Type 2 hydrocortisone and blood sugar

[Gd485]

Hi all,
I have both type 2, hypothyroidism and Addison's disease. As a result my adrenal glands have stopped producing cortisone instead I take a replacement dose. I'm told cortisol helps promote the liver in releasing glucose.
I have to increase the dose of hydrocortisone at times of stress, both physical or mental. Would this dose increase push up my blood sugar?
I'm new to diabetes and at present its controlled by diet but I was wondering if I need to test my blood sugar more in times of stress?

Geoff

 

[Daibell]

Hi. Steroids will normally increase blood sugar so it's important to have a meter to check where you are.

 

[CarbsRok]

Hi all,
I have both type 2, hypothyroidism and Addison's disease. As a result my adrenal glands have stopped producing cortisone instead I take a replacement dose. I'm told cortisol helps promote the liver in releasing glucose.
I have to increase the dose of hydrocortisone at times of stress, both physical or mental. Would this dose increase push up my blood sugar?
I'm new to diabetes and at present its controlled by diet but I was wondering if I need to test my blood sugar more in times of stress?

Geoff

Hi Geoff, yes the HC will push up your blood sugars unless you are actually in crisis. Be very careful about increasing steroids just because you have a little bit of stress. Too much HC will cause loads of other problems. Is your type 2 written is stone as Addison's unless steroid induced is autoimmune as is hypothyroidism? So make sure you watch your blood sugars carefully.

If you haven't seen it this is a good site for info http://www.addisons.org.uk/comms/adshg/page1.html

 

[nickm]

? Be very careful about increasing steroids just because you have a little bit of stress?
Failure to adequately increase dose with stress is a common cause of death in Addison's, particularly in males. It is a big contributor to reduced life expectancy. My blog on diabetes and Addison's is at
http://t1diabetesafter55.blogspot.com.au

 

[CarbsRok]

? Be very careful about increasing steroids just because you have a little bit of stress?
Failure to adequately increase dose with stress is a common cause of death in Addison's, particularly in males. It is a big contributor to reduced life expectancy. My blog on diabetes and Addison's is at
http://t1diabetesafter55.blogspot.com.au

With respect it depends on what people call stress.
I was given strict instructions for when to increase my dose and what definitely does not warrant an increase. Hence the link in my original post

 

[anniertyu]

Hi, I also have Addisons, Hypothyroidism, Type 1, pernicious anaemia, Osteoporosis from the steroids and MS. I advise keeping a very careful eye on your sugar levels when increasing steroids, mine tend to keep going up and up I have to inject a lot of insulin to get them down. Have you seen an Endocrinologist recently? With Addisons and Hypothyroidism you will be a prime candidate for type 1,

 

[arniemouse]

Hi very interested in this thread have secondary adrenal failure so cannot call it Addisons but in effect it causes the same problems. I have a huge problem with hypo's (and have reactive hypoglycaemia - see other thread) which my consultant says is due to the adrenal problem. I also have type 2 which muddies the water! I am going into hospital in 3 weeks to have tests to see how much hydrocortisone I am absorbing of my current dose to see if I can have a bit more which might help with the hypo's. I cannot take any tablets or insulin for the diabetes because too many hypo's so trying to control with diet. I don't find I have to take extra hydrocortisone very often but it does mess up the BS if I do.

 

[CarbsRok]

Hi very interested in this thread have secondary adrenal failure so cannot call it Addisons but in effect it causes the same problems. I have a huge problem with hypo's (and have reactive hypoglycaemia - see other thread) which my consultant says is due to the adrenal problem. I also have type 2 which muddies the water! I am going into hospital in 3 weeks to have tests to see how much hydrocortisone I am absorbing of my current dose to see if I can have a bit more which might help with the hypo's. I cannot take any tablets or insulin for the diabetes because too many hypo's so trying to control with diet. I don't find I have to take extra hydrocortisone very often but it does mess up the BS if I do.

If it's of any help to you I found that I absorbed the HC very quickly which as you have found causes problems, so switched over to prednisolone and HC. This has for me keeps things running on an even keel most of the time.
I hope you hospital stay manages to sort things out for you. Wishing you the best.

 

[arniemouse]

If it's of any help to you I found that I absorbed the HC very quickly which as you have found causes problems, so switched over to prednisolone and HC. This has for me keeps things running on an even keel most of the time.
I hope you hospital stay manages to sort things out for you. Wishing you the best.

Hi
Thanks. My consultant tells me there is a long acting hydrocortisone tablet but at the moment its not approved by NICE as its about 50 times cost of the ordinary one. But maybe that could also help when it finally gets to us sufferers.

 

[CarbsRok]

Hi
Thanks. My consultant tells me there is a long acting hydrocortisone tablet but at the moment its not approved by NICE as its about 50 times cost of the ordinary one. But maybe that could also help when it finally gets to us sufferers.

For the life of me I can not remember it's name do know about the tablet, there is a lady on another forum who uses it. On looking up the price it was about £250 for 30 tablets, which is disgusting amount as is the £60/30 for HC yet pred is only a couple of quid for 28 tablets.

 

[Bertiedog]

I am also on steroids because of mild adrenal insufficiency (Sheehans) and I take 6mg Prednisolone plus 2 grains desisted thyroid for hypothyroidism. Have been on these since 2003. I had severe reactive hypoglycaemia before treatment which took many years to get under control but still have a tendency to getting it.

Recently I can see that my bs is creeping up as the day goes on and I find that in the evening, despite just meat or fish and non starchy veg, 4 hours after eating my bs is around 6.3. I find this very frustrating because I don't need to loose any weight apart from a couple of pounds. The past week I have stopped eating so often and I am eating less and lost 4lbs in weight but this has now stabilised.

This morning I had a nasty hypo attack when out walking my dog. It was just like I used to get in the 90s before I knew what was going on and its because I have cut back on what I am eating. Also I only have 2 strips left in my cassette meter otherwise I think I might have checked before going for the walk.

What I don't really understand is that I get no warnings that my bs is too low for me I just get so dizzy and get lots of adrenaline too which makes me feel very panicky. This has only started happened since cutting back on food and my snacks of peanuts and almonds but it reminded me of how horrendous it used to be.

Hopefully tomorrow my new cassettes for my meter will arrive so I can test a bit more to see what is going on. This adrenal issue seems to make things a lot more difficult. I just cannot have say eggs and a few veg for breakfast, there isn't enough carb there to raise my bs to make me feel ok. However it is fine if I eat this for an evening meal. It doesn't look as if "normals" have this problem from what I read.

Do others with Addisons or adrenal insufficiency find that knowing what to have for breakfast is the most difficult meal for them ? My fasting bs used to be in the 4s but I notice that as my bs creeps up in the evenings it is reflected in the fasting reading which has been 5.3 on occasions.

 

[CarbsRok]

Do others with Addisons or adrenal insufficiency find that knowing what to have for breakfast is the most difficult meal for them ? My fasting bs used to be in the 4s but I notice that as my bs creeps up in the evenings it is reflected in the fasting reading which has been 5.3 on occasions.

I don't actually eat any breakfast except for steroids and thyroxin. My blood sugar tends to start rising about 12noon from the steroids though, hence why I set my pump to deliver extra insulin from 10AM .

 

[Bertiedog]

I cannot believe that I am 3/4 dead first thing in the morning if I don't eat anything! I do have a diagnosis of ME/CFS/Lyme disease so that might be the reason for our differences.

 

[CarbsRok]

I cannot believe that I am 3/4 dead first thing in the morning if I don't eat anything! I do have a diagnosis of ME/CFS/Lyme disease so that might be the reason for our differences.

I have ME Addison's under active thyroid type 1 diabetes and a neurological condition caused by a spinal lesion.

You might find that as pred takes a couple of hours to kick in that's your problem. I use 5mg of HC as well as 5 pred, the HC gives the kick start

 

[Bertiedog]

I have ME Addison's under active thyroid type 1 diabetes and a neurological condition caused by a spinal lesion.

You might find that as pred takes a couple of hours to kick in that's your problem. I use 5mg of HC as well as 5 pred, the HC gives the kick start

Thanks for the suggestion but I naturally wake up anytime from 4.30 am to 5 or 6 am and take 2.5 mg Pred then plus 25 mpg thyroxine and then go back to sleep. Around 7 am or on waking I take another 1 mg Pred plus 1 grain desisted thyroid. Around 1 pm I take the other 2.5 mg Pred and another 1 grain which seems fine.

First thing in the morning I would kill for food!

 

[arniemouse]

Hi Bertiedog
I have adrenal failure from steroids use for asthma. I am just like you without carbs to start day my BS just sit around 4 and refuse to go up. I also have reactive hypoglycaemia and have hypo's quite regularly and its such a pain. But I find that my body is unable to rescue itself so my BS just keep going down and then I have to have help. I also can cut carbs later in the day.
I also wake at 5 to have my 10mg of Hydrocortisone to try to get my body to be good when I get up an hour later
Much sympathy

 

[ClairedeMort]

I’m new to all of these in my 3rd month.

Diagnosed with Addison’s and started on hydrocortisone and felt rubbish.
Found that my BM are 8.7 in the evening. 3-5 fasting at 0500hrs.

I already have a low carb diet, low BMI, don’t eat sugars and exercise.

Yesterday I decided to get a grip. Took my usual 0500hr 5mg HC. BM 4.3. Ate porridge with water and seeds with pre training 2.5mg HC. By 1015hrs BM was 6.2. Proving something to myself if did about 1000watts exercise and BM dropped to 6.1.

Utterly ******** today. 1200hr BM 7.4

Just help.

 

[Gd485]

Hi Clairedemort,

Your Hydro cortisone dose seems a bit low to me. I am now in my 10th year with AD. I take 10mg in the morning and 10mg at lunch time and that works well for me most days. A typical dose for AD is between 5 & 20mg per day but can be as high as 30mg for some people.
My Endocrinologist suggested I play around with the times and dosage for the hydro to find out what works best. I did try 10mg them 2 x 5mg doses, taking the last dose around 6.00pm but I found it affected my sleep. Some patients find a larger dose in the morning works best with one or two smaller doses during the day.
With the extra stress of hard exercise it is recommended the dose is increased. (Addison's disease self help group-ADSHG).
Do you take Fludrocortisone as well?
Although the Blood sugar increases with Hydrocortisone it should only be as a replacement dose and the BG rise should be the normal response your body has to healthy level of HC. This needs to be checked every 3 months or so by blood test until you find the right dose and then the Blood Sugar needs investigation as a seperate problem.
It takes a good 6 to 12 months to get the dose right and for your body to get back into a steady rhythm. Stress is difficult to assess and to know when to increase the dose.
With me it's sudden loud noises that cause my BP to take a dive, I often end up sitting on the floor waiting for my light headedness to go.

Best of luck .

 

[ClairedeMort]

It’s a hard place!
You’re right that the HC is on the lower dose but I am not large. So on mg/kg is should be 16mg/day and I’m on 15-17.5mg/day as advised to do.

The dose of HC is replacement only and I’ve never had high sugars before. The high of the sugars is related to the cumulative dose of the HC over the day.

I can’t go lower on the HC for the reasons you’ve said.

The HBa1C limitation is that it’s an average .This takes into account the hypos from lack of glucocorticoid/Addisons and the high from steroids so isn’t that useful as it does show the range. Just the average.

How do you manage your sugars?

 

[Gd485]

Hi Claire,
I'm Lucky, my BG has got a lot better since losing 12Kg and getting my BMI down to 27.5. Yes I was a fat old.....!
It doesn't sound like you can afford to lose weight.

My blood sugar is controlled by diet. I stopped all the carbs. Bread, cakes, sweets, fizzy drinks, junk food and moved to a mainly veggie diet.
I have a feeling that a veggie diet alters the gut bacteria and might help in reducing the uptake of sugars. That's my personal theory and I have no proof that happens.

My morning BG used to be 6.7 to 7.3 now it's 4.3-4.7.

Cortisone levels rise naturally in the morning to get you cranked up for the day. have you tried 10mg in the morning and 5 mg at lunch. It could make you feel a lot better. As for the exercise I'd be tempted to try an extra 5 mg HC 30 mins before for a few weeks until you get a healthy routine going

By the way I'm 65 years old.