of study was considerably less than the contributionof either salbutamol, or aminophylline.