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Control

Addisons 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 increased.

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 dramatically.
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 my dosage 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 of Addisons:

• 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 Levemir.  
• 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.