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Campylobacter Infection, Glycemia Falling At Night. What Is Going On? Have Congenital Hyperplasia Of Adrenal Glands.

Posted on Sun, 17 Jun 2012

Question: Not fealling well since 2 month. Been hospitalised in october due to ion imbalance, lack of appetite, nausea and extreme fatigue due to campilobacter jujeni (diagnosed after 8 fays of hospitalization witout textbook symptoms). They prescribed cypro for 5 days. Problem is, after all that time things are not better at all (it was better for 2-3 days after my hospitalisation but not now). Something that they didn't understand at the time is that now my glycemia is falling high at night (ex 9.5 to 3.7), even if I ate un small lunch at night and reduce my diamicron and metformine dosage significantly. What is going on? Is the infection still there? Is glycemia suppose to go up, not down when a diabetic get an infection? I also have ketones a lot (sometimes all day), mostly with normal or low glycemia.

By the way, i also have congenital hyperplasia of the adrenal glands since birth. That could explain the initial ions problem (low sodium, followed by low potassium after sodium IV.

Answered by Dr. V. Kumaravel (7 hours later)

Hello.

Thanks for posting your query.

I do understand that you are a 41 year old female suffering from Diabetes and Congenital Adrenal Hyperplasia (CAH). Your concern seems to be related to blood sugars.

I am concerned about 2 issues in your case.

1. You have been on steroids for CAH. Whenever you get hospitalized for any illness, your dose of steroids has to be doubled or tripled and if necessary parenteral steroids has to be considered as your adrenal is not normally secreting steroids.

2. Whenever you have infection or hospitalized, the blood sugars normally fluctuates it can go up and also down. Your ketones is definitely a concern and I would prefer to start you on insulin for your blood sugar control.

you can discuss these options with your primary care physician and I am sure he will be able to guide you.

Hope, this answers your query to your satisfaction. Please accept my answer in case you do not have follow up queries.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. V. Kumaravel (2 hours later)

Since I don't know if i'm still having and infection (we are investigating but not evident), should i still double my prednisone? Is mental stress or amother type of physical stress (headhache, neck, shoulder and upper back hache) necessitate that I double it?

Answered by Dr. V. Kumaravel (12 hours later)

Hello,

Thank you for writing back.

Today’s research indicates that a move toward individualizing the dosing of prescription agents is warranted and it can happen only after physical consultation. Hence please consult your treating doctor before you make any changes in your prescription.

Any kind of stress is going to increase your requirement of prednisone. I personally feel that it is preferable to double the dose for a short time and keep monitoring your sodium, potassium, 17 hydroxy progesterone and your clinical profile. Discuss about the same with your doctor.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

Regards

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E