Second visit to endocrinology today.

[Karenjaninaz]

Second visit to endocrinology today. I originally went to the endocrinologist because of low blood sugar. She put on a continuous glucose monitor and gave me instructions about managing this problem. At the same time I was on the Diflucan. As time went on my hypoglycemia seem to get worse and worse and so matter what I did. I was up half the night trying to eat based on the results of the continuous glucose monitor which is the drop down to 60. Alarms would go off and I’m walking into the kitchen staring in the refrigerator trying to figure out what to eat. I did join a Facebook hypoglycemia foundation which gave very good ideas about how to eat. So I have incorporated this thing but it turned my life topsy-turvy. Interestingly I felt absolutely terrible on Mother’s Day even though my blood sugar my fingerstick and my monitor was adequate. Sounds like cortisol doesn’t it? The doctor on call told me to take additional prednisone based on how I feel keeping in mind I will be having an appointment in a few days. I begin to research that fluconazole/hypoglycemia/cortisol interaction problem at the in the medical literature. And it turns that drug decreases the natural formation of cortisol in the adrenals. This one has a long half life; I saw two cases reports where cortisol production returned to normal after9 and 11 days based on the synthacten test. So for me it’s just about 11 days since my last dose. The endo suggested I reduce as comfortable realizing my long tapering history. I feel creepy having take. 10 mgm on Mother’s Day; tried 9 mgm the next day but felt ill so took another 5(14total) and yesterday, having had a removal of a long term dental implant(might be allergic to the metal/or PMR?) so I took 10 yesterday amd today. Yikes, I don’t want to be here!

My question is should I try9 tomorrow, then, 8, then 7 decreasing 1mgm daily until I get to 5 where I started? If I feel terrible where do I go/dose?

I think this is unknown territory. I mean can my adrenals accept 5 mgm after this circus?

[SheffieldJane]

I would need instructions from the Endocrinologist whose priority is to support your Adrenal system. This can conflict with dealing with your disease but is more immediately urgent, if I understand you correctly. The decreasing by 1 mg at a time will be gentler on your all round symptoms I think. I did experience conflicting advice from my Endocrinologist and Rheumatologist. I hope this answers your complex question. You do need extra Pred after invasive surgery. Why was it creepy on mother’s day - did it feel inauthentic or something? Apologies if I haven’t understood you.

[Karenjaninaz in reply to SheffieldJane]

I felt like collapse; very weird and strange- rather frightening.My endo understood.

[SheffieldJane in reply to Karenjaninaz]

Then I expect that the stress of a special day was demanding adrenaline that you couldn’t produce, as you say.

[Purpleazalia]

Gosh what a lot you've been through, it must have been a very stressful time. Have I understood correctly that your blood sugar levels are now under control and any ill effects on your usual level of cortisol should have ended?

The sick day rules say you can drop back down to your previous dose if you feel well enough to do so within 7 days of increasing. If you go over 7 days on the higher dose, it advises to seek medical advice about tapering.

I think that if I felt well enough to stop the sick day dose after a few days, I'd prefer to try reducing at 1mg/day to ease myself back down. I'd also be guided by how I felt each day before reducing the next day.

I do hope you feel better soon.

[Karenjaninaz in reply to Purpleazalia]

After discussing with my doctor thats what I’ll try.

[Karenjaninaz in reply to Karenjaninaz]

I add I believe my PMR is in remission for awhile because tapering difficulties at lower doses elicited no pain just feeling very unwell - unable to function. This points to cortisol; who knows maybe pain would come back but I haven’t had any PMR pain maybe in over a year.

[Amkoffee]

I have recently been diagnosed with adrenal insufficiency (Addison disease). My endo started me on hydrocortisone 20 mg a day. That's equivalent to 5 mg of pred. But since your already on 5 mg I'm wondering if you should bump it up to 10 mg of pred. I am not a doctor and am not prescribing anything. It's just a guideline.

[Karenjaninaz in reply to Amkoffee]

Why? I was doing well on 5 but the usage of fluconazole impaired my adrenals from making whatever I was able. The half-life of the drug is long so my adrenals should go back to their previous puny state about now.It’s about 11 days after the last dose. I was taking 10mgm during this sudden crisis for a few days- similar to sick day rule; now going back to 5 after a few days. Today I took 9 and did well.

[Amkoffee in reply to Karenjaninaz]

I didn't start having addrenal insufficiency until about 5 months after stopping pred so I think it can take quite a while.

[Carver63]

coming off Prednisone is slow. i am 12 months in and down to 7mg decreasing 1 mg / month. talk to your doctor about the rate that works best for you. too fast caused lots of relapse issues for me.

[Carver63]

Prednisone is a asteroid that really slows your adrenal gland production and changing dosage too fast can really set you back i have had 3 runs now at reducing my dosage and i go slow. So consider (and talk with your doctor) slowing down the dosage reduction to 1 mg /month. slow and easy has let my body adjust better and i do feel better now most days. fyi i went 60 -50-40-30-25-22.5-20-17.5-15-12.5-10-9-8-7 in monthly intervals this last round. will be trying for 6 in June. will see what the side effects are but i am hoping my body will kick in and fill the gap I don't want another relapse. Wrt blood sugar levels i have had some fluctuation as well and have focused on a low carb diet to help stabilize the highs and lows related to sugar and to help in weight management. hope you feel better and keep reading and responding to Health unlocked I really like the experience sharing with other people.

[PMRpro Ambassador in reply to Carver63]

It doesn't really "slow your adrenal gland production" - the only thing taking pred affects is your production of cortisol and that is like the thermostat stops the central heating boiler pumping out heat for the central heating when there is a different source of heating in the room where the thermostat is. The hot water system still works. The body requires a certain amount of corticosteroid to function - it doesn't care whether it is natural cortisol or synthetic pred and above a certain level it knows it doesn't need any more so doesn't stimulate the adrenal gland to make any.

[Carver63 in reply to PMRpro]

thanks for clarifying. i understood it as a source that when available would cause the Adrenal gland to stop producing cortisol.