Thanks, @wadawabbit - My endo’s outfit has a “large” number of endos (considering the area). It turns out my endo is an Internist, but is called an Endocrinologist, but Internal Medicine types are rated lower than the actual Endocrinologists on their list and everywhere as far as I can tell. I don’t get that, do you understand? I also know that she’s listed near the bottom of the list, and it’s not alphabetical.
The only other collective of endos in the area numbers 3 doctors, and they’re at the hospital that “nobody goes to” around here. (It’s full.) Hey, I’m from away, I’m just reading the lay of the land, far be it from me to understand why one hospital became the Snob Hospital that everyone (doctors included) wants to go to, and the other became the Other Side of the Tracks Hospital that has less -well-off-looking people in the waiting room.
In any case, I can’t see one of the higher-flight endos at my outfit without a referral - and a diagnosis, I am told sternly by the appointment-making staff, even though I already see Dr. ___ there. I’m looking for a diagnosis. So I’m reading up on all sorts of things to test for that my PCP could run that might be appropriate. Cortisone levels are certainly going to be one. But from those results, maybe my doctor can write a referral to have me see a different endo.
----[read on only if you dare]----
Adrenal levels. Since December, I’m having sudden, extremely-rapid-onset DKAs, random except that they’re ONLY between 6 AM and 7 AM. BG starts going up at the same time always, 4 AM, and rises slowly until taking a steep step up at 6.
I’ve often reached the throwing-up and ketones climbing fast stage when my blood sugar (finger sticks for immediacy) is still between 160 and 220 at 6:20, 5:20 in Standard Time - before BG is high enough to justify a diagnosis of diabetes-only DKA.
Most mornings, my BG is still going down very slightly or level, depending on activities the day before. But during these episodes, BGs will be topping 250 by 6:30, and reaching 300 - if untreated - any time before 7:00. This is VERY fast. (And it’s always when my brain is normally not the least bit functional (grumble).)
If I ask for a bolus, I see the result right away, and the insulin reacts at about same effectivity as normal (given that I’m fighting to reverse a parabolic skyscrapering of my BGs). A bolus of 1 unit over recommended (by Dash) very early on can almost practically abort one of these. My BGs might not even get over 220 - but I still have Moderate ketones by about 6:45 AM. But MY PUMP IS WORKING. This is not a pump failure, although I will need more boluses in about an hour or so and when I am physically capable, I will change the pod as a precaution.
But the graph of my BGs exactly mirrors the graph of cortisol in the “Normal Diurnal Rhythm” graph at Understanding Cortisol | Cortisol Matters, which kind of takes the air out of any concern for my cortisol levels. The whole episode just feels like my Dawn Phenomenon - occasionally - has gone ballistically out of control. (Dawn Phenomenon on steroids? nm, inside joke.)
But “adrenal fatigue” can cause low BPs at rest, which I’m having only the mornings of these episodes… Bears ruling out. Let’s look at adrenal levels.
And Blood pressure - I finally realized that my BP, blood pressure, is dropping extremely low during these episodes, so theoretically I’m now measuring BP when I wake myself up around 5:50 (UGH). But low BP is contributing. Still. Getting fluids has helped dramatically the few times I got it. And I hadn’t put together, but I’ve been reading how extreme and/or sudden hypotension causes / exacerbates hyponatremia.
But when BP drops, BGs can rise (the “catecholamine response”). If maybe a slight sign of adrenal fatigue is making my BP lower and both together making BG rise… but that fast??? and only occasionally? (This is the round-and-round-in-circles phase of my trying to understand.)
Sodium. I already have Hyponatremia. Normal blood sodium minimum is 135, but normally my blood sodium is 125-128, and has been measured at 121 back when I used to drink the recommended 8 cups of fluids/day (8 years ago). Now I drink about 54 oz/day, and have made so many changes to lifestyle / diet / meds, etc, all for naught. Nephrologist says oops I forgot - amygdala? - has decided for itself what my sodium level should be - it happens, apparently - and it’s acting beyond correcting. Even taking sodium tablets for a while didn’t seem to shake its certainty.
Anyway, sodium levels can play a part in all this chemist’s lab combination of things going on. Bears looking at. I need 6 AM tests, preferably on a morning when I’m sure this is going to happen hahahahahaha…
And no more soup for me.
We also need to take a closer look for any signs of background infections. I’ve had a few incidences of those, and they can cause DKAs. But - since December?? nahhhh… (Did you know about “the 7 I’s of causes of DKAs”? I didn’t.)
I have so many web pages open of things to learn more about because they have implications for the nexus of adrenal hormones, diabetes, dawn / dawn phenomenon, blood sodium, and more.
So far nothing screams out at me, so it’s not entirely implausible that my internist can’t help me. BOY her beside manner leaves a lot to be desired, though! HONEST to GOD, to say to a patient in her office “I can’t help you,” with an air of finality, then literally turn her back on me and indicate that any conversation is ended, with me in tears - yeah, she’s toast, in my personal medical cadre.
Geez. I’ve tried to write about this here so many times. This is the shortest version I’ve managed so far. SORRY!