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Medical Forum / Diseases and Disorders / Diabetes / August 2007More on hypercortisolemia at root of DM
Many patients with type 2 diabetes have hypothalamic-pituitary-adrenal (HPA) hyperactivity and declarative memory deficits, researchers report. Dr. Antonio Convit of New York University School of Medicine and colleagues studied 30 middle-aged diabetics and a like number of controls to compare HPA axis function and cognition. The average time since diagnosis of diabetes was 7.5 years. Compared with the controls, the diabetic group had elevated plasma cortisol levels basally and after dexamethasone suppression, and a greater response to corticotropin-releasing hormone (CRH). Cortisol levels during the dexamethasone/CRH test were positively associated with HbA1c. This was independent of age, body mass index and other factors. A neuropsychological battery assessing declarative and working memory, attention, and executive function showed that cognitive impairment in the diabetics was restricted to declarative memory. Moreover, across all subjects, declarative memory was inversely associated with cortisol levels. However, say the investigators, "these associations were subsumed by glycemic control (glycosylated hemoglobin)." The authors call for further study of the role of the HPA axis in cognition in diabetic patients. In particular, they conclude, "improvements in glycemic control might lead to improvement in cognition." Commenting on the findings, Dr. Convit pointed out in remarks that "most cases of type 2 diabetes are associated with weight problems and a staple of diabetes treatment is weight control." He added, "A speculative interpretation of the data presented in the article is that given the dysregulation of the stress system, it may be a good idea to institute stress reductions strategies, such as relaxation or meditation, as part of the weight reduction plan in individuals with type 2 diabetes." J Clin Endocrinol Metab 2007;92:2439-2445. ================================ High cortisol causes obesity even without excess caloric intake. Susan > The authors call for further study of the role of the HPA axis in > cognition in diabetic patients. In particular, they conclude, [quoted text clipped - 16 lines] > > Susan Interesting reading, Susan. Your posts about the linkage between cortisol (hypercortisolemia) and diabetes have been very helpful, and they have prompted me to begin some of my own investigations into cortisol... For instance, I find the fluctuating diurnal nature of cortisol levels and the correlating variations in blood glucose relating to the dawn phenomenon to be intriguing. Also, as I think you have mentioned before, hydrocortisone (sold as an inflammation reducer and pain reliever) is merely a synthetic form of cortisol. That would seem to makes its use by diabetics and those suffering from adrenal problems very questionable.... What is your take on the much advertised weight loss aids and supplements that seem to be aimed at reducing cortisol, through vitamin and herbal approaches? In addition to Cushings syndrome, the information you have been posting also relates in some ways to a whole host of other conditions, including addisons and myasthenia gravis, from which our Billie suffers.... Thanks again, Will, T2 > Interesting reading, Susan. > [quoted text clipped - 7 lines] > to makes its use by diabetics and those suffering from adrenal problems > very questionable.... Will, I've often thought of intruding to the extent of suggesting that both you and your daughter be evaluated for hypercortisolemia by someone familiar with cyclical Cushing's. If you do a search on cortisol and bipolar disorder, you'll find that they're connected. Also, your old photo on the ASD gallery looked Cushingoid to my now trained eye. > What is your take on the much advertised weight loss aids and supplements > that seem to be aimed at reducing cortisol, through vitamin and herbal > approaches? I don't really have a take, haven't looked into them. > In addition to Cushings syndrome, the information you have been posting also > relates in some ways to a whole host of other conditions, including addisons > and myasthenia gravis, from which our Billie suffers.... And hypertension, so often found to be caused by aldosteronism (adrenal hormone) and easily controlled with time released potassium instead of more toxic bp meds. Susan > > Interesting reading, Susan. > > [quoted text clipped - 13 lines] > bipolar disorder, you'll find that they're connected. Also, your old > photo on the ASD gallery looked Cushingoid to my now trained eye. A jaundiced eye is not a trained eye. It would be a physician, who has a trained eye. > > What is your take on the much advertised weight loss aids and supplements > > that seem to be aimed at reducing cortisol, through vitamin and herbal > > approaches? > > I don't really have a take, haven't looked into them. Cortisol is actually an essential hormone. Pills that reduce cortisol would contain a poison. Such poisons like other poisons would kill hunger (health). > > In addition to Cushings syndrome, the information you have been posting also > > relates in some ways to a whole host of other conditions, including addisons > > and myasthenia gravis, from which our Billie suffers.... The latter would arise from cortisol deficiency and not excess. If hypercortisolemia were at the root of DM as you subscribe, folks like Billie would not have DM. > And hypertension, so often found to be caused by aldosteronism (adrenal > hormone) The 1% of total hypertension cases attributable to hyperaldosteronism (Conn's syndrome) is not "often." > and easily controlled with time released potassium instead of > more toxic bp meds. Time-release potassium supplementation does not lower blood pressure in someone with Conn's syndrome. Instead, aldosterone-receptor antagonists such as spironolactone are used to help such folks control their blood pressure. This discourse simply shows that the Holy Spirit is absolutely right to convict you: http://HeartMDPhD.com/Convicts It continues to sadded me to see that you have only the spirit of error (self) guiding you, Susan. One has to wonder how many people you are hurting along with yourself by your errors. Be hungry... be healthy... be blessed: http://TheWellnessFoundation.com/press.asp Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > x-no-archive: yes > Will, I've often thought of intruding to the extent of suggesting that > both you and your daughter be evaluated for hypercortisolemia by someone > familiar with cyclical Cushing's. If you do a search on cortisol and > bipolar disorder, you'll find that they're connected. Also, your old > photo on the ASD gallery looked Cushingoid to my now trained eye. > Susan Hey, what are the tests for cushings? Last time I saw my p-doc (I am bipolar) she was shocked at how puffy my face was, and thought I looked cushingoid. I told her that the last time my BG's were out of control my face got puffy and then when they got back in control (with the insulin) my face went back to normal. They were again out of control, I figured from the UTI from HE**. Now that they are back in control (and I am back on my tiny doses of insulin) my face is indeed not so puffy. I'd also lost my thyroid med and missed a couple of doses and had just found it again, and I know missing two doses of it puffs my face out as well. (the last time I was puffy with poor BG control, I had just had an increase in the thyroid med as a blood test showed I was a tad low...). I did promise my p-doc I'd see my doc if things didn't get better, but this may be something worth mentioning at my next endo apt. (Of course it is with the NP who didn't want to medicate me when my BG was 200-400 and sometimes 500 until test results were in and she knew if I was type one or type two...so she may not really think much of it..). I've kinda figured it was the BG control and low thyroid that made me puffy both times, but my p-doc did say I looked cushingoid with a moon face. Made me think of you and your posts Susan. She wanted to take my BP, but never did. I had been to my regular doc several times (for the UTI, severe knee pain, an anal fissure amongst other things), and my face was puffy then too (or at least by the end it was, I was also bloated, but figured that was my menstrual cycle that came two weeks early). My BP wasn't particularly high. It was 110ish over 70ish rather than my usual 100ish over 60ish. Anyways, if it is a simple test for cushings, I might push for it. If it is a complicated test then I might wait a bit. I know that extra cortisol can increase BG's and cushings can cause poor BG control, so the association between puffiness and poor BG control could mean that cushing's is behind both rather than the BG control behind the puffiness. We shall see. I don't have time or money to fly across the country to your fancy doctor in CA, so I guess I'll just have to see what the tests here show. Maybe if I wait until I'm at my peak puffiness I can get the highest cortisol reading, or perhaps I should have it done as I'm getting puffy, but before the peak, as the cortisol may be waning by the time I'm at the peak, but rising until then? Any input would be appreciated. Thanks, Emily > Hey, what are the tests for cushings? Emily, there are many, and many false negatives, due to the sporadic nature of tumor hormone secretion, as compared to normal glands. 24 hour urinary free cortisol, midnight salivary cortisols, midnight serum cortisol, dynamic pituitary MRI with contrast as well as abdominal C-T scan for adrenal masses or hyperplasia are for starters. In addition, ACTH at 4 pm. (it's very hard to find a lab where they know how to handle ACTH properly). Last time I saw my p-doc (I am > bipolar) she was shocked at how puffy my face was, and thought I looked > cushingoid. I told her that the last time my BG's were out of control > my face got puffy and then when they got back in control (with the > insulin) my face went back to normal. They were again out of control, I > figured from the UTI from HE**. Now that they are back in control (and > I am back on my tiny doses of insulin) my face is indeed not so puffy. Emily, you sound like a classic case. If you google up bipolar and cortisol, you'll find the connections. > I'd also lost my thyroid med and missed a couple of doses and had just > found it again, and I know missing two doses of it puffs my face out as [quoted text clipped - 5 lines] > and sometimes 500 until test results were in and she knew if I was type > one or type two...so she may not really think much of it..). TSH is suppressed by cortisol, as is T3. > I've kinda figured it was the BG control and low thyroid that made me > puffy both times, but my p-doc did say I looked cushingoid with a moon [quoted text clipped - 5 lines] > early). My BP wasn't particularly high. It was 110ish over 70ish rather > than my usual 100ish over 60ish. That low bp makes it seem as if your receptors may not be responding to your cortisol, hence your body overproducing. > Anyways, if it is a simple test for cushings, I might push for it. If it > is a complicated test then I might wait a bit. I know that extra [quoted text clipped - 7 lines] > as I'm getting puffy, but before the peak, as the cortisol may be waning > by the time I'm at the peak, but rising until then? Emily, there are no simple tests for Cushing's, or so many of us with known Cushing's wouldn't be testing for years. But you don't have a choice; unaddressed, it destroys your body, your brain and leads to premature mortality. Many of the tests are simple, but have to be repeated, often, to get the needed results due to erratic secretion by tumors. PLEASE join the boards by registering at www.cushings-help.com and read the archives, the forums and the bios of other women there. Susan > x-no-archive: yes > PLEASE join the boards by registering at www.cushings-help.com and read > the archives, the forums and the bios of other women there. > > Susan Thanks for the link, I'll check out the site and see if I find myself there (I think I probably will). As for the tests, nothing is ever simple, is it? Sigh. I'll mention it to the endo when I go next (I'd mention it to my regular doc, but if it's as complicated as you say, then she'd just refer me to the endo, and I'd not get in any sooner than my next appointment anyway). I did have an abdominal CT scan in late February/early March, (with both the swallowed yucky white junk, barium I think, and the injected contrast dye as well. I know I had to have a kidney function test done prior to the CT scan because I'm diabetic and the dye can be bad for kidneys.) It was normal, or at least that's what my doc said. (and presumably the report from the radiologist who read it too.) But, it was for GI distress, and not other stuff, so they could have missed adrenal abnormalities... Dunno. My face is less puffy, but my fingers are swollen, and I'm obviously still retaining water. Sigh. Of course, this could relate to a myriad of other things as well. Nothing is ever simple with my body. I will look into it though, thanks. Emily > Thanks for the link, I'll check out the site and see if I find myself > there (I think I probably will). [quoted text clipped - 16 lines] > of other things as well. Nothing is ever simple with my body. I will > look into it though, thanks. Emily, from what you've said here, you're a classic case of some sort of pit/adrenal condition. Susan > Will, I've often thought of intruding to the extent of suggesting that > both you and your daughter be evaluated for hypercortisolemia by someone > familiar with cyclical Cushing's. If you do a search on cortisol and > bipolar disorder, you'll find that they're connected. Also, your old > photo on the ASD gallery looked Cushingoid to my now trained eye. Well, I would say that the situation certainly warrants being evaluated. I have long had a tenency to "roundness" sometimes worse than others, episodes of extreme "hypertension* to the point of acute medical emergency, *diabetes*, and sometimes a difficult to describe feeling that seems like it might be "adrenal" in origin... a little bit like an adrenalin rush effect, when there is no reason to be hyped up. That is the cause of much of my insomnia at times. One of my daughters has pretty much the same symptomatology, except she is also severely bipolar.... It does all seem to fit... I take about 500 mg of potassium twice a day, which seems to help. Thanks for your suggestions and concern. Will, T2 > Well, I would say that the situation certainly warrants being evaluated. I > have long had a tenency to "roundness" sometimes worse than others, episodes [quoted text clipped - 3 lines] > when there is no reason to be hyped up. That is the cause of much of my > insomnia at times. I know it VERY well. For me, that's a symptom of an adrenal low, feeling sleepy while too jittery to sleep. It was one of the worst and most consistent of my metformin induced adrenal insufficiency symptoms. > One of my daughters has pretty much the same symptomatology, except she is > also severely bipolar.... It does all seem to fit... I take about 500 mg of > potassium twice a day, which seems to help. > > Thanks for your suggestions and concern. Will, consider asking the doc for K Dur MEQ to take twice per day or so. I can send you a list of tests to try to get your doc to run for you and your daughter. This is progressive disease. Susan > Will, consider asking the doc for K Dur MEQ to take twice per day or so. > I can send you a list of tests to try to get your doc to run for you and > your daughter. This is progressive disease. Thanks, Susan... That list of tests would be good to get. Also, I will run this by my daughter, Rachel, so she can look into it with her doctor.... Will, T2 >>Will, consider asking the doc for K Dur MEQ to take twice per day or so. >>I can send you a list of tests to try to get your doc to run for you and [quoted text clipped - 4 lines] > > Will, T2 Finding a doc competent to diagnose this is like finding a needle in a haystack. But if you can get your primaries to screen first... Here's my list, with instructions that MUST be followed for the ACTH; lab techs never know this: 24 hour urinary free cortisol (UFC) with 17 hydroxy steroids Midnight salivary cortisol X3 Midnight serum cortisol (have doctor arrange for a standing order at local hospital's lab so you can go directly there) Serum: (draw at 4 p.m.) 25(OH) D 4 p.m. ACTH (must draw into chilled tube, place on ice immediately and centrifuge in an ice water bath and freeze immediately) Renin Cortisol Insulin (handle like ACTH) Cortisol binding globulin Anti diuretic hormone Corticotropin releasing hormone Cortisol binding globulin Sex hormone binding globulin IGF 1 ferritin > Finding a doc competent to diagnose this is like finding a needle in a > haystack. But if you can get your primaries to screen first... > > Here's my list, with instructions that MUST be followed for the ACTH; > lab techs never know this: Yipe! Those are a lot of tests.... Well, I'll be seeing my doc in the next week or ten days, so I shall be sure to ask about all this. What is the treatement for Cushings, if that turns out to be one of my problems? I really would like to get a better handle on the hypertension.... without so much medication. It has already given me "copper wiring" in my retinas What are they doing for yours? Thanks, Will,T2 > What is the treatement for Cushings, if that turns out to be one of my > problems? It depends upon what the source is, pituitary, adrenal or ectopic tumor. Surgery, typically. I really would like to get a better handle on the hypertension.... > without so much medication. It has already given me "copper wiring" in my > retinas People with Cushing's have the highest rates of DM complications and die early from the effects of hypercortisolemia on the body and metabolism. > What are they doing for yours? I'm in a lengthy diagnostic process; tumors secrete in cycles and I have both abnormally high and low test results now, even though my pituitary tumor is visible on MRI. Diagnosis often takes a year or more. Most docs don't know this and don't bother. Susan |
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