Explaining adrenal insufficiency to others
By Desley Rolph.
If any of you have people around you who don’t understand how having low cortisol affects us, this explanation that I often use to explain how we can be affected by any sort of stress.
Imagine a healthy person uses about 20mg of cortisol for a day, a day that has no bumps in it, a sedate ordinary relax at home day. Then, they realise that they are running late and have to run for the bus, the body may give it an extra boost of a milligram of cortisol to do this. Imagine a fight with the boss and your heart starts pumping. Your adrenaline is pumping and the body needs extra cortisol to surge in and do its job to calm everything down. Cortisol in a healthy body rises, but in our bodies, our cortisol (medication) gets used up. Our bodies cannot do that naturally.
The same happens with illness, the normal body doubles (or more) its rate of cortisol needs to cope with the illness, our bodies cannot do that. Our little pill bottles or our pumps are our external adrenal glands, and we have to think like an adrenal gland and give ourselves more medication to function normally. No normal healthy body sits on a static dose of cortisol every day, it fluctuates accordinging to the stressors that affect the body ie. physical illness, accidents, surgery, dental procedures, any sort of pain as it is a stressor, emotional stress, as well as strenuous exercise, dehydration (heat stress).
Everyone’s individual’s triggers for stress are different, and we cannot always compare ourselves with other adrenal insufficient people, because we all react differently to stress. In time with this disease, we learn to recognise our own low cortisol needs. It may help to keep a diary of symptoms and doses, to remind yourself of your impending symptoms that need updosing to avoid adrenal crisis. We need to act early with our symptoms also, because if we delay we may be affected cognitively and fail to administer our life saving medication properly.
We also need to realise that updosing for any sort of stress is a bit of a guessing game. Although there are general updosing recommendations for different situations in much of the literature, we are still individuals often with other health issues as well and react differently to stress. We are unable to measure our cortisol levels like a diabetic, who can measure their blood sugars and treat more accurately.
The best we can do is not just follow the guidelines, but also take note of our symptoms and hopefully over time we get to know what our updosing needs are. This is perhaps the most difficult situation we face. Many papers recommend erring on the side of caution, meaning it is better to take a little more than you think you might need rather than underdose and risk adrenal crisis. An occasional updose is not going to hurt us.
Take care everyone, and don’t underestimate this disease.