# Addison's, Type 1, Exercise and Hypos



## declan88 (Oct 18, 2017)

Hello 
I,ve had type 1 nearly all my life (>40yrs).
About 10 yrs ago, I also developed Addison's Disease- characterised when undiagnosed by extreme and habituated hypoglycaemia through insulin sensitisation, dizziness,nausea, extreme weariness and ultimately death- if not diagnosed.
But it was diagnosed, so I was lucky and treatment is effectively by a few tablets a day, in addition to type1's normal insulin and blood monitoring requirements. Woo, good! 
But almost any exercise (gardening, vacuuming, sport) sends my blood sugar crashing, showing that exercise is a form of stress to the body. 

One day I took karate for 2 hrs. While doing it, I unplugged my insulin pump and had eaten a mars before.  But even with 4L of coke, I was hypo during, after and some time after.  It took some time to restore my blood sugar. I didn't repeat the experience.

Does anyone have Addison's and type 1 and manage to carry out normal exercise?  I,d like to be able to do more.  I used to walk 30 miles with diabetes before I got Addison's, but now I,m frightened to.


----------



## Pumper_Sue (Oct 18, 2017)

What you need to do is take extra HC, your consultant should have told you this.
Basically a non Addison would produce more cortisol naturally to counteract the stress the exercise is causing to your body thus you have to take extra via tablet form.

PS nice to meet another Addison


----------



## declan88 (Oct 18, 2017)

Hi Sue
Thanks for the advice.  I had a feeling it might be that.  But I worry about developing aggressiveness post exercise.  Hmmm.


----------



## declan88 (Oct 18, 2017)

PS Yes it's nice to meet another adder ;-) too.


----------



## ThoseDamnCrows (Apr 2, 2020)

Hi I just signed up to the forum and just browsing through the posts.
I've also got diabetes type 1 and Addison.
I do a lot of running but have never taken any extra HC.
My favourites is 5k and 10k and and  I'm doing a couple of half marathons each year. I've done two full marathons and I was knackered when I finished both of them and I've decided not to do it again. Maybe I should have taken any extra HC for long runs?


----------



## Pumper_Sue (Apr 2, 2020)

ThoseDamnCrows said:


> Maybe I should have taken any extra HC for long runs?


Hello and welcome to the forum. 
It does sound as if you need extra HC and possibly double for the following day as well. Mind you anyone would be knackered running a marathon


----------



## Pumper_Sue (Apr 3, 2020)

This website might be of some help to fellow Addison's https://www.addisonsdisease.org.uk/ @ThoseDamnCrows


----------



## daducky88 (Jun 24, 2020)

ThoseDamnCrows said:


> Hi I just signed up to the forum and just browsing through the posts.
> I've also got diabetes type 1 and Addison.
> I do a lot of running but have never taken any extra HC.
> My favourites is 5k and 10k and and  I'm doing a couple of half marathons each year. I've done two full marathons and I was knackered when I finished both of them and I've decided not to do it again. Maybe I should have taken any extra HC for long runs?




How did you fare with your marathons TDC?


----------



## ThoseDamnCrows (Jun 24, 2020)

It's nearly three years since I did the marathon. It was just for a new challenge. I'm more into shorter runs. But I hit the wall after about 20 miles and was a struggle from there. Little did I know at that time that I should have taken more hydrocortisone. But hey,lesson learned


----------



## daducky88 (Jul 11, 2020)

ThoseDamnCrows said:


> It's nearly three years since I did the marathon. It was just for a new challenge. I'm more into shorter runs. But I hit the wall after about 20 miles and was a struggle from there. Little did I know at that time that I should have taken more hydrocortisone. But hey,lesson learned



That's what i woulda expected.  Mowing the lawn( standard semi) is enough to make my blood sugar sugar fall by 4mM.  I sometimes save the moving until i had a nice scone .


----------



## trophywench (Jul 11, 2020)

daducky88 said:


> That's what i woulda expected.  Mowing the lawn( standard semi) is enough to make my blood sugar sugar fall by 4mM.  I sometimes save the moving until i had a nice scone .



Oh blast - we haven't got a lawn .......


----------



## daducky88 (Jul 11, 2020)

But i think for a marathon, i probably get thru the whole strip of 10mg tabs.
They say i have practically no cortisone production in a synthacten? time course and additions of cortisone are cleared in 1.5 hrs.

I read an unusually good article reporting on cortisone production in normal people.
From 9pm to 3am, cortisone is 20% of the max level.
From 3am to 830am, levels rise to maximum.
From 830am to 9pm levels fall linearly, with 2 bursts in levels toward the maximum at lunch and dinner.  Clearly eating is a stressful acting.  Although speaking for myself... ;-)

Recalling, cortisone desensitises tge bidy to the effects of insulin, 
for T1Ds without addisons, i'd imagine from the articles falling cortisone profile, that insulin dose/ g CHO should fall between 830am and 9pm and be lowest between 9pm and 3am as the levels of cortisone fall across the day with exceptions for lunch and dinner, which as mentioned had bursts of cortisone approach maximum.   The lowest cortisone levels seen at night likely account for raiases likelihood of suffering night hypos.





trophywench said:


> Oh blast - we haven't got a lawn .......




Poor Trophy Wench :'-/


----------



## trophywench (Jul 11, 2020)

daducky88 said:


> for T1Ds without addisons, i'd imagine from the articles falling cortisone profile, that insulin dose/ g CHO should fall between 830am and 9pm and be lowest between 9pm and 3am as the levels of cortisone fall across the day with exceptions for lunch and dinner, which as mentioned had bursts of cortisone approach maximum.   The lowest cortisone levels seen at night likely account for raiases likelihood of suffering night hypos.



Please don't assume anything - it may not make and ass out of me, but .....

My greatest hourly rates of basal insulin are required between roughly 10.30pm and 1.30am and MANY 'early hours' hypos are actually greatly exaggerated by the peak of the activity of something called Lantus!


----------



## Pumper_Sue (Jul 11, 2020)

daducky88 said:


> But i think for a marathon, i probably get thru the whole strip of 10mg tabs.
> They say i have practically no cortisone production in a synthacten? time course and additions of cortisone are cleared in 1.5 hrs.
> 
> I read an unusually good article reporting on cortisone production in normal people.
> ...


Steroids are given/taken on waking as this is the lowest cortisol level time. This is also the highest dosage time as well with a top up at lunchtime and some need and extra 5mg of HC at about 5pm as well.

When I was super active as in 15 horses and a days work on the farm I used to have a mix of Prednisolone and HC this stopped me from running out of steam  As I understand it athletes quite often do the same. I'm having major issues with my BP at the moment IE I stand up and BP drops to 80/60  so playing around with my fludrocortisone to improve matters.


----------



## daducky88 (Jul 12, 2020)

daducky88 said:


> But i think for a marathon, i probably get thru the whole strip of 10mg tabs.
> They say i have practically no cortisone production in a synthacten? time course and additions of cortisone are cleared in 1.5 hrs.
> 
> I read an unusually good article reporting on cortisone production in normal people.
> ...





Pumper_Sue said:


> Steroids are given/taken on waking as this is the lowest cortisol level time. This is also the highest dosage time as well with a top up at lunchtime and some need and extra 5mg of HC at about 5pm as well.
> 
> When I was super active as in 15 horses and a days work on the farm I used to have a mix of Prednisolone and HC this stopped me from running out of steam  As I understand it athletes quite often do the same. I'm having major issues with my BP at the moment IE I stand up and BP drops to 80/60  so playing around with my fludrocortisone to improve matters.



Jeepers Sue, the standing wobbles take me back to prediagnosis which very unpleasant.  I hope you get it sorted soon.
My endo consultant i needed to up my fludro recently although i didnt really feel.any mal effects.  I'm not really sure what the consequences if i hadnt increased my fludro outside of Addisonian consequences e.g. could low flydro lead to renal problems for example.  I asked him what the consequences might be but got a standard Adfisonian consequence reply.


----------



## daducky88 (Jul 12, 2020)

Pumper_Sue said:


> Steroids are given/taken on waking as this is the lowest cortisol level time. This is also the highest dosage time as well with a top up at lunchtime and some need and extra 5mg of HC at about 5pm as well.
> 
> When I was super active as in 15 horses and a days work on the farm I used to have a mix of Prednisolone and HC this stopped me from running out of steam  As I understand it athletes quite often do the same. I'm having major issues with my BP at the moment IE I stand up and BP drops to 80/60  so playing around with my fludrocortisone to improve matters.



Are you.still fludro with a pred +hydroC mix or only with hydroC now?  And if only with hydroC, why did drop the pred?


----------



## Pumper_Sue (Jul 12, 2020)

daducky88 said:


> Are you.still fludro with a pred +hydroC mix or only with hydroC now?  And if only with hydroC, why did drop the pred?


I don't have such an active lifestyle now due to having progressive MS, so hence no need for the pred. Each 1mg of pred is equal to 4mg of HC. Pred lasts a lot longer in the system than HC as well.

The Fludro I suspect needs to be increased in warmer weather as I tend to suffer more when we have higher temps.
I was amazed at the difference in me this morning as managed my normal walk without getting breathless and feeling as if I was going to faint. So all is good


----------



## daducky88 (Jul 12, 2020)

trophywench said:


> Please don't assume anything - it may not make and ass out of me, but .....
> 
> My greatest hourly rates of basal insulin are required between roughly 10.30pm and 1.30am and MANY 'early hours' hypos are actually greatly exaggerated by the peak of the activity of something called Lantus!



In the words Berterolli, " iii knoaa naathing".
Of course your right about total insulin intake ie the combo of basal and bowl head intake.

I make know recommendations for others, merely report the report ;-).

For me, if split the day

Time.  Bolus  Basal. Total. CHO.





Pumper_Sue said:


> I don't have such an active lifestyle now due to having progressive MS, so hence no need for the pred. Each 1mg of pred is equal to 4mg of HC. Pred lasts a lot longer in the system than HC as well.
> 
> The Fludro I suspect needs to be increased in warmer weather as I tend to suffer more when we have higher temps.
> I was amazed at the difference in me this morning as managed my normal walk without getting breathless and feeling as if I was going to faint. So all is good




Well i'm very glad your feeling better .   There's sure a world of difference between better and worse Addison's control.  

I heard pred has a longer lasting effect which is why i dont use it as i found hydroC after 4pm gives me bad insomnia.  I imagine pred would do the same but even worse as it's designed to last longer.


----------



## daducky88 (Jul 12, 2020)

trophywench said:


> Please don't assume anything - it may not make and ass out of me, but .....
> 
> My greatest hourly rates of basal insulin are required between roughly 10.30pm and 1.30am and MANY 'early hours' hypos are actually greatly exaggerated by the peak of the activity of something called Lantus!



Well I did what turned out to be a not so quick look at insulin use across the a few days from different perspectives:
a stnadard theoretical 3 meals (3x40g) a day
actual meals eaten
extreme day values (fish and chip dinner driven which I think equates to about 9 portions with about 1/3 cone of chips)
actual meals average minus extreme meal day
future settings taking accout of blood sugar variations
a comparison of total insulin used between the different calculations

What became apparent is that for combined basal and bolus in different bands of time across the day, the total insulin per hour is
i) less overnight and late in the evening
ii) increases across the day as carbohydrate load inceases across the day
      I tend eat no/little carbs for breakfast, light lunch and occassional moderate to heavy carbs in the evening plus a beer or two.


Time bandDuration hrsBasal rate U/hrBolus g/UActual mealsActual Total rate U/r0000-050050.751200.750500-11306.51.15812.251.391130-18006.51.55.621.252.081800-220041.35.6413.132200-240020.956.600.95rates and meals - actual average of last 3.5 days




Time bandTheoreticalActualExtremeActual Minus ExtremeFuture0000-05000.750.750.750.750.850500-11301.921.391.251.391.311130-18002.602.081.502.082.081800-22003.093.136.801.903.132200-24000.950.951.100.950.95Comparison of Total Insulin Used (U/hr) Theoretical, Actual, Extreme, Actual Minus Extreme and Future Insulin utilisation rate

which all goes to totally undermine my theory. Back to the drawing board. Think I need a beer now.


----------



## Pumper_Sue (Jul 12, 2020)

daducky88 said:


> I heard pred has a longer lasting effect which is why i dont use it as i found hydroC after 4pm gives me bad insomnia. I imagine pred would do the same but even worse as it's designed to last longer.


I used to take my pred at 7am and found it ran out about 5pm in the evening. The best part was no peaks and troughs.


----------



## daducky88 (Jul 12, 2020)

Thanks.   I read perhaps the best combo was pred as background with hydroC at lunch and predinner to mimic the natural peaks at meal times.  Hmmm.


----------



## Pumper_Sue (Jul 12, 2020)

daducky88 said:


> Thanks.   I read perhaps the best combo was pred as background with hydroC at lunch and predinner to mimic the natural peaks at meal times.  Hmmm.


I took my pred in the morning with 5mg of HC and did very well on it. Now changed back to all HC so take 15 HC AM and 10 at lunchtime. (That's if I remember.)


----------



## daducky88 (Jul 18, 2020)

Pumper_Sue said:


> I took my pred in the morning with 5mg of HC and did very well on it. Now changed back to all HC so take 15 HC AM and 10 at lunchtime. (That's if I remember.)



Thanks Sue.
And you didnt feel tired by dinner time?


----------

