| My Endo History |
| AddisonsDiabetes Forum
makes controlling diabetes much more challenging. Before
I had Addisons, I was able to have good control over my diabetes with
injection therapy (3 shots/day), diet, and exercise. When my
adrenal gland began to fail, my sugars started to drop
significantly. I started to have frequent and severe hypoglycemic
reactions even after lowering my insulin dosage by 40%. After the Addisons was diagnosed and I started taking hydrocortisone, my health
improved dramatically. I regained my normal energy and weight. My blood sugar control was another story. I
started to have highly variable sugars. Before I had Addisons, I
would rarely have a blood sugar in the 300's and now it was a frequent
event. The frequency and severity of low blood sugars also
In the face of this degradation in control, several changes to my
diabetes therapy were made. These included carbohydrate counting, going
from 3 to 4 shots per day, a higher number of blood sugar tests, and switching from NPH to ultralente
insulin. All of these changes improved my control only
marginally. The real breakthrough came when I started using an
insulin pump. The major shortcoming of injection therapy is long
acting insulin. Long acting insulin has inconsistent absorption
rates which make its action unpredictable. My body
could handle this inconsistency before Addisons but, certainly not
after. Only fast acting insulin is used with the insulin pump
which has a more consistent performance. Insulin delivery can be
customized based on time and amount with the pump to suit individual
needs. My sugars improved significantly after getting on the pump
and most importantly, the number of low blood sugars was reduced
Since initially writing this section, two new long acting
insulins have been released, Lantus
and Levemir, which are big improvements over the older long acting
insulins like NPH and ultralente. Lantus is widely available worldwide.
Levemir is available in European Union countries and release in other
countries will follow. I've heard from several people with Addisons and
diabetes who reported significant improvement in their sugars after
switching to Lantus from older long acting insulins.
The other thing that was done to improve control was to reduce
of hydrocortisone from 25 to 20 mg per day. This reduction in dosage
reduced the variance in my sugars, had no effect on my energy
level, and had no impact on my Addisons related lab tests. You have to
be careful not to reduce the dose too low as the risk of low blood
sugars will increase. Take the minimum amount of glucocorticoid that
maintains your well being and alleviates your Addison's symptoms.
The last bit
of advice I have is to find yourself a good endocrinologist. You
need one who is knowledgeable about diabetes and Addisons and stays
current on these conditions.
In summary, to improve control of your diabetes impacted by the effects
Refine your diabetes therapy: tighter dietary control (carbohydrate
counting), test often, consider insulin pump therapy, exercise. If you aren't a good pump therapy
candidate, consider the newer long acting insulins Lantus and
- Minimize your glucocorticoid dosage (hydrocortisone/prednisone).
Take the minimum amount that maintains your well being and
alleviates your Addison's symptoms.
- Get a good endocrinologist.