Hypoglycaemia & sleep

I'm finding these days I have to be ever more careful what I eat, and as much when. If I go for anything more than 3-4hrs without eating during the day, the night's sleep is destroyed as I either can't get to sleep or wake early (~4am). If I wake I'm usually upset/angry (not about anything specific, it seems to be blood sugar related) and it can take hours to recover from the stress burst and sleep again.

Usually the only solution during the night is to eat, eat, eat (eggs usually), so I'm putting on weight and all this eating is making me heavy, and more tired. It's driving me crazy as all I need to do is eat one bit of food a little late, I get a bad night's sleep, which relapses me. I manage my pacing etc pretty well, but if I can't sleep it's game over. Dr Enlander told me to just eat regularly and use whey protein shakes, but the precision required requires almost super-human timing and skills.

It seems likely what I'm experiencing is hypoglycaemia but it seems odd it's happening as much as it is as I don't eat much in the way of sugar, and although I eat carbs (bit of potato, wheat flour) the vast majority of my diet is eggs (6+ a day), fish and vegetables (peas, carrots etc).

Is anyone else seeing these sorts of issues? I'm wondering if I need to consider cutting the carbs right down, so I'm basically eating a diet somewhat akind to ketosis/Atkins - fish, avocado, butter, veg, nuts, etc. I'm interested in recommendations of books on hypoglycaemia or resources that give practical advice on management. I'd really appreciate any tips from anyone who's been here.

Ollie

Hypoglycaemia causes adrenaline and cortisol release - so as to balance blood sugar from reserves. Night time waking is common.

This is something I've been dealing with for a few years. Things I've noticed - snack before bed is important. Toast with butter and peanut butter works well for me. Lately I have found eating a bigger breakfast - eggs, toast and peanut butter has stopped this need for a pre bed snack. But you need to find what works for you.

Adrenal gland issues are common in people with ME. As the adrenals regulate cortisol production you can see that this starts to tie in with the blood sugar problems and hypoglycaemia. Dysfunctional adrenals can cause cortisol patterns to completely switch. Do some research into adrenal fatigue to learn more about this. There's loads online. This guy has some of the best info:

http://www.drlam.com/articles/adrenal_fatigue.asp

I don't agree with the advice you've been given on whey protein shakes. For me a shake will be broken down in half an hour and I'll feel worse. You need to find what eating pattern works best for you. For me Paleo did well for a couple of years and now I've started adding in more carb as it's giving me more energy. You could also have underlying food allergies making things worse. For me wheat and dairy makes me gain weight.

Your diet also sounds rather restrictive. Some people are allergic to eggs and don't realise it. I eat 3 a day. 6 is quite a lot. The reason I'm mentioning this is that with ME in particular your body is starved of the necessary nutrients it needs so eating the most nutrient dense food possible is really important. Unfortunately when our bodies are worried about starving they often hold on to excess weight or even add loads more.

Hi Ollie. Sounds a bit like my past experience. I'd had ME/CFS 8 years, was going downhill, poor sleep, needing to eat frequently, while losing interest in most foods. I serendipitously discovered Gut and Psychology Syndrome and started the GAPS diet. This changed my life. Thus I uncovered my life-long celiac disease, so-called asymptomatic, because my gut was never my primary complaint. I've been on the GAPS diet 1.25 years, finally getting better. There are additional things I've learned since, and implemented, that have had radical effects on my health, ie. pyroluria, and genetic testing.

GAPS is similar to Atkins in that it initially is low carbohydrate. No starches until gut is healed. Meals rely on meat broth, fat, meat. Plus cooked veggies, juicing when tolerated, and slowly adding in foods as tolerated. My diet is quite limited, as I uncovered sulfur and histamine intolerances. So, no eggs, cabbage, yogurt, no avocados because of histamines, etc. But I've never felt better. GAPS eating can be a real challenge, as there's prep time involved, and the ability to socialize in situations w/ food can be difficult. But for those whose health has deteriorated it can be a gift of life. I follow a couple GAPS yahoo forums, there are countless blogs, you can get lot's of help, if you choose this path. I'm currently treating gut bacteria and metals detox. Hopefully this process will allow me to add in more foods. Best to you, ahmo

All those advised are true. Me and my son had it, also histaminosis, mastocitosis etc. Now we are doing parasite protocol and allergies are retreated, headache also, gut problems also. I did enormous labor to prove parasites with no significant result. I'm glad that I started the protocol and will write as soon as I have more to share.

There are unknown parasites as this one, so you never know for sure:

http://arxiv.org/ftp/arxiv/papers/1301/1301.0953.pdf
http://arxiv.org/ftp/arxiv/papers/1301/1301.2845.pdf

I'm very interested in what you've said about parasites. The links you posted are interesting. What is the parasite protocol that you are on?

This is the author of the protokol : http://andreaskalcker.com/index.php/en/health/parasite and I'm attaching the same protocol in readable form. It's important to know the full moon calendar and start according to it. I'm not using MMS. I'm practicing enemas with milk and salt and water only enemas. The grey on the calendar is the full moon day. So ask if something is needs clearance. The most important thing on the protocol after meds is this: Diatomaceous earth which I order from here human type one: http://diatomx.co.uk/

I'm finding these days I have to be ever more careful what I eat, and as much when. If I go for anything more than 3-4hrs without eating during the day

Yes this definitely sounds like hypoglycemia. Could be reactive hypoglycemia. Step 1 is to keep a detailed food journal. See if there are any patterns.


the night's sleep is destroyed as I either can't get to sleep or wake early (~4am). If I wake I'm usually upset/angry (not about anything specific, it seems to be blood sugar related) and it can take hours to recover from the stress burst and sleep again. Yes, hypoglycemia can really cause all kinds of emotional extremes For me, I always find that a combo of protein/fat/carbs, or carbs/high fibre really works for snack before bed. If it is all protein/fat then I find as well that I get a drop in my sugars. I have found that I need some carbs to prevent me from going too low too. The lows are what are likely waking you up. As when your sugars drop suddenly (doesn't even have to be critical low, it is the suddeness of the drop - i.e. reactive hypoglycemia) it signals, "emergency," and you get an adrenaline rush what has the purpose of mobilizing glycogen stores from liver to ensure that you don't die (good thing . There are basically two issues going on here that you are talking about: sleep onset, and sleep maintenance, and they both have their own individual set of possible interventions. With sleep onset, I find that it has more to do with the quality and macronutrients of the food (as spoke above), but also the food needs to not be agitating in anyway. You have to figure out what foods leads to agitation. I would recommend doing a strict elimination diet & food diary similar to what is suggested above re: GAPS diet. A recent discovery for me was the role that high copper foods are playing in interfering with sleep onset due to causing neurological distress (mind racing). As well, I am highly, highly sensitive to glutamates, and struggle with glutamate to GABA conversion (mind racing). So for example the other night I ate some chicken that had been fried with some non-pasteurized honey. Unheated honey, I am fine with, but I figure the heating process caused more free-glutamate, and wham- bam - mind racing, can't get to sleep. You have to find out what your triggers are.




In regards to sleep maintenance, the right combo of fat/protein/carbs can see you through the night, but you might also want to look at your serotonin function. Impaired melatonin function can cause sleep maintenance as well as sleep quality issues (less REM). If this is an issue, you need to also work on refraining from bright lighting before bed as bright light can affect melatonin function.

Lastly, heightened cortisol at night due to compromised adrenal function can interfere with all stages of sleep. I use Seriphos a product made through Interplexus (you can get it from iHerb), which is amazing. It is a concentrated form of Phosphatidyl Serine. You may need to use a lot, I take 8 tabs a night, 3 - 2 hours before bed, and 5 @ bedtime.

Usually the only solution during the night is to eat, eat, eat (eggs usually), so I'm putting on weight and all this eating is making me heavy, and more tired. It's driving me crazy as all I need to do is eat one bit of food a little late, I get a bad night's sleep, which relapses me. I manage my pacing etc pretty well, but if I can't sleep it's game over. Dr Enlander told me to just eat regularly and use whey protein shakes, but the precision required requires almost super-human timing and skills. I agree with what was said above. I have never had success with whey protein shakes or any other highly processed foods. My advice would be to start with a "clean diet" (free of preservatives and additives), that is moderately low in carbs. Although you often hear the advice to eat more complex carbs like grains, I found that these spiked my sugars the worst. The reason why you are having the hypoglycemia can be complicated. As already suggested the adrenals play a big role in blood sugar regulation, but the VDR Fok/COMT gene is involved with Blood sugar regulation. As well disrupted gut function can wreak havoc on blood sugar control. You will find out what your perfect storm is as you go along. For me, gut function has always been huge, and I found more simple fruit sugars to be easier to digest (more upper gut) and to cause less difficulty than complex carbohydrates which are thought to be digested lower in the gut where I have a great deal of problems.

It seems likely what I'm experiencing is hypoglycaemia but it seems odd it's happening as much as it is as I don't eat much in the way of sugar, and although I eat carbs (bit of potato, wheat flour) the vast majority of my diet is eggs (6+ a day), fish and vegetables (peas, carrots etc). Eggs are really high in sulphur. Have you explored the idea of CBS mutation? I recently took some sulphur based antibiotics as part of a parasite therapy, and it pushed what was already a baseline sulphur problem into crisis. ++Allergy like responses (racing mind, adrenaline rush, can't sleep) - keep in mind that the "adrenaline" like symptoms/heightened cortisol from immune response could be coming from food sensitivities as well. As soon as I did sulphur protocol these all disappeared. It's possible that you have more than just one thing going on. If you are eating that many eggs, it would serve to stabilize your sugars, and shouldn't give you issues, unless you are sensitive to them.

Is anyone else seeing these sorts of issues? I'm wondering if I need to consider cutting the carbs right down, so I'm basically eating a diet somewhat akind to ketosis/Atkins . Yes there is much to be gained from taking a look at how carbs are working for your body. More carbs often means more insulin demands, which puts extra stress on your adrenals, which likely are already stressed. However, I also find extremely low can be stressful for the adrenals as well. I haven't thoroughly researched it, but I found that there were ebbs & flows as to when I could go extremely low carb, and when I couldn't. I think for a woman, it is also related to cycle, and there has been considerable work done in regards to muscle-building phases & fat loss phases related to carbs & menstruation cycle.
Something else worth exploring is what are you referring to as "hunger?" Is is hunger pangs, burning sensation, empty, hollow feeling in tummy, or systemic hunger. What I refer to as systemic hunger is what individuals who are balanced might feel. It is not a ravenous, must eat now hunger, or a burning sensation, it is more related to a motivation to eat. I had some irritation in my stomach, not an official ulcer, and I have to take an acid suppressor right now (tried everything natural), until it heals. I think it might be a weakening of stomach lining. Anyhow, sometimes there can be actual issues with GI tract/stomach that can also be contributing to constant hunger.
Lastly, for me, graded exercise, focusing on muscle resistance, was **key** in stabilizing my reactive hypoglycemia. Increased lean muscle mass goes a long ways in combating any insulin resistance that can be part of the hypoglycemia train. As well dietary: high fibre (increased flax/chia seeds) as much at meals helped, because it slows the digestion (Diabetes expert here @ hospital where I work identified hypoglycemia as often this mismatch between the digestive system & pancreas), and I took Chromium for a long time; I likely was deficient, as this gets burned out from high-carb, refined sugar diet from my youth. I also used a product called Cinnamon force for a long time too.

Best of luck! Star

Thank you so much for the replies. Since I posted I tweaked my diet so it's now mainly fish, vegetables, avocado, flax seeds and eggs. About 10-20% of my diet previously was carbs of some sort - wheat flour, potato, fruit, but for now I've dropped those. I'm cutting the eggs back to 3x per day, and replacing the morning eggs with a smoothie of water, avocado and whey protein, that seems to work ok. I'm trying to eat a bit more in the mornings than I was.

So far I've noticed three things:

1. My urine smelling a bit weird (sort of sweet)
2. It seems to be harder to get to sleep (using meds much more often, rather than just melatonin)
3. I seem to be waking less early in the mornings
4. The fatigue is worse, and anxiety up.
5. Cravings for carbs and sugar

I'm going to hang in for a few days more as it may be some of the downsides are just my body adjusting to a new diet.

I take chromium as a matter of course and often cinnamon too, but not sure they help with me. I find connecting the input (food, etc) to the symptoms very hard as things are often delayed, so hard to make any connections.

It's interesting to read about reactive hypoglycaemia as I'd never heard of it, but it seems to match my symptoms. I find during the day if I don't eat for a few hours, my brain switches off - people talk to me and I can't think or speak easily, I have to tell them to let me eat first and ask me the question again.

Star, I'm intrigued to hear about exercise. I have wondered about doing some resistance training, though as ever I am waiting until I am stable enough to consider it, I'm too ill at the moment. I find it hard to make much progress with these things as I'm so wiped out and struggling to think straight it's completely overwhelming considering what my options are.

I've been dealing with similar problems for the past few years. Without eating every 3 hours, my condition gradually worsens, with a tendency towards postprandial hypoglycemia (another name for reactive hypoglycemia), though it doesn't necessarily occur. My body is usually capable of avoiding clinical hypoglycemia, but at the cost of fatigue and worsening of overall condition. As far as I know, the symptoms are not caused by hypoglycemia itself, but by attempts of the body to avoid it via release of adrenaline. Interestingly, I never have this problem in the morning, so the usual blood glucose tests failed to identify the problem. It took a blood glucose curve in the afternoon to prove that the problem exists.

Eating right is the key to manage this comfortably. In my experience, a protein-only diet is *definitely* wrong. You need a balanced meal with low glycemic index. Don't skimp on (good) fats. Also eat right before going to bed. Everything that is sweet and/or has a high glycemic index is dangerous, and some foods fall into this category even if you don't expect it. Potatoes for example are highly glycemic. Consult a table with the glycemix index for various foods to learn more.

If you haven't excluded adrenal, pancreas, thyroid or liver problems it's good to verify whether you have a clearly defined illness in this area.

If dietary changes are not enough, take low dose cortisone or unprocessed licorice.

In my case I recently learned that I have autoimmune thyroid disease which may explain it, though it's too early to tell yet.

First, I would suggest a sleep study. I had one and found out my feet were twitching and waking me up. I added in a large amount of magnesium and that solved the problem.

Magnesium and other electrolytes will be leaking out if you have adrenal problems. I do a homemade electrolyte drink throughout the day to replace them.

I don't know if this would work by itself without other co-factors, but I've been doing methylation, and once I added in lecithin, my blood sugar issues have more or less vanished.

I would also suggest getting your GABA and glutamate in balance. GABA is calming and glutamate is stimulating. You can take either GABA or theanine throughout the day, which will help at night. You can do Kavinace at bedtime for more GABA support. I've tried phosphatydal serine too, but maybe it's not so good if you already have low cortisol. Like the other poster, I don't remember it having much of an effect.

In general, doing methylation is fixing all of these things for me and I'm sleeping deeper.

Hi Ollie

What you wrote really hit home to me, that is exactly how I used to be as my body gradually developed ME/CFS. This happened around 1999/2000 and it got that I just couldn’t regulate my blood sugar, I needed to eat all the time and put on a couple of stones in weight over those years.



My sleep was terrible and I would wake at night with terrible panic attacks and sweating but I also got severe panic attacks when I was out walking my dog. I cannot remember if I tried to go lower carb, I think I did but just couldn’t cope with it then.



It was like living in a nightmare I had no control over.



Well I am a success story because 12 years later and I generally sleep great, usually for about 6 hours minimum non stop and then I take my adrenal and thyroid meds go back to sleep and then wake anytime between 6.30 and 7.30 am. Its wonderful, for some time now I actually look forward to go to bed whereas I had got that I dreaded it.



Things turned around for me when I saw a knowledgeable private doctor who said that from my adrenal stress profile my adrenals were unable to function properly they were worn out and I needed a steroid, Prednisolone. I started off at a low dose but it turned out that my adrenals just went on getting worse so for the past 3 years I have been on a full replacement dose, the equivalent of 26 mg hydrocortisone and I have stayed at that dose only needing a touch more if I have an infection. I also need a touch of fludrocortsone a few times a week because of salt wasting.



It also turned out I have Hashimotos thyroid disease and needed 2 grains dessicated thyroid plus a tiny amount of thyroxine daily. The NHS let me down I had to find everything out for myself but it was so worth it.



I also have been taking a small amount of bio-identical oestrogen for over 10 years and I am sure this has helped too. For quite a long time now I have been able to eat low carb with good amounts of fats and protein without any problems and I have lost the 28 lbs of weight without any effort on my part (well I do walk my dog every day and keep fairly active).



I still have to eat small amounts quite often in the mornings because my adrenals still feel a bit weak at that time of theday. In the afternoons I can go 4 hours without eating ok and the same in the evenings but I do like to have some salted peanuts. I rarely get any hypo attacks now because of the steroid and it is such a huge relief.



Hope my experience doesn’t scare you but if you find you just cannot regulate your blood sugar despite changes to your diet, it could be because your adrenal function is too poor and/or your thyroid has taken a nosedive too. I would definitely suggest that you also work on your gut function because I still have to do that now. It is hugely better but I still lack enough stomach acid and still have too many bad bacteria and a few yeasts that I would be better off without.



You might want to consider doing a 24 hour adrenal stress profile (saliva) which can be ordered direct through Genova Diagnostics and also have a full thyroid panel done (antibodies too because that is what showed up for me).



Good luck, please let us know how things go.



Pam

ollie:
Since I posted I tweaked my diet so it's now mainly fish, vegetables, avocado, flax seeds and eggs. About 10-20% of my diet previously was carbs of some sort - wheat flour, potato, fruit, but for now I've dropped those. I'm cutting the eggs back to 3x per day, and replacing the morning eggs with a smoothie of water, avocado and whey protein, that seems to work ok. I'm trying to eat a bit more in the mornings than I was. As A.B. posted above, be careful with going to ketogenic with your diet. Are you trying to lose weight? I know often that a ketogenic diet is suggested for individuals with CFS, however, this needs to be done with caution, in my opinion. In my recovery, I found timing was everything. When I was working on the insulin resistance part of the equation, I found a ketogenic diet to be very useful in losing some of the extra weight that I needed to lose, which was causing all kinds of problems & adding to my insulin resistance. However, this needed to be balanced with strategic carbs, as I as well found that the fatigue increased when I stayed too low carb for too long. My opinion is that the energy rush that people often experience with a ketogenic diet is an extra push from the adrenals with adrenaline based hormones. I have found lots of reports in regards to this on internet, but no scientific research studies, or thorough explanations as to *why* this occurs. If your adrenals are too weak to give that extra push of energy, then it really just leads to further burnout for them. Many people do best on a low-glycemic diet, with periods of time where they do go very low-carb if needed only for weight loss purposes (to combat insulin resistance). For muscle building, which is essential in establishing a baseline of good glucose control (in my opinion), you actually need insulin & thus, carbs. From decreased activity we CFSers can be low on lean muscle mass, and then when we do pursue activity our bodies are very inefficient at doing so. A well-muscled body will perform activities of daily living more efficiently (using less energy) than a low muscled one.

2. It seems to be harder to get to sleep (using meds much more often, rather than just melatonin) This could be in response to low-carbing too much. But as Caledonia suggested above, sleep onset is usually related to a disrupted Glutamate-GABA conversion. Is sleep onset a chronic problem for you? I personally have had great success with using a product called Seriphos (Interplexus) which is a concentrated form of Phosphatidyl Serine, but as Caledonia stated this can be counterindicated in individuals with extremely low cortisol function. As well, I noticed that as my energy levels generally started to improve during day, my baseline insomnia problems arose more, but I don't think this is the case, as your fatigue is worse.
3. I seem to be waking less early in the mornings Good. You are on to something.
4. The fatigue is worse, and anxiety up.Could be related to going to low carb. Carbs are calming. Fats are calming too. Low glycemia, high fibre carbs are key.
5. Cravings for carbs and sugarCould be gut issues (key part of treating reactive hypoglycemia), but also you might be just too low on carbs & starving your muscles. As well with adrenal fatigue, carb cravings are normal. Carb cravings are also often related to low serotonin, which is related to sleep disturbances as well. As I previously suggested you may want to consider Tryptophan supplements. As well, are you taking any supplements to support your adrenals? I think one poster recommended getting testing if you haven't already. I found saliva testing works best, as am/pm cortisol doesn't give you a picture of how cortisol if functioning over whole day.

I take chromium I took Chromium for a long time too. But now as I am entering into the mineral balancing phase of my recovery, I am becoming more cognizant of how minerals work in partnership with eat other. If you have been taking for a long time, consider taking a break here & there & see how your body responds with it. You may not actually need it. as a matter of course and often cinnamon too, but not sure they help with me. I find connecting the input (food, etc) to the symptoms very hard as things are often delayed, so hard to make any connections.Yes be careful of making too much causal connections. Just use good sense, and eat clean, low preservatives, low glycemic, high-fibre, high-protein.

It's interesting to read about reactive hypoglycaemia as I'd never heard of it, but it seems to match my symptoms. I find during the day if I don't eat for a few hours, my brain switches off - people talk to me and I can't think or speak easily, I have to tell them to let me eat first and ask me the question again.Yes, this is one of the core symptoms of hypoglycemia.

Star, I'm intrigued to hear about exercise. I have wondered about doing some resistance training, though as ever I am waiting until I am stable enough to consider it, I'm too ill at the moment. I find it hard to make much progress with these things as I'm so wiped out and struggling to think straight it's completely overwhelming considering what my options are. Start slow, and target your carbohydrate intake around increased activity. I started with walking. I know many people that have had great success with this. I actually hired a personal trainer that had some specialty in dealing with CFS. We started on core exercises that focused on increasing the efficiency of how my body moved, so I could use less energy to do more. My posture became so deteriorated and this again led to inefficient movement. Too much too fast will 100% lead to more fatigue. It's about finding the right amount that will lead to marginal increases in energy and strength over a long period of time. Whenever I would go to a yoga class even if it would be "gentle" or "beginners," it would be too challenging, or I would push myself too much & it would set me back a week. My personal trainer & I took it really, really easy, & focused on simple straight-forward exercises (not compound - too much stress for brain, i.e. doing a squat & a shoulder press), with low weights. Even using resistance bands could be a place to start. I found good success with pilates, & using the reformers. Again, focus on resistance training, low weight to tolerance, and with the reformers there is support for you (often laying down).

All the best, Star

Interesting. As I said, I have the exact same blood sugar problem, although I haven't put on any weight despite constant eating. Last week I found out that I have anti-thyroglobulin antibodies ca. 5 times above reference value, which is most likely Hashimoto's. It also took a very long time to figure that out because my TSH, T4 and T3 were not pathological.

On the topic of how hypoglycemia actually feels like. It's important to distinguish between a pre-hypoglycemic state, and actual hypoglycemia.

My observation on the pre-hypoglycemia state is that subtle symptoms can appear with blood sugar values that are well above clinical threshold for hypoglycemia.The emphasis is on subtle, they can be as simple as inability to think clearly, and either an aggressive/irritable mood, or a depressive/fearful mood.

They are presumably caused by adrenaline release, which is known to induce fight or flight responses and the mood reflects that (if you're fighting for your life, you don't need to be capable of performing intellectual work). The evidence that these symptoms are related to blood sugar comes from the observation that they improve quickly with eating, always occur at lower than optimal fasting glucose values, and that actual hypoglycemia is always preceded by them (this evidence was obtained via a hand held glucose meter over several weeks).

Doctors don't pay attention to the pre-hypoglycemia state because they don't realize that it is significant. My experience clearly shows that with this problem, following a diet specifically tailored to stabilize blood sugar is helpful and worth doing.

A ketogenic diet is the wrong answer though because the body must work hard to get energy from it. A balanced and varied diet of foods selected to have low-medium glycemic index, with small meals every 3 hours is best. Glycemic index isn't everything either: fibres are just as important because they slow digestion. Beverages are also digested much more quickly than solid foods, so beware of them regardless of glycemix index.

What actual hypoglycemia feels like for me: visible tremor, feeling of weakness in muscles, abundant sweating, drop of body temperature, reduced perception of surroundings, feeling alarmed, hunger. Other people will notice that something is wrong when it happens in public.

Yes, although I describe it as low blood sugar I experience actually the readings aren't that low at all these days, I should be fine but it is definitely connected to blood sugar because after about 20 minutes after eating I start to feel a lot better.

Sometimes I have wondered if the blood sugar is literally in the blood but not getting into the cells. Could this happen because of the lack of oxygen and blood flow in cells? I know for sure that my cellular levels of oxygen are too low because I had Autonomic Testing done last year that showed that at that time I have over 50% less oxygen than a normal person should have.

I also realise that my situation is complicated by the fact I am steroid dependent and Prednisolone even at physiological doses causes insulin resistance. Definitely I experience this in the day where I take 2.5 mg Pred around 5 am (then go back to sleep) and again midday and 1 mg just before getting out of bed around 7.30 am. In the afternoon I need a tiny top up of 2.5 mg hydrocortisone. Overnight my blood sugar drops to around 4.6 so I am positive the steroid isn't that long lasting for me (it certainly feels that way too)., I feel awful when my blood sugar is around that level, cannot wait to eat some peanut butter and have a cup of tea to start to feel human again.

Pam

According to table 1 on this page Prednisolone has a plasma half life of 115-200 minutes, and a biological half life of 18-36 hours.

Have you tried experimenting with dosing schedule?

Yes, I know that is what is stated but it doesn't last that long with me. I think it can vary depending on things like your gut and also detoxification system which I am sure varies from person to person. If Pred was lasting a long time my blood sugar would stay up higher as it does in the daytime and I also wouldn't naturally wake up around 5 am for a dose and then go back to sleep.

I didn't do well on just h/c because it ran out too quickly and I got horrible highs and lows, thankfully the effect of the Prednisolone just felt natural and my body felt supported.

Pam