Hydrocortisone for adrenal failure giving High BMs.

[Minus Tran]

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

Diagnosed with Addison’s and started on physiology replacement dose hydrocortisone worked out at 0.3mg/kg. (BMI 21. Early morning cortisol 39. Pre diagnosis BM 2-4. HBa1C 34.)

Since starting the hydrocortisone I’ve felt rubbish in the afternoon/evenings which I thought was because I hadn’t taken enough HC and was getting hypos. But
Found that my BM are 8.7.

My pre HC fasted BMs 3-5 at 0550hr.

I already have a low carb diet, low BMI, don’t eat sugars, vegan 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. (I shouldn’t take 7.5mg HC by 1200hrs) By 1015hrs BM was 6.2. (Proving something to myself) i did about 1000watts exercise and BM dropped only
to 6.1.

Utterly rubbish today. 1200hr BM 7.4

Just help.

Reading up the tablets of T2DM are all long acting which would mean that I will have hypos over night /first things.

Not taking the HC is dangerous as in death as my natural cortisol production is so low. Missing a dose or taking it late has me wilting, stopping still, can’t talk/move. Late lunch and a bit of stress out me in adrenal crisis.

High BMs have me irritable, bitingly short tempered and itchy.

What’s your experience?
How are you managing this?

 

[DCUKMod]

Minus tran, I'm sorry you seem to be having a few problems sorting out the balance with your medications and blood sugars.

Whilst we can make comment on your blood sugar levels, there are very few here who will have specific advice to offer you, relating to your Addison's.

Looking at your blood glucose numbers, they aren't dire and at 3 months in, it strikes me that you are at the beginning of your journey to good health. In my personal experience, anything to do with the endocrine system takes a while to sort out, balancing all the factors in play.

Looking at the description above, your starting HbA1c was excellent. 34 is a very healthy number. Of course., one of the symptoms of adrenal insufficiency can be low blood sugars, but as an A1c, that's a nice number and not at all alarmingly low, for a healthy person.

Of the numbers you are describing above, there are absolutely none that are alarmingly high. These are a summary of desirable blood sugar levels from this site, including for those not living with diabetes.

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html



I have a feeling what could potentially be happening is your bloods have been running quite low for a whilst, and then the hydrocortisone you have been prescribed has pushed them up a bit. In some ways this is the opposite of what is known as a false-hypo.

Our bodies get very used to running in a range, which is our normal. When something happens to change that - we become unwell, start on new meds, or whatever, our bodies object and try to keep us in that "normal place", but secreting additional hormones or dietary enzymes, but it also signals us to feel a bit "off" - to make us sit up and take notice and do something about it. It could be this is where you are now.

It could be (and this is all speculation in my part) that either you need to ride this out a little while longer, or maybe your meds need a tweak. The only person who can advise you on that is your doctor. So, I suggest you make any appointment to see him or her.

Finally, relating to oral medications to manage blood sugar levels; your assessment of those is a bit flawed. Sure, the most common tablet given, Metformin does work on a therapeutic dose, to is longer and slower acting. but there are other options for faster acting.

Again, this is something you need to discuss with your doctor.

I'm sorry if this isn't what you were hoping for.