Addison's Disease?

[Pumper_Sue]

I do know that Sue, it's one of the reasons I have such trouble with Hypos. On a normal day, I'm on 2 HC (or 40mg per day) at the moment. I had some problems with indigestion so I take them with my meals (20:10:10).

Wow that is a lot of HC 😱 double the normal dose.
Do you think you just use it very quickly? I found just using HC on it's own was a diaster with me as seemed to gobble it through my body at a rate of knots.
So to solve the problem I use Prednisolone as well as HC. 5 pred and 5 HC. As pred is longer acting I just take both tablets in the morning. This stopped all the crashes very nicely thank you. 5 pred and 5 HC is equal to 25 mg of HC.

 

[AlisonM]

I was on a lower dose to start with and we ramped it up until things stabilised. I've been on the current dosage since the 'ologists' conference earlier this year and it seems to be working, one of the few things that is going right so I ain't messing with it.

 

[Pumper_Sue]

I was on a lower dose to start with and we ramped it up until things stabilised. I've been on the current dosage since the 'ologists' conference earlier this year and it seems to be working, one of the few things that is going right so I ain't messing with it.

I wasn't suggesting you messed! with it. All I was doing was pointing out what worked for me in the same situation. As 40 mg HC is an awful lot of HC and carries a lot of dangers at that levels (weight gain, high A1's, catteracts and cushings)

The idea was perhaps it was something to discuss with your team if things started to be probmatic again.

 

[AlisonM]

We have, of course, discussed the risks and I am closely monitored and regularly tested. By we, I mean myself and the specialist team at Raigmore (would that the Diabetes people were so on the ball). I've also done my own quite extensive research so that I understand the dangers and benefits.

Unfortunately, I am faced with a whole range of medical conditions each with it's own needs and complications, and the drug interactions are often fearsome. This is another thing that must be considered as we have to be very careful what I take and when. All of this has a serious effect on any possible medications regime and HC, even at this high dose, is causing few problems so far. As long as that continues we see no need to change it when there are other problems more immediate that need sorting. Indeed, the only thing I can't seem to get under any sort of control at the moment is this blessed Diabetes.

 

[Pumper_Sue]

Indeed, the only thing I can't seem to get under any sort of control at the moment is this blessed Diabetes.

This was the problem I had and as soon as I changed to a different action of steroid it stopped the ruddy hypo's big time.
There's a forum on the www. that deals with Addison's and diabetes and another member suggested a change of steroid without the peaks and troughs might work. So after discussion with my team who hadn't even thought of the idea it was agreed for me to try it. Talk about an oh wow feeling.
Hypo's now are of my own making ie miscalculation of insulin or carbs 🙄
Obviously pred can't be used as an emergency dose due to it's slower onset so HC is used for that as is injectable HC if I hit crisis point.

 

[Northerner]

Interesting stuff. Is the fact that carbs don't raise BG due to the fact that you need the cortisol as part of the process to stimulate the liver? I'm always a bit hazy about how directly those jelly babies get into my blood!

 

[Pumper_Sue]

Interesting stuff. Is the fact that carbs don't raise BG due to the fact that you need the cortisol as part of the process to stimulate the liver? I'm always a bit hazy about how directly those jelly babies get into my blood!

I think so Alan.
Interesting thing also is if you look on a glucogen kit it states not to be used with adrenal inaficiency. (hopefully they spelt it better than me lol)
Basically people with addison's have no storage to dump so no point in the injection.

 

[Twitchy]

This is really fascinating stuff! Albeit a tad scary & a bit of a blooming pesk for people with multiple conditions...interacting meds are never much fun. 😱 I still don't have a date for the test yet, wondering how long to leave it before calling the endo nurse myself I did see the GP earlier & he stated in one breath that it's good that the endo seems to be seeking to 'rule out' hypoadrenalism rather than confirming it (as it were) and then in the next confirmed the symptoms did all point that way & it was unlikely to be anything else, doh! If it IS Addisions I just hope it won't stop my Vitrectomy in early '12, I'll have been waiting nearly a year & will be soooooo unamused! Maybe I'll call the endo nurse tomorrow if I don't hear anything today...?!

 

[Northerner]

I think so Alan.
Interesting thing also is if you look on a glucogen kit it states not to be used with adrenal inaficiency. (hopefully they spelt it better than me lol)
Basically people with addison's have no storage to dump so no point in the injection.

So would you need to be put on an intravenous glucose drip to raise your levels, or would a steroid injection work? Am I also right in thinking that glucagon injections don't work if you are intoxicated or if you have already had one in the previous 24 hours, as your liver can't respond?

 

[Pumper_Sue]

So would you need to be put on an intravenous glucose drip to raise your levels, or would a steroid injection work? Am I also right in thinking that glucagon injections don't work if you are intoxicated or if you have already had one in the previous 24 hours, as your liver can't respond?

Hi Alan,
it's a funny thing to say but I can tell the difference between lw steroid hypo and hypo lneed carbs.
Hypo as in need carbs just treat as normal and carry on with life as per normal.
Addison's induced hypo means low blood sugar and low BP and can also involve winning the prize for vomiting. Dehydration is a very big danger.
The only time I have been admitted for a full blown crisis it involved after hours doctor x 2 plus 2 teams of paramedics. They set up an IV line to get fluids into me plus steroids. No glucose was involved at all. Once admitted The drip was continued for 24 hours with steroids 100mg every 6 hours.
The same has happened when needed a GP call out just an extra injection of steroids into arm or leg to tide me over with instructions to ring if going down hill again. ( I tend not to ring as know where I will end up)
Consultant does his nut about this says if you need to inject you come in. (seems a dreadful waste of resources if I can manage)
You then need double steroid dose for 3 days after as well so your body recovers. Washed out rag springs to mind as the feeling.

I'm not sure about the usage of the glucogon injection as don't have one. Liver would be well and truly depleted after booze though so can't see it being any good if nothing to work on.

 

[Ellie Jones]

Yes Alan you'll correct about the Glucogen Jab, not sure though whether it's actual 24 hours, but it can only dump what ever is stored in the liver.. Also if you suffered a series of hypo's in quick succession then this also depletes the liver store (the liver won't re-blemish the store while hypo hence higher risk of a rebound hypo).. So can make the Glucogen pen ineffective..

If a glucogen jab is administered by an ambulance crew then they should automatically admit you into A&E for monitoring in case of a rebound hypo!

I actually didn't know this until last Wednesday, Yep Les had an hypo which I ended up having to call the paramedics out for😡 Ellie did her bit, but alas because Les had dosed off on the settee, he woke up disorientated and contrary and wouldn't have any Jelly Babies would drink anything, attempting to spoon feed him sugar didn't work, I tried wetting my finger dipping sugar to see if I could get that in his mouth... Absolutely having none of it as he got nearer to unconsciousness I got the Glucogen kit out only to find both ours were out of date last month😱

So had no option but to call out the paramedics... We had a newly qualified paramedic who really wanted to avoid the Glucogen Jab due to having to having to go into A&E, so he tried a last ditch attempt to get Les to drink something but failed, then we tried pining Les (the technician, me and flo) so the paramedic could get a cannula into Les, failed both times he managed to get the cannula in, but because Les was fighting us, ended up going through the vein.. So Jab it was

Les was taking a long time to come around after the Jab, I found out why when I looked through his meter.. He had 3 previous hypo's that day 2 at work, and the 'low' he said he had when his mum was here, was quite a nasty hypo! Oh and 2 hypo's in work the day before..

 

[Northerner]

Blimey Les! C'mon mate, get yer act together! 🙄 Sounds scary Ellie, he's very lucky you were around!

 

[Twitchy]

So had no option but to call out the paramedics... We had a newly qualified paramedic who really wanted to avoid the Glucogen Jab due to having to having to go into A&E, so he tried a last ditch attempt to get Les to drink something but failed, then we tried pining Les (the technician, me and flo) so the paramedic could get a cannula into Les, failed both times he managed to get the cannula in, but because Les was fighting us, ended up going through the vein.. So Jab it was
.

That's horrific - am I right in interpreting that as the paramedic didn't want to be bothered with a trip to A&E?? And as a result basically caused unnecessary injury & distress? That sounds like someone who shouldn't be qualified at all if that's how they are 'caring' for people! 😱 Not confidence inspiring at all... Hope Les is recovering well! xx

 

[Ellie Jones]

No it wasn't a dereliction of care or duty of the paramedic, he was honestly thinking of best treatment in the interest of the patient...

Our A&E department is in the next town which is 15 miles away we only have an small injury unit.. So Les's was more than happy to sign a disclaimer form, that's a first before I've just signed to say that I'm happy to take over care of Les..

Mind you, if you can stifle a snigger and maintain a straight face, when muppet (Les) first words has he came round was 'oh I say' in a rather feminine voice...

 

[Twitchy]

No it wasn't a dereliction of care or duty of the paramedic, he was honestly thinking of best treatment in the interest of the patient...

Our A&E department is in the next town which is 15 miles away we only have an small injury unit.. So Les's was more than happy to sign a disclaimer form, that's a first before I've just signed to say that I'm happy to take over care of Les..

Mind you, if you can stifle a snigger and maintain a straight face, when muppet (Les) first words has he came round was 'oh I say' in a rather feminine voice...

Glad to hear it wasn't shortcuts being taken, phew! 🙂 ...and have you told him what he said yet?! Scary time for you though, glad he's ok now! x

 

[trophywench]

LOL at Les - puts me in mind of an ambulance lady asking me to tell her my name as I was coming round. I can remember thinking what a stupid question (?) and saying, Well I do KNOW it, of course. She said eg Perhaps you'd like to share it with us then? Me - I just can't be bothered ! and went to sleep. They carted me into the hosp and once I got there and they came to tend to me, I could actually have sat up and made sense, but just on it the ambulance were doing the handover and telling doc what I'd said, they had a laugh - and I cringed with embarassment and decided to stay 'asleep' for another 10 minutes! LOL

 

[Twitchy]

Well had the test this morning, just back...looking like a 'pin the tail on the donkey' board lol! 🙄 Won't get the results for a while it seems...feeling really queasy which I'm taking as a good sign that something internally must be kicking out some kind of hormonal response to the jab?! Anyhoo, waiting game now...

 

[Northerner]

Well had the test this morning, just back...looking like a 'pin the tail on the donkey' board lol! 🙄 Won't get the results for a while it seems...feeling really queasy which I'm taking as a good sign that something internally must be kicking out some kind of hormonal response to the jab?! Anyhoo, waiting game now...

Hoping for the best possible outcome Twitchy 🙂

 

[Steff]

Hoping for the best possible outcome too Twitch xx

 

[AJLang]

Hi Twitchy hope that they get this all sorted out for you soon and everything starts to improve for you. As we are getting to the end of this year I hope that next year goes brilliantly for you, you deserve it to xx