May 4, 2010
Other Illnesses
Question from Richland, Washington USA:
My son was diagnosed with type 1 in 2004 with a blood sugar of 1236 mg/dl [68.7 mmol/L] and in DKA. Although he was overweight with negative anti-islet cell antibodies, his diagnosis was supported with the high anti-GAD antibody. No C-Peptide was done at that time. He lost weight and was able to maintain a good healthy weight until around 2007 when he began to feel physically poor throughout the whole year experiencing headaches, diarrhea, significant acne over his face and neck, lower than normal body temperatures, a rash down both arms, heat intolerance, pains in his legs, and just feeling tired most of the time. He also put on a lot of weight. After a year of visits that included a complete blood work-up, thyroid testing, celiac testing, it was realized that he was on far too much insulin (Lantus). By the end of that year, he was taking a split dose of approximately 38 units in the morning and 40 units in the evening which turned out to be almost double what he should have been on. It is assumed he was experiencing undetected lows while sleeping. I am assuming that with each of those lows, his body was in panic mode and releasing far too much cortisol, therefore causing him to experience many symptoms of Cushing’s syndrome. Is this possible? He has been trying to lose the weight gained during that time but with little success. With my concerns about the weight loss, his endocrinologist did a low dose dexamethasone test which came back under 1. My son still experiences some of those symptoms on occasion but not as much as what went on during 2007.What I am trying to find out is if a person’s body is releasing all that extra cortisol, would a person without Cushing’s syndrome experience the same reaction (symptoms) as one who did have Cushing’s during that time? Also, could that extra released cortisol during that time cause other health issues (like Cushing’s)?
Answer:
It is unlikely that he has Cushing’s from what you have described. Obesity often has associated high cortisol levels, so sometimes it is difficult to decide. Imaging of the adrenals system, ACTH and cortisol levels, dexamethasone suppression testing as well as urinary cortisol levels all can help to decide. Weight loss usually solves this problem, however, and the weight gain causes the insulin resistance. The extra insulin is in response to the obesity and the extra fat cells produce the insulin resistance through mechanisms not fully understood. Thus, the increased insulin dose needed. This becomes cyclical with more insulin resistance, higher glucose levels, more insulin needs, etc. The key is a lower caloric intake and more energy expenditure through vigorous, daily exercise. You should go back and discuss this in some detail with your endocrine/diabetes team since they will know more specifics. From your note, it sounds like thyroid, pituitary, celiac and other testing has been carried out and normal and that is also important to look for other sources of the problem.
SB
