Fludrocortisone and diabetic nephropathy

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Fludrocortisone and diabetic nephropathy

Postby lucy » Thu Feb 25, 2010 11:19 am

Hi

I'm just wondering if anybody knows....

Diabetics are more likely to get kidney disease due to nephropathy and when you have nephropathy, you should not have a low salt intake (as salt increases BP which is bad for nephropathy).

However, people with adrenal insufficiency on fludrocortisone need quite a high salt intake for it to work properly.

How do the two conditions get managed together?

I can find loads of info on each individual aspect of PAS-II but there seems to be very little on how the separate elements combine.

Thanks
Lucy
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Re: Fludrocortisone and diabetic nephropathy

Postby Poly » Fri Feb 26, 2010 8:07 am

OK, I'm certainly not a doctor, but I'll take a stab! If a person with primary Addison's is on the proper dose of Florinef and the sodium/potassium levels are normal, there should be no need for additional salt intake, unless of course, the person is getting ill; with even a cold, I will crave salt until I increase my cortisone. If a person with Addison's and diabetes develops nephropathy, the ensuing low-sodium diet, I think, wouldn't be a problem. What I would think would be a problem is additional potassium, which I understand is encourage in people with hypertension. Regarding blood pressure, my previous doctor (now retired) once said that, between the Monopril to protect my kidneys and the Florinef, my blood pressure could be whatever we wanted it to be. But, in short, if the Florinef is right, extra salt intake wouldn't be necessary.
Anyone?
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Re: Fludrocortisone and diabetic nephropathy

Postby lucy » Mon Mar 01, 2010 8:26 pm

Hi Poly

Thanks for answering - it's good to know what your doctor said about yoru BP.

Before I got ill, I never ate salt at all but now I find myself salting all my food. My doctor actually told me to do this as she said that fludro works best when there is salt in your system.

lucy
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Re: Fludrocortisone and diabetic nephropathy

Postby Poly » Tue Mar 02, 2010 6:30 am

Lucy,
Something's not making sense here. Do you have primary Addison's disease, i. e., your pituitary is making enough ACTH, but your adrenals don't produce cortisol? If so, your salt cravings should have been very strong, BEFORE diagnosis. Afterwards, if you are on correct doses of a cortisol replacement (hydrocortisone with or without a little nighttime prednisone, for example) and Florinef, a mineralcorticoid that maintains sodium and potassium levels, you shouldn't be craving salt. Your doctor's advice to eat more salt because you are on Florinef, IMHO, doesn't make sense. Typical dose for most people is .01 mg. daily of Florinef, but it can vary some. What were your other symptoms before diagnosis and what was your diagnosis? Also, how long ago?
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Re: Fludrocortisone and diabetic nephropathy

Postby SueM » Thu Mar 04, 2010 8:30 am

lucy wrote:Hi

I'm just wondering if anybody knows....

Diabetics are more likely to get kidney disease due to nephropathy and when you have nephropathy, you should not have a low salt intake (as salt increases BP which is bad for nephropathy).

However, people with adrenal insufficiency on fludrocortisone need quite a high salt intake for it to work properly.

How do the two conditions get managed together?

I can find loads of info on each individual aspect of PAS-II but there seems to be very little on how the separate elements combine.

Thanks
Lucy


Hi Lucy,
I must admit to being a bit confused by your post.
Diabetes well controlled does not mean complications also gentic makeup also plays a big part in whether people with diabetes end up with complications. I've had type 1 diabetes for 45 years and have no complications.
Unless you crave salt then there is no need to keep adding salt to food/meals.
I have just checked the instructions for florinef use and there is no mention of taking extra salt.
If you crave salt then you need to talk to your specialist about your medication as it sounds as if it needs adjusting.
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Re: Fludrocortisone and diabetic nephropathy

Postby lucy » Sat Mar 06, 2010 7:19 am

Hi

Congratulations Sue on not having complications over the 45 years - it sounds like you are a great example of what's possible with good control.
However, 40% of diabetics develop diabetic nephropathy and as you say, some of that is under the influence of genetic predisposition. My control is okay at the moment (low 6s) but I can't control my genes.

I do not have strong salt cravings now although I did have some cravings before starting on medication, especially when my blood pressure kept dropping very low.

However I cannot do without salt now, whereas for many years preceeding my illness, I never added salt to my food or cooked with salt at all.
I currently make all of my food from scratch, so I do not get any salt from processed foods - the only salt I get is the salt I actively add to my food.

I have read of other people on Addy forums saying they need to actively take salt or sodium tablets to keep their sodium levels right, for example on http://www.addisonssupport.com/ there are lots of people saying they drink salt water and take salt tablets along with their florinef.Also on ADSHG (which is a closed forum so I can't quote directly the post) someone was saying their endocrine professor encouraged them to actively add salt to all of their food.

That's why I'm wondering what the interaction would be between one disease (diabetic nephropathy) that requires restricting salt intake, and another disease (adrenal insufficiency) that requires (at least in the case of me and some other people who are on florinef) active salting of food.

I see my endo soon so I will ask if she knows about the interaction and also why she recommends using salt. Maybe she recomnmends it because I don't eat any processed food.

thanks
Lucy

PS. Poly, it was originally thought that I had a secondary problem as I had low ACTH with low cortisol, however after I started on HC, I developed strong aldosterone insufficiency symptoms (dizziness, low BP, dehydration, frequent urination and thirst unrelated to my diabetes). I started on Florinef as well and saw dramatic improvements within days. For whatever reason, it seems I need both HC and florinef.
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Re: Fludrocortisone and diabetic nephropathy

Postby llake » Fri Mar 26, 2010 12:58 pm

When an addisonian has low salt it is usually corrected with florineff, Since it is a replacement does it should be fine.
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Re: Fludrocortisone and diabetic nephropathy

Postby lucy » Sat Mar 27, 2010 12:22 pm

Hi Llake

Thanks for your message.

I asked my doctor about this question. Apparently if I were to develop diabetic nephropathy, it would be necessary to taper down the florinef to the point where my blood pressure was in an acceptable range.

Lucy
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Re: Fludrocortisone and diabetic nephropathy

Postby janemaan » Wed Sep 14, 2011 1:44 am

Is it common to have diabetes symptoms after surgery? My father just had major surgery and after the hospital said he was a diabetic. But I'm a diabetic and have checked his bloodsugar at home from time to time and it has alway's been normal under 100. At the hospital it hasn't been higher than 120 after a meal and 70-80 before so what's up?
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