Is there an "in between" phase of diabetes ?

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Is there an "in between" phase of diabetes ?

Postby mootech » Thu Jun 05, 2008 12:24 am

Hi, new guy here, though I've been haunting Addisons newsgroups off an on since the internet sprung up. Basically I have Addisons, Type II diabetes, Candidiasis, Osteoporosis, and recently Uveitis. (45yr old male) Heres the readers digest condensed version:

Diagnosed at 6mos old with Systemic Mucocantaneous Cadidiasis. Spent the better part of my childhood in Emory University and NIH in Bethesda being the lab rat for such goodies as ketoconizole, clotrimizole, and Ampheterison-B. My Candida started as thrush and diaper rash, then went on a rampage. Both hands and feet up the the ankles and wrists were covered, along with mouth, throat and esophagus, scalp and crotch area. After the second round of Ampheterison-B, and the removal of all my fingernails and toenails, I was pretty well cleared up except for the internal stuff.

At age 13 I went in to get my esophagus dialated, and didn't come out of the anesthesia for 6hrs. Subsequesnt trip to NIH got me to a Dr that diagnosed Addisons. (which I probably had since birth, but it's the chicken and the egg scenario) They handed me Hydrocortisone, Synthroid, and Florinef, patted me on the butt and I was off !

Somewhere in my mid thirties I started getting Hypoglycemic, which then turned into Type II diabetes. The Osteoporosis came in my 40's as a result of the steroids over the years. Uveitis was kinda like the extra parting gift I got with the diabetes diagnoses.

So heres my big question,.......is there and "in between" stage of diabetes ?? I'm not insulin dependent, I control everything with intake, but my A1C is high enough for the Type II diagnosis. (roughly 6.8, used to be 7.2 but I lost some weight) If I eat like a diabetic, I get sugar drops like no ones business, down to the 60's and below. But if I eat normally, and just watch carbs, I tend to do ok. (example: I can eat 3-4 slices of pizza, top off at 185, and be below 100 in 2hrs) I've never gone over 255, and that's rare, and again, I'll drop back down to normal or under in 2hrs. I don't dare take anything for the diabetes anymore, Metformin dropped me into a 2hr battle to get my sugars back into safe range one night. I've heard Prednisone can raise sugars, which is what I've been taking since about 1995, but I started out on Hydrocortisone when I was diagnosed. (the HC had me either bouncing off the walls, or comepletely exhausted, it was a roller coaster) I'm wondering if the Prednisone (7.5mg every morning) is giving off a false A1C reading ? Or is it possible to have just enough pancreas function to work intermittently, and cause the high / low spikes ?

Sorry to ramble, thanks in advance !

Mike
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Re: Is there an "in between" phase of diabetes ?

Postby gkardel » Sat Jun 07, 2008 12:39 pm

Hi Mike,

Welcome to the forum. Wow you have an interesting case. Given your conditions, sequence and age of occurrence, you may have what's called polyglandular autoimmune syndrome type 1. In this syndrome there's a clustering of multiple endocrine gland insufficiencies. The three primary conditions in PAS type 1 are chronic mucocutaneous candidiasis (occurs first), hypoparathyroidism (causes osteoperosis), and autoimmune adrenal insufficiency. Here's some reading on this: http://www.emedicine.com/med/TOPIC1867.HTM. Ethnicity can also play a role in this syndrome and this is detailed in the above article. Knowing that you may have this condition is important as it can tell you what conditions to look out for in the future. Type 1 diabetes can be associated with PAS type 1 although it is less common.

In regards to the diabetes, to differentiate between type 1 and 2 you should have a fasting c-peptide and insulin level test. You can also get tested for GAD65 and islet cell antibodies. Here's some reading on this: http://www.medscape.com/viewarticle/449804

How was your Addisons diagnosed? 7.5mg prednisone in the morning is generally not the recommended way to treat Addisons ( too high of a dose and usually not best to take it the morning). This high of a dose of pred will definitely mess with your sugars. You also mentioned you take synthroid. Do you have hypothyroidism? This is another condition that can be associated with PAS type 1.

Glenn
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Re: Is there an "in between" phase of diabetes ?

Postby mootech » Sun Jun 08, 2008 12:32 am

Thanks Glenn !

The Poly Type 1 is something I've heard mentioned before with doctors lately, but back in the 60's - 70's when I was diagnosed, they hadn't put any of this together yet. I was actually told that my Candidiasis attacked or destroyed my adrenals, causing the Addisons. The hypothyroidism was probably diagnosed the same time the Addisons was, because thats when they started me out on Synthroid. But, for some odd reason, an endo I had in my late 20's discontinued the Synthroid. He said I didn't need it anymore, I've been wondering about that ever since. I originally was on hydrocortisone (probably 20mg a day, been awhile) but as a kid I was bouncing off the walls with that stuff. The highs and lows were just crazy, and I asked for something different around age 32 or so. The 7.5mg of Prednisone is what I was prescribed. It's definately alot more stable, but I have to wonder if it isn't what excellerated the onset of the diabetes and the osteoporosis. I do take Calcitriol and Caltrate, since a major calcium drop nearly killed me a few years back. Thats was worse than any crisis I'd ever had.

The Addisons diagnosis was one of those weird things of being in the right place at the right time. When I was a baby, the Dr who had diagnosed the Candidiasis was Dr Charles Kirkpatrick, this was in Kansas at the time. He moved to Atlanta and Emory University, and my dad packed us up and followed. We worked with him at Emory and through the CDC trying all kinds of crazy stuff to combat the Candidiasis. When Kirkpatrick got a gig at NIH, we kept in touch. After the "anesthesia incedent" my old man called Kirkpatrick at NIH, and summer vacation was in Bethesda ! They were stumped, until an endocrinologist there came up to me, asked me if I was "always that tanned",......and "if I craved salt". I answered yes to both, they did the tests, and bingo, I was a winner !

The ethnicity thing is a new one, I'd never heard that before, but after reading the link you posted it makes sense. Funny thing is, I'm adopted. Never found my birthmother till I was 28yrs old, or my birthfather till I was 40yrs old. Come to find out my birthfather is Italian, go figure. (Pellegrino on Grandfathers side / Spoto on Grandmothers) I know the Spoto side is Sicilian, but the other side of the family is definately northern boot.

Through my 20's and 30's I was totally guilty of putting my condition on "cruise control", basically avoiding Dr's at all cost. Growing up in research hospitals will do that to ya. But even now, I'm without an endocrinologist. I do have a great internist thats pretty good, but she keeps trying to get me to go to an endo. Problem is I gotta find one I like, or basically one I don't want to beat with a stick. (last one told me my sodium count was too high,.....yet I take Florinef, we got into it)

As far as the morning doses, I've been doing that all my life really. I've functioned pretty well like that, and no one ever told me any different. But I've always wondered if the 7.5 of Pred wasn't jacking up my sugar numbers ! I'll have to talk to the Doc about fiddling with that dosage, or maybe just going back to the HC. And I need to check about the Synthroid also, haven't taken it in 20yrs probably, there has to be a reason why I'm not...... or why I should !

Thanks again, I gotta go read the Diabetes link now !

Mike
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Re: Is there an "in between" phase of diabetes ?

Postby Wanda » Sun Jun 08, 2008 7:04 am

Mike,
I am surprised that you take so much prednisone at once when you have diabetes. Does your doctor actually know you take it all at once? It would be better to take 5mg a.m. & 2.5mg about 4 or 5pm. Your max dose of prednisone could have caused the diabetes & osteoperosis. Would be better yet to take hydrocortisone split in 3 doses.

Take care,
Wanda
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Re: Is there an "in between" phase of diabetes ?

Postby mootech » Sun Jun 08, 2008 8:12 am

Wanda wrote:Mike,
I am surprised that you take so much prednisone at once when you have diabetes. Does your doctor actually know you take it all at once? It would be better to take 5mg a.m. & 2.5mg about 4 or 5pm. Your max dose of prednisone could have caused the diabetes & osteoperosis. Would be better yet to take hydrocortisone split in 3 doses.

Take care,
Wanda


Amazingly, since I switched to Pred (about 1995 or so) I've had a total of four different doctors, one of which was an endo. None of them ever questioned the dose or the timeframe. I've been tossing back a handfull of pills every morning for nearly 35yrs now, the only thing anyone every said to me about it was "not to take things with coffee".

As for the diabetes and osteoporosis, I'd love to blame it on the Pred / dosage. But I've probably brought it on myself. Back in the 70's they handed me a Rx and said "if you take these, you'll be just like any other kid. If you feel sick or tired out, double up. If your under stress or have a cold or flu, double up." Needless to say, I doubled up,.....alot. Took HC like candy in my teenage years. I was an athelete, and it helped keep me up with the other kids. (not saying it was a bright thing to do, just saying I did) And I had a "dark period" so to speak, in the 80's, where I'm pretty sure I was drunk from 1983 to 1990. (quit drinking in 1990,.....stopped smoking in 2000) And yes, my liver enzymes are fine, go figure.

I'm just happy to still be alive. :mrgreen:

Mike
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Re: Is there an "in between" phase of diabetes ?

Postby gkardel » Mon Jun 09, 2008 9:47 pm

I was put on a very low dose of synthroid about 10 years before I was diagnosed with Addisons and hypothyroidism. The doc I had at the time tested me for thyroid antibodies and I was positive. He put me on the synthroid to trick my immune system to stop attacking my thyroid.

You should get an intact parathyroid hormone and calcium level test to evaluate the function of your parathyroids.

You should try to see a good endocrinologist to help you figure out what's going on.

There's a big debate regarding pred and HC on what's a better med to treat Addisons. Each has weaknesses and people respond differently to these meds. Pred is a stronger steroid, has a longer half life and has a bigger risk of side effects compared to HC. 7.5mg pred per day is at the high end of the recommended dosing for Addisons. You should talk to your doc about trying to get down to 5mg per day. This would ease the pressure on your sugars.

Glenn
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