Hi I have been seen by an endocrinologist now-finally! It went ok but not great. Dispite having alot of the symptoms of adrenal insufficiency (low BMI cant gain weight, hypoglycemia, dizzy spells, anxiety, tiredness, weakness, cold etc...) he seemed to dismiss any thought of adrenal insufficiency etc as my single serum cortisol was in the 'normal' range. I thought that that test was not a definate final answer to adrenal investigation plus the fact that it was done in febuary and im feeling a lot worse with it all now?
Anyway at least he has not given up on me totally, he has requested a 72 hour supervised fast. I was wonering if anybody knows why this is done? What is he looking for? Also how is it done? Please post back, thanks.

Hi Jenn,
I have been following your posts, because we share some of the same symptoms. I usually post on the thyroid board, but have recently been on the Diabetes board more often due to high and low blood sugar. I too suspect that my many symptoms are related and are caused by an underlying endocrine disorder--either pituitary or adrenal. I went to an endo in February for Hypoglycemia at that time and all my tests came back normal.. though some were in the bottom range..like FT4, Random Cortisol, fasting insulin, etc. You can see my other posts if you have time to read a lot :-) I am planning on returning on 6/22 even though the endo had told me that if my tests came back normal to cancel that appointment--I didn't! My symptoms have also gotten worse since February and now any time I eat food with sugar or any carbs at all, my blood sugar spikes to 200 -350 an hour later than 2 hours later dips down to 70 or below, with all the shakiness, dizziness, etc that goes along with it. Have you taken your blood sugar an hour after you've eaten to see how high it spikes? Also, not to be too personal, but how is your menstrual cycle? Last, I know exactly how you feel about doctors believing it's in your head..I was also told it was anxiety/depression and have been taking anti-depressants for a few years now with minimal results. Take care and I wish you the best of luck :-)
BJM

Hi Jen!

I did a search on the 72 hour fast and found this:

The purpose of the prolonged fast is to provoke the homeostatic responses that keep blood glucose concentrations from falling to concentrations that cause symptoms in the absence of food. Increased release of epinephrine, glucagon and, to a lesser degree, growth hormone and cortisol are the most important components of this response. In normal subjects, the following thresholds have been identified in response to graded reductions in the plasma glucose concentration [1-4]:

* Insulin secretion decreases when plasma glucose concentrations fall below the normal postabsorptive level, which is about 80 mg/dL (4.4 mmol/L).

* Glucagon and epinephrine secretion rises when plasma glucose concentrations fall below 65 to 70 mg/dL (3.6 to 3.9 mmol/L).

* Growth hormone secretion increases when plasma glucose concentrations fall below 60 to 65 mg/dL (3.3 to 3.6 mmol/L).

* Cortisol secretion increases when plasma glucose concentrations fall below 60 mg/dL (3.3 mmol/L).

These thresholds were established with measurements of arterialized venous blood, in which the glucose concentration is approximately 3 mg/dL (0.2 mmol/L) higher than the venous concentration. (See "Physiologic response to hypoglycemia in normal subjects and patients with diabetes mellitus").

All the hormonal responses begin well before the onset of symptomatic hypoglycemia [1-3].

* Initial symptoms of sweating, anxiety, palpitations, hunger, and tremor occur as plasma glucose concentrations fall below 55 mg/dL (3 mmol/L).

* Early cognitive dysfunction is first noted in normal subjects at plasma glucose concentrations of approximately 50 mg/dL (2.8 mmol/L) [4].

Now, I have never had this test done, nor have I heard of it before or performed it on any of my patients (I am a nurse), so it was an interesting study for me. I am wondering if they check all these levels (cortisol, glucose, growth hormone, etc) as you fast to ensure you respond correctly. It could be another way to discover what is wrong. Sounds interesting! Please tell us how it turns out! When do you do it?

MaryAnn :)

Hi Jenn,
Have you taken your blood sugar an hour after you've eaten to see how high it spikes? Also, not to be too personal, but how is your menstrual cycle? Last, I know exactly how you feel about doctors believing it's in your head..I was also told it was anxiety/depression and have been taking anti-depressants for a few years now with minimal results.
BJM

Hi thanks for your reply. In response to your questions, I have not taken my blood sugars after i have eaten. I usually do them first thing when i wake up, mostly because i feel really low (really drousy and find it hard to wake up) and it is usually in the 2'smmol. The rest of the time i usually do it when i feel bad, but what i dont get is that it isnt always low went i test it. It seems to be all over the place with not logic to it (one min it will be ok the next right down, so i found it really hard to explain to the endo, as he wanted to whether it was fasting or reactive hypo, it is mostly fasting but the odd time it does go down within 5 hours - i just dont know!) I might try what you suggested - it might help see something. Also at the mo my menstrual cycle seems to be normal - no obvious changes.
I'm so worn out with it all, I hate it when they say its 'normal', I really do start to doubt myself and think im going mad. But then when the blood sugar drops it proves to me its not - after all im not able to alter blood! What i find hardist is proving that it does go down and it is real. I just dont know how theyre going to get the results theyre looking for. I just hope this 72 hour fast will be time enough to catch it! Goo luck to you to. thanks.