Adrenal probs and sugar levels

[yaf_user681_15459]

I really am looking for some advice. I'm worried about my little girl

Maddie is 5, brittle asthmatic, adrenal insuficiency and aspirates.

She changed from maintenance pred to hydrocortisone in June and had massive near fatal attack. Basically her hydrocortisone wasn't strong enough. We have a fab resp consultant. She doubled th hydro immediately. (Was the endo cons who gave initial dose). Maddies asthma thankfully stabilised. However she is sooo tired!! She is weak, sleeping during the day, tired all the time. The resp cons told me to check blood sugar levels before meals which I have been. They are low. About 3.6/3.8 in the morning and the highest they get, even after a big meal and pudding is 5.2.

Her resp consultant is away for 6 wks and the endo cons I just can't trust after the last episode!!

I called the GP today who said increase protein. (Trouble is she can't eat meat as can't swallow it) Will this really sort it all out?? The adrenals are struggling surely?? The gP was kind on the phone but I feel like screaming at the moment. Maddie is so weak..just like when first diagnosed with adrenal insufficiency 3 yrs ago!!

Has anyone ever had this?? She's little so can't tell me how she feels..just says she's tired and keeps sleeping.

What can I do??

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Curiouser is probably better placed to answer this, she's a blood sugar/adrenal stuff genius!! I'll drop her an email in a second see if she is around to help you out

In terms of protein, I'm vegetarian, and I get protein from pulses, beans, cheese, milk, yoghurt, eggs and meat substitutes. I think nuts are as well! Scrambled eggs and cheese are good for protein that's easy to swallow. You can also get protein shakes from most supermarkets and health food shops ATM as they're big for muscle building, but they taste ok and are an easy way to get a load of protein!

It does sound like something isn't right from the adrenal POV and as much as you don't feel like you can trust the endocrinologist, they're probably best placed to advise about that. Remember they almost certainly did things right from an adrenal point of view, it just wasn't enough to manage her resp needs. So go in with the mindset of ""this is the lowest dose of steroids for her asthma, but does she need something more from adrenal POV) . It'd be good for the endo to liase with a resp consultant but I'd imagine that you know her resp steroid needs pretty well.

My thought was that steroids increased blood sugar, so I wonder if there is an underlying infection or something making her body work hard! To me it sounds like she needs properly checking out, I'd bob her to GP and see what they say!!

Sending hugs to little mrs!!!

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Hi Emily - I believe 3-10 is normal range for young children, whose levels are often lower than adults.

In terms of the highest she gets being 5.2, that's fine, I think. In people with an efficient pancreas spikes >6 are very short lived, so unless you'd tested every 5-10 minutes for a couple of hours, you probably missed the 'spike' which then triggered insulin production - or her body matched it in real time. No matter how bad her adrenals were, a big glug of something sugary would bring her levels up until she matches it with insulin, so post-prandial levels aren't an indicator for/against adrenal insufficiency, they only tell you about insulin production.

Although we arbitrarily set 3.8 as the boundary for hypoglycaemia, this would mean that a lot of perfectly healthy young people are borderline hypoglycaemic a lot of the time. In the majority of people anything over 3.5 is fine, and it's not considered 'true' hypoglycaemia until it's <3 (as this is the level at which the brain starts to run out of glucose).

Obviously you should chat to your Dr about it, but true hypoglycaemia in adrenal insufficiency looks more like the 1.x and 2.x range. Generally, I wouldn't say weakness was a symptom of clinical hypoglycaemia - hypos tend to make you jittery as your body makes adrenaline locally to try to raise sugar levels. Though of course the weakness could be a sign of being hypo-adrenal.

I don't think raising the protein in your diet would have as big an effect as just eating more long-acting carbs, especially just before bed. Milk is good (if she can have that).

I think if you tested all the children and teenagers in the UK you'd find a substantial number with those kinds of blood sugars first thing in the morning, so I wouldn't panic too much about that part specifically. It's numbers <3 that you need to worry about. If you get any of those (or even 3.0) then you need to start kicking up a fuss...

Are you doing a bedtime dose of HC? GOSH now advise that to reduce nocturnal hypoglycaemia in children.

The main thing is to get her feeling well... that needs to be the focus.

Of course unfortunately being over-steroided will also cause weakness and lethargy. But if you find that giving her an extra 2.5mg peps her up a bit then that would be a clue that she's under dosed.

Good luck - I know it's all really flipping hard!

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