Reflection

Patient needs to be provided with diabetic card that clearly indicates she is a diabetic and on what dose of insulin she is. The dose of insulin need to be checked.In the patient’s notes a dose of 20 units was given, where the patient said she is on 24 units of insulin.

Patient has a steroid emergency box and opened it a week before the admission. This is her 3rd box for this year; also she was only admitted a month ago with similar symptoms which may indicate poor asthma control.

Before being put on corticosteroid tablets patient should have been given, in addition to the other asthma drugs, inhaled corticosteroid at a high dose, e.g Beclomethasone dipropionate 0.4- 1 mg twice daily. If that therapy was inefficient regular corticosteroid tablets must be added to the treatment.16 BNF p178

If control achieved, stepwise reduction may be possible. Reduce dose of inhaled corticosteroids slowly – every 3 months, decreasing the dose by up to 50 %. If patient’s exacerbations continue it is best that she is referred to asthma clinic.

Asthma treatment should be reviewed every 3 months. Ster...