Unwell on Mother’s Day.

[Karenjaninaz]

Unwell on Mother’s Day. My sister and I have had hypoglycemia for many years. But we were able to manage it quite easily. As I taper down the prednisone to around 4 to 5 mg my hypoglycemia tend to get worse but I was able to manage it pretty well. I consulted an endocrinologist who then suggested I go for a second opinion because my case was complex. In the meantime I needed to take fluconazole for thrush. Now my blood sugars are so low and so hard to manage that my life is really unmanageable. My endocrinologist applied a continuous sugar monitor backed up by fingerstick sugar checks. The last few nights My sleep has been so disturbed by responding to the low glucose monitor alarm. I tried different recommended modalities so that I could have a halfway decent sleep. Now I suspect that my adrenal sufficiently was made worse by the fluconazole. I believe this is the reason why my blood sugar is so crazy. I made an emergency call to the doctor’s practice. She immediately responded and we discussed taking extra prednisone to control this until I have further evaluation. I had taken already an extra 5 mg over the 5 mg I take every day because I felt so ill and I canceled a trip to visit my family in New York. She also suggested taking one more 5 mg in the evening if I still felt so ill. As of right now I think the prednisone is making me feel a little bit better because I was dizzy shaky belly aches a real mess. I suspect my adrenal insufficiency is worse as a result of that medication the fluconazole. In the literature it says eventually that the adrenal insufficiency will return to its previous state which in my case was not great to begin with. Any ideas folks?

[SheffieldJane]

I may have missed this, but has the doctor taken you off fluconazole? A quick google search showed that there could be a drug interaction that increased the effect of diabetic medication causing low blood sugar. I am surprised that the Endocrinologist has suggested you seek a second opinion. Have they recommended someone specific?I imagine that this query is beyond the skills of most people on here except perhaps PMRPro.

[Karenjaninaz in reply to SheffieldJane]

Jane, I am a retired nurse anesthetist/practitioner. I am not on diabetic medication-so no interaction there in my case. The first endocrinologist said I “am a complex case” and to seek another opinion in NY at Mt. Sinai Hospital; my new endocrinologist, who I just saw last week, was trained there.

The fluconazole was prescribed by a doc at our walk-in clinic for thrush from my inhaler. They usually order a “swish and swallow”med which never worked in the past but fluconazole worked in the past so he gave me the lowest dose. When I consulted the second endo- who applied a continuous blood sugar monitor I was in this drug for a few days but then my hypoglycemia became so often and hard to manage I wondered about fluconazole as making it worse. I consulted the professional literature and, indeed, that drug can reduce adrenal function. I stopped it on my own after 6 days of a 7 day course.

I felt so ill today I called the endo on call who suggested I double my dose(5 if doubling wasn’t enough to take another 5 at bedtime.

Since the second pred my sugar has stabilized and not really gone up excessively.

[SheffieldJane in reply to Karenjaninaz]

So sorry. I sincerely hope this is resolved soon. X

[PMRpro Ambassador]

"In the literature it says eventually that the adrenal insufficiency will return to its previous state "

Is that referring to poor adrenal function secondary to long term pred or as a result of the fluconazole?

[Karenjaninaz in reply to PMRpro]

The literature says “returns to normal”

That presupposes it was normal in the first case. Not normal in my case. Hopefully to the level I was at: 4-5 mgm.

[Songbird69]

Hello. It was so strange reading this, as I took a Fluconozole and I had a very similar reaction to you - literally a few days ago. I upped my pred immediately from 3mg to 10mg - and worked a fast taper back to 3mg just today. It seems fine now. I never saw a connection until I read your post.

[Karenjaninaz]

How long did you stay upped dose before the fast taper? How long were you on Fluconazole? For me 6 days; did not take the last dose of the 7 day regimen (100mgm). I feel immensely better today after the extra 5mg this morning.