Question: I am on permanent steroid replacement following a bilateral adrenalectomy and was recently changed from Hydrocortisone 10 mg two per day to Prednisone 5 mg at bedtime because of a low morning blood sugar and elevated ACTH. I am now having trouble sleeping. Is this a common problem?

Answer: The suggestion here is that Prednisone being longer acting will counteract the nighttime low blood sugar. Glucocorticoids of any kind are excitatory and will keep you awake, so the bedtime dose will keep you awake and should be given during the day and in the morning. For the low blood sugar I would focus on the possibility of being growth hormone deficient because if you had prior pituitary surgery, you might have lost growth hormone which is the hormone of the pituitary that tends to keep our blood sugar in the normal range. Deficiency of this Growth Hormone can be associated with inability to maintain a normal blood sugar. Low cortisol during the night is not usually associated with low blood sugar at any time.

By Dr. David Cook MD (February, 1999)