When a COPD patient has diabetes as well, the doctor must consider two essential issues when choosing an appropriate bronchodilator medicine. For all such patients, the doctor must know which drugs affect the body's release of stored sugar and its metabolism of sugar in general. For diabetics whose disease has affected their autonomic nervous system, the doctor must know what the implications of this are for COPD, and which COPD drugs may worsen this impairment.

Also, diabetics are much more susceptible to all sorts of infections. The diabetic chronic bronchitic in particularbecause his lungs become a fertile breeding ground for infectionsneeds aggressive surveillance by clinical exam, laboratory tests, and X-rays. Intervention should begin immediately when a beginning infection is indicated.

Creating a glucose (sugar) imbalance in the diabetic COPD patient is a particular worry when steroids must be used to treat the COPD. Glucose is the body's primary energy source. The presence of insulin allows cells to take in the glucose they need. Then the cells use oxygen to burnor "metabolize"this sugar to produce their energy. Since the diabetic does not produce the amount of insulin needed to allow his cells to take in enough glucose, he must take supplemental insulin (or