I’ve suffered from adrenal insufficiency since at least 2007, having badly failed an ACTH-stim test and a subsequent diurnal saliva test. I made some cortisol, but it was low enough to keep me bedridden.
I began treatment in 2008 with hydrocortisone dosed throughout the day. After a few years, tired of my alarm going off all day long, I switched to dexamethasone because it only had to be dosed once a day.
When I began seeing my endo, she switched me to prednisone, as she felt that was the best treatment for adrenal insufficiency and I didn’t really object. When I began this experiment, I was on 5 mg in the morning and 2 mg in the afternoon.
Note that this is a physiological dose, not a pharmacological dose. When being treated for an inflammatory disorder, much higher doses of prednisone are involved. My dose was intended to just replace the cortisol I was not making.
My full adrenal history and a description of how I got help is documented on my previous blog, where I was attempting to heal via real food, Deductive Seasoning. If you currently suffer from adrenal fatigue, I highly recommend you read it; my adrenals were so fried that I was literally bedridden most of the time.
When I saw my endo at the end of August 2019, I had suggested we try weaning the prednisone.
Anytime you’re on a corticosteroid, it has to be weaned, because having an exogenous source suppresses your adrenal’s production of cortisol. And I’d been on one or the other for 11 years, so it was a guess as to whether or not mine would come back.
My hypothesis was if reducing pancreatic fat could improve insulin production, perhaps a reduction in adrenal fat could improve cortisol production.
Besides, I was having to dose insulin to “cover” my morning prednisone dose, and that just irritated the heck out of me. I wanted off the insulin!
So with my endo’s support, I began.
|date||what I did and the results|
|Sept 11, 2019||I reduced my dose from 5 mg morning and 2 mg afternoon to 5 mg morning and 1 mg afternoon. I felt kind of crappy for a few days, tired in later afternoon and early evening. But it wasn’t too bad, so I decided to give it time.|
|Sept 18, 2019||I dropped the afternoon dose entirely, so just remained on the 5 mg in the morning. I had a similar reaction; I felt poorly for a few days, then bounced back.|
|Oct 2, 2019||I went for a blood draw to test my morning cortisol. The draw was at 9 AM and I didn’t take my morning dose until afterwards, so could assume whatever the test showed would be what my adrenals were making. When I got the results, I saw my level was 9.1 mg/dL and the lab range was 2.5-19.5, so I was pretty close to the middle of the range.|
|Oct 10, 2019||This wasn’t directly adrenal-related, but this is the day I began using my Libre for bG testing. Rather than just testing at a moment in time like most bG meters, the Libre tests continuously, producing graphs showing what bG is doing 24/7.|
|Oct 16, 2019||I reduced my remaining morning dose to 4 mg. I noticed on my Libre that I had two morning peaks, one that began when I woke and a second after I took my meds. This meant my Dawn Phenomenon was back, Dawn Phenomenon being when cortisol normally rises before one awakens, which then raises bG to give you energy to start the day. Seeing 2 Dawn Phenomenon peaks meant my adrenals were awake!|
|Oct 22, 2019||Because I had no symptoms at the previous reduction and had an obvious Dawn Phenomenon happening, I decided to jump down from 4 mg to 2.5 mg. Also, I only had 1 mg and 5 mg pills; it was easier to take half a 5 mg pill than 3 of the smaller pills.|
|Oct 30, 2019||I weaned down to 1 mg with no symptoms whatsoever. Woohoo!|
|Nov 4 – 6, 2019||I had a minor respiratory infection. Because illness uses up cortisol, often requiring stress dosing for those who rely on exogenous steroids, I decided to postpone weaning for a while.|
|Nov 14, 2019||Having not needed to stress dose and being fully recovered, I stopped all prednisone.|
|Nov 25, 2019||Having been off prednisone for well over a week, I went for another morning cortisol test. Though honestly, I’d forgotten there was a morning cortisol test scheduled, I just went for blood work in general, so was late. At 11:30 AM, my value was 8.6. The morning range only applies to draws from 5-9 AM, so this was a wonderful result, to still be close to the middle of the morning range of 2.5 – 19.5, even though my level ought to have been dropping for hours.|
|Nov 27, 2019||I saw the endo and excitedly said that I seemed to be OK, but might need a bit of hydrocortisone now and then for stress dosing. She suggested we find out, so we did sort of a semi-ACTH-stim; she gave me the shot and we tested my cortisol an hour later. Before they even did the blood draw, I knew I was either massively making cortisol or having an adrenaline rush. When the labs came back, my level was 26.97 ug/dL! Given the top of the morning range (when cortisol is expected to be highest) is 19.5, my adrenals are great at handling stress!|
Having kicked prednisone to the curb, the next step was getting rid of insulin for good.