I was recently diagnosed with Addison's disease - my adrenals have failed. Treatment is 'just' replacement steroids for life.
Around 50% of people with addison's also have diabetes - half Type 1 (or 1.5) and half Type 2. In a cortisol crisis your BG plummets, and I had a few up and down readings in hospital, so I've been using a BG meter to track hypos to help me get my steroid replacement dose correct.
What I've discovered is that I also have dramatic hypers. So far my record is 22 (white rice in a japanese restaurant). I regularly get post-meal levels in the teens. I am not a big eater and I don't have a sweet tooth, and I'm on a low carb diet, so I'm never eating large quantities of anything particularly high carb. A couple of small roast spuds in an otherwise carb-free meal is enough to send me to 12 or 13.
I did a home glucose tolerance test last weekend (410ml of lucozade original) - peaked at 14 after 1 hour, and at 2 and 3 hours was still at 9. Then I did a minimal amount of housework and plummeted rapidly to 3.5. I have needles and have learned IV access as part of my addision's crisis management, so I've confirmed that my finger-prick levels and venous levels are consistent enough. I always repeat test a level that is unusually high, so I'm confident that the high readings I get aren't just errors.
My GP says my GTT shows that clearly I'm glucose intolerant, and probably diabetic. The complication in confirming that diagnosis is that I'm on steroids, and other asthma meds, that can cause hyperglycaemia, so it's hard to know whether it's 'me' or the meds causing the problem.
I have temporarily dropped those meds that I can, so I'm now only on the minimum maintenance dose of steroid that I need to keep me alive - my BP is on the low side so that confirms that I'm not over-steroided right now, and shouldn't be contributing to hyperglycaemia.
I'm going to repeat the OGTT tomorrow now that I'm on minimal meds, but in making sure that I've eaten 150g of carbs per day for the last 3 days I've regularly had readings of over 11, more than 2 hours post-meal.
My fasting glucose is around 5.8 in the morning, and as I also regularly have hypos I don't think my HbA1C would be high.
My Dad has your classic Type 2 - tipped over to diagnosis at around 60 after 30 years of being seriously overweight. My sister has insulin resistance and is on metformin since her mid 20s, but she has all the classic metabolic syndrome features. On the other hand my BMI has never been over 18.5, it's currently about 17. I'm 37, never been overweight, never overeaten (ever) though I was a big drinker in my 20s (now abstinent for 8 years).
I have severe polyuria and polydipsia - that's actually how my addisons got picked up, as they were testing for diabetes insipidus. On those occasions I didn't have sugar in my urine, but it hasn't been tested while my BG was high.
Assuming my OGTT this weekend is also spiking over 11 and then coming into the 'pre-diabetes' range, what should I do next?
My concern is that if I am early 1.5 (given that I have multiple auto-immune problems this seems at least as likely as Type 2), I'd like to get on supportive treatment asap so that I can put off my insulin production failing completely for as long as possible.
Any time my sugar is over 11 I jump on the treadmill to get it down as fast as possible, but of course also when it suddenly swings from 10 to 3.5 I feel like a rageful toddler!
I have a great, engaged, young, interested GP, but I have so much going on with the Addison's as well that this keeps getting pushed to the bottom of the list. (I'm currently on weekly GP appointments because we have so much to sort out).
My questions are:
1) Does it matter? Am I being daft in thinking that it's not ok to just ignore these kinds of hypers?
2) What else can I test myself? Is it worth buying urine-ketone test strips to use when my BG is up in the teens?
3) How significant are spikes at 1-hour post-meal? If I'm coming back down to 10 or less within 2 hours, does it matter if after an hour it's 14?
4) Can I get the auto-immune / c-peptide tests via my GP or do I definitely have to be referred? I'm already under multiple specialists and can't face the thought of another...
Thanks for any perspective or advice,
Cx
Around 50% of people with addison's also have diabetes - half Type 1 (or 1.5) and half Type 2. In a cortisol crisis your BG plummets, and I had a few up and down readings in hospital, so I've been using a BG meter to track hypos to help me get my steroid replacement dose correct.
What I've discovered is that I also have dramatic hypers. So far my record is 22 (white rice in a japanese restaurant). I regularly get post-meal levels in the teens. I am not a big eater and I don't have a sweet tooth, and I'm on a low carb diet, so I'm never eating large quantities of anything particularly high carb. A couple of small roast spuds in an otherwise carb-free meal is enough to send me to 12 or 13.
I did a home glucose tolerance test last weekend (410ml of lucozade original) - peaked at 14 after 1 hour, and at 2 and 3 hours was still at 9. Then I did a minimal amount of housework and plummeted rapidly to 3.5. I have needles and have learned IV access as part of my addision's crisis management, so I've confirmed that my finger-prick levels and venous levels are consistent enough. I always repeat test a level that is unusually high, so I'm confident that the high readings I get aren't just errors.
My GP says my GTT shows that clearly I'm glucose intolerant, and probably diabetic. The complication in confirming that diagnosis is that I'm on steroids, and other asthma meds, that can cause hyperglycaemia, so it's hard to know whether it's 'me' or the meds causing the problem.
I have temporarily dropped those meds that I can, so I'm now only on the minimum maintenance dose of steroid that I need to keep me alive - my BP is on the low side so that confirms that I'm not over-steroided right now, and shouldn't be contributing to hyperglycaemia.
I'm going to repeat the OGTT tomorrow now that I'm on minimal meds, but in making sure that I've eaten 150g of carbs per day for the last 3 days I've regularly had readings of over 11, more than 2 hours post-meal.
My fasting glucose is around 5.8 in the morning, and as I also regularly have hypos I don't think my HbA1C would be high.
My Dad has your classic Type 2 - tipped over to diagnosis at around 60 after 30 years of being seriously overweight. My sister has insulin resistance and is on metformin since her mid 20s, but she has all the classic metabolic syndrome features. On the other hand my BMI has never been over 18.5, it's currently about 17. I'm 37, never been overweight, never overeaten (ever) though I was a big drinker in my 20s (now abstinent for 8 years).
I have severe polyuria and polydipsia - that's actually how my addisons got picked up, as they were testing for diabetes insipidus. On those occasions I didn't have sugar in my urine, but it hasn't been tested while my BG was high.
Assuming my OGTT this weekend is also spiking over 11 and then coming into the 'pre-diabetes' range, what should I do next?
My concern is that if I am early 1.5 (given that I have multiple auto-immune problems this seems at least as likely as Type 2), I'd like to get on supportive treatment asap so that I can put off my insulin production failing completely for as long as possible.
Any time my sugar is over 11 I jump on the treadmill to get it down as fast as possible, but of course also when it suddenly swings from 10 to 3.5 I feel like a rageful toddler!
I have a great, engaged, young, interested GP, but I have so much going on with the Addison's as well that this keeps getting pushed to the bottom of the list. (I'm currently on weekly GP appointments because we have so much to sort out).
My questions are:
1) Does it matter? Am I being daft in thinking that it's not ok to just ignore these kinds of hypers?
2) What else can I test myself? Is it worth buying urine-ketone test strips to use when my BG is up in the teens?
3) How significant are spikes at 1-hour post-meal? If I'm coming back down to 10 or less within 2 hours, does it matter if after an hour it's 14?
4) Can I get the auto-immune / c-peptide tests via my GP or do I definitely have to be referred? I'm already under multiple specialists and can't face the thought of another...
Thanks for any perspective or advice,
Cx
