Advocacy

What is the Cortisol Pump?

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What is the cortisol pump?

Basically, the cortisol pump is a repurposed insulin pump that delivers solu-cortef instead of insulin.

The use of solu-cortef (injectable version of cortisol when mixed with saline) is placed in an insulin pump that is programmed to disperse cortisol according to circadian rhythm dosing by programming rates of basal delivery into the pump. The pump also has options to bolus for stress dosing.

This helps adrenal patients maintain better control of their cortisol levels by allowing them to get cortisol quicker instead of waiting until steroid pills metabolize through the stomach and finally enter the bloodstream.

This therapy bypasses the gastric system and is able to deliver cortisol in a more consistent way. With a pump, an adrenal insufficient patient can receive a constant supply of cortisol and will not suffer the ups and downs with oral cortisol replacement tablets. They are able to sleep through the night without having to wake up to take steroid pills.

This can be of great benefit to adrenal patients who are hypermetabolizers of cortisol. Some patients have to take medications more frequently than others due to their body’s high cortisol clearance rate. The pump is a great asset to these patients because they are no longer forced to take pills every couple of hours around the clock.

Side effects due to mal-absorption can be decreased and patients have been reported to have improved sleep, weight management, gastric issues and experience an overall improvement in their energy levels and sense of well-being as opposed to taking steroid tablets.

Professor Hindmarsh, of CAHISUS is a pioneer for this life changing treatment.

For more information on the medical information visit his website-http://www.cahisus.co.uk/pdf/USING%20THE%20PUMP%20METHOD%20IN%20ADDISON%27S.pdf

The pump is not a cure for adrenal disease and is difficult to obtain. This treatment is relatively an unknown in the United States and this foundation is actively working to raise awareness on this alternative treatment to managing adrenal insufficiency.

It is a difficult process but it IS POSSIBLE!  For more information please read our article on HOW TO GET ON THE CORTISOL PUMP.

If you feel you could benefit from the cortisol pump, speak with your endocrinologist but be prepared to hear “NO.”

Don’t lose heart!

There are doctors in the USA who will manage this treatment and we hope to continue raising awareness so that one day it will be as available to adrenal patients as it is to diabetics.

We’re here to lead all adrenal patients to every adrenal alternative!

 

 

 

 

 

Advocacy

Up-dose or Collapse: A Lesson about managing cortisol with adrenal disease

In a normal person, during situations of emotional or physical stress their body releases more cortisol. The excitement from a happy event, the sadness from a death of a loved one or the strain from exercising are examples of things that would cause the body to release more cortisol.

In an adrenal insufficient person, this does not happen.

They have to artificially manage their cortisol. Their personal cortisol needs may differ from day to day. No two days are the same and it is a struggle to regulate proper cortisol levels.

Most of us “adrenal disease veterans” know this.

We know we have to constantly be vigilant of our cortisol levels.

Yet, most of us still struggle when deciding to up-dose.

We typically think things like……

Do I REALLY need more cortisol?

I can push through this….

I’ll be fine….

Some of our endocrinologists scold us for up-dosing or relying on a higher basal cortisol dose.

All these things flood our minds when we are trying to manage our adrenals artificially.

Unlike diabetics who can check their blood sugar, there is no cortisol meter for adrenal patients. We have to constantly be aware of our levels, which can present with various signs of “lows” and everyone is different.

How do you know when you need to up-dose?

How do you know when your cortisol replacement is correct for you?

I had to learn a hard lesson recently about the true importance of up-dosing with adrenal insufficiency.

I have adrenal disease, endometriosis, medullary sponge kidney disease and I am currently on the cortisol pump.

This past weekend, I was a bridesmaid in my baby brother’s wedding. The wedding required me to travel, stay away from home and was very physically taxing.

The wedding was Saturday, we traveled to the destination on Thursday and the weekend was filled with pre-wedding activities.

It was a massive struggle with my health. The traveling alone was taxing….then the rehearsal dinner….entertaining guests and having to sleep on a couch….

I started to develop low symptoms, which for me are unbearable cluster migraines which usually result in temporary blindness.

A board member of this Foundation and fellow adrenal disease patient texted me to check on me. I told her my migraines had come with a vengeance.

“Are you sure you are replaced enough? Sounds like your low.” She said.

“Yeah, I’ve bolused a few times here and there.” I responded.

(My bolusing was 2-4mg here and there…which I now realized was like nailing jello to a tree with all the activity, heat and symptoms I was enduring)

I did all my pre-wedding duties and was exhausted.

When I woke up the day of the wedding, my migraine was even worse. But it didn’t matter. I HAD to DO what I HAD to DO!

I was determined that I was going to be in my baby brother’s wedding.

I determined that I was stronger than this disease. Mind over matter was going to work for me that day!

So, I pushed through……

My board member friend called me.

“Winslow, I just wanted to call and make sure you were preparing for today. Have you bolused? Did you adjust a temp basal increase?” She asked.

I had never before done a temp basal increase. I always think I can just endure whatever I force myself through.

I explained to her I’d bolused here and there and she convinced me to set my rates to a 200% temp basal increase. I hesitantly did it, mainly because the migraine was at an unbearable point and I hoped it would quell the awful pain.

My pump rates were set higher and I continued to get ready for the wedding.

Migraine didn’t stop but I pushed through anyhow.

The first duty of the day was to take pictures before the wedding.

Little did I know, these pictures would be done fully dressed in the ballgown bridesmaid dress, in the Florida heat with tons of walking around to different areas outside.

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(Here is a picture during the ceremony, as you can see the dresses were not made for the heat of Florida in the summer!)

We started taking pictures at 11:30 and didn’t get done until 1:30. I had spent 2 hours in the heat. Being salt wasting, I struggled to keep control of my consciousness.

My head was killing me. All I wanted was to lay down in a cool room and eat an entire shaker of salt and drink cold water.

But the wedding started at 2:00pm. I had to push through. I had to make it. I had to smile and look like I wasn’t as absolutely miserable as I truly was.

I didn’t have any water so five minutes before the wedding, I choke down/dry swallowed a migraine pill (sumatriptan) and hoped it would quell the unbearable throbbing going on in my head.

I was in a corseted dress and couldn’t get to my pump. I felt myself struggling to stay conscious. Even with the temp increase, I was getting dangerously low. I quickly asked my mother to access my pump and give me a bolus. This was a challenge because it was hooked to my spanx in the back of the dress. Mom had never before touched the pump so explaining how to bolus was a challenge, especially since we were in a hurry.

She bolused the max my pump would at 5units (mg)

I quickly rushed into the wedding line up and smiled the best I could.

During the wedding, I stood the whole time. My headache only got worse but I kept smiling.

Thoughts of my stubborn personality mindset swirled through my head.

I will not ruin this day for Joshua and Rachael.

I can make it through this.

I will not throw up.

I am stronger than my disease.

I will not let anyone see me collapse.

I’m stronger than this pain.

Just breathe, Winslow. Just breathe……

You are strong enough to endure this suffering.

Smile…..don’t ruin this for your brother….

I made it through the wedding, they said I do and I wanted to say GOODBYE and go lay down.

I’ll just sneak off and miss the reception….. I thought.

No. We had pictures to take after the wedding.

After that, I was informed we would be announced into the reception as the bridal party.

I realized sneaking away wasn’t an option.

My assigned seat was right next to the bride at the head table.

I felt my cortisol dropping. After I was announced into the reception I grabbed my plate, acted like I was going to get food and just kept on walking back into the church.

I started losing my eyesight, getting tunnel vision and realized I was heading into crisis.

I wasn’t going to ruin this day for my brother.

I refused let everyone witness the trainwreck that my health is.

I struggled to walk back into the room the bridesmaids had gotten ready in, turned the lights off and collapsed in the floor.

How am I low with a 200% increase?! I wondered.

I suddenly got a strong wave of nausea and started vomiting.

Crisis, I knew I was headed straight into crisis.

I texted a friend of mine with my fading eyesight and hoped they’d alert my family…which they did not……

The bride’s sister found me laying in the floor of bridal suite room.

My intention was to slip away and get it together enough to return to the reception. But I was too low and ended up vomiting and passing out.

By the time my dad got to me, I had lost my eyesight and was fading in and out of consciousness.

He took me back to the house we were staying in. I laid down and tried to keep it together.

I knew I needed more cortisol.

My good friends from home had come to the wedding and immediately came to my aide so my dad could return to the reception.

My best friend, her sister and her mom helped me get out of my dress, administered more cortisol and gave me electrolytes (pedialyte).

Throughout the whole wedding, I had only had 50mg of cortisol. My normal dose is 37mg daily.

Though I had 200% increase, it was NOT enough for all that activity, physical and emotional stress.

Had the board member not called me and made me increase my basal rates, I’m quite sure I’d have suffered a major crisis and may not have survived.

My choices were either UP-DOSE or COLLAPSE.

The lessons I learned-

1-There is NO magic number for cortisol. If you need it you need it!

2-Do not be afraid to updose.

3-Give your body what it needs!

4- Artificially managing a body system is complicated and needs careful attention.

5- It’s better safe than sorry.

Take a page from my stupid book and up-dose BEFORE you crash.

This is your life, your disease and your health.

Take care of yourself. Give yourself enough cortisol.

Wishing you comfort and cortisol,

Winslow E. Dixon, Adrenal Alternatives Founder

Thank you foundation board member, Erin Fallon for talking some sense into me.
Advocacy

DISEASE EQUALITY- DIABETICS AND ADRENAL PATIENTS BOTH DESERVE ACCESS TO INFUSION PUMPS

DISCLAIMER- This post should not be used to diagnose, treat or manage any condition. Management of adrenal disease is serious and requires medication that is managed by a reputable endocrinologist. There is no cure for adrenal disease and this post is not suggesting this treatment is a cure, only a management tool.

Adrenal Insufficiency and Diabetes are both difficult diseases to manage and this Foundation sympathizes with T1D and T2D patients. Both are serious, endocrine disorders are we are in no way downplaying the battle of diabetic patients, we are simply using it as a comparative tool to explain adrenal disease, as most people are unaware of it.

Adrenal insufficiency is a disease where the adrenal glands fail to produce the proper amounts of steroid hormones. There are many different forms of adrenal disease, but the treatment for all forms is the same- steroids for cortisol replacement.

Diabetes is the disease where the pancreas fails to produce the correct amount of insulin, thus rendering someone insulin dependent.

Both of these diseases are endocrine disorders.

Both of these diseases require life-long replacement therapy.

The adrenal insufficient person is dependent on cortisol.

The diabetic is dependent on insulin.

Both of these diseases are life threatening.

Both of these diseases require daily monitoring.

Almost every cell in the body has cortisol receptors, making it a crucial hormone. This hormone impacts multiple functions of the body. Without adequate levels of cortisol, the body will go into an adrenal crisis which will result in organ failure and eventually death.

Cortisol impacts blood sugar levels, metabolism, stress response, inflammation levels, aids in the immune system, affects the metabolic processes such as the salt and water balances within the body and it also greatly impacts the circadian rhythm.

Unlike diabetic patients, adrenal disease sufferers have no meter to check their cortisol levels. They must be constantly vigilant of their own personal signs and symptoms of low cortisol. and require an emergency injection if their levels drop too low.

The standard treatment for all adrenal disease patients is daily cortisol replacement medication- steroids.  Medications such as prednisone, dexamethasone or hydrocortisone are prescribed to replace the deficits of steroid hormone in the body. Steroids have a myriad of side effects ranging from weight gain to emotional disturbances. Long term steroid use has been linked to damage of the bones, eyesight and even muscle tissue.  Yet, this is the only treatment for adrenal disease.

In a normal person, during situations of emotional or physical stress their body releases more cortisol. The excitement from a happy event, the sadness from a death of a loved one or the strain from exercising are examples of things that would cause the body to release more cortisol.

In an adrenal insufficient person, this does not happen. They have to artificially manage their cortisol with pills. Their personal cortisol needs may differ from day to day. No two days are the same and it is a struggle to regulate proper cortisol levels.

The most commonly prescribed steroid for adrenal insufficiency is hydrocortisone (HC). This is the bio-identical steroid medication. This medication has a blood serum half life of 90 minutes and must be taken multiple times a day.

Most adrenal patients struggle with quality of life due to this mismanagement. Oral HC must be processed through the stomach and the liver before reaching the blood stream.  This causes a constant rise and fall of cortisol levels, which results in subpar function.

Below is what the natural circadian cortisol rhythm is supposed to look like-

naturalCircadian

This is the circadian rhythm of an adrenal patient on HC.

UnnaturalCircadian

(This image was created using Clearly Alive‘s Steroid Dose Plotter)

Notice how it is a constant up and down motion? This causes fatigue, headaches, irritability, blood sugar issues and lowers quality of life.

The quality of life is vastly poor due to this lack of balance. Oral HC cannot do what natural cortisol can.

But there is solution to help create a more natural circadian rhythm!

The use of solu-cortef (inject-able version of cortisol when mixed with saline) used in an insulin pump programmed to disperse cortisol according to the natural circadian rhythm by programming rates of delivery into the pump.

This therapy bypasses the gastric passage and is able to deliver cortisol in a more natural way. With a pump, an adrenal insufficient patient can receive a constant supply of cortisol and will not suffer the ups and downs with oral HC replacement. Side effects due to mal-absorption are decreased and patients have been reported to have improved sleep, weight management and experience an overall improvement in their energy levels and sense of well-being.

This therapy can literally give adrenal patients their lives back, and yet so many are unable to receive this treatment.

Professor Hindmarsh, is a pioneer for this life changing treatment. He has done much international research and has proven that every single patient he has placed on this therapy found improvement. Yes, 100% success rate! That is unheard of in the rare disease community.  Granted, this is a small group of patients who’ve been exposed to the pump so as awareness grows that stat may fluctuate.

The pump is not a cure for adrenal disease, but it is an option and a ray of hope for those who are bedridden with no quality of life.

If there is another option for adrenal disease, why is the pump therapy only available to diabetics?

Are adrenal patients not worthy of a better life?

Adrenal patients should have the same rights as diabetic patients. All diseases should have the opportunity to receive the best treatment and care possible.

PumpAware