Saturday, November 21, 2015

Theoretical Steroid Curve Plotter

Gone are the days where doctors are suggesting just twice daily dosing of hydrocortisone to achieve that "normal" life with Adrenal Insufficiency. We're smarter now. We've learned that cortisol levels vary throughout the day, following the circadian rhythm. We've learned the benefit of splitting up our dosage and combining different types of steroids to give us more even coverage over 24 hours.

But there wasn't an easy way to visualize this theoretical steroid curve.

Until now.

(Are you using the cortisol pumpThis version of the tool is much easier.)



How to Use This Tool

This tool was designed in Google Chrome, and therefore runs best in Google Chrome. Additionally, if you are having problems on your mobile device, please switch to a computer. If you notice a problem, send me a message on my facebook page. We'll work to fix it.

For Google Chrome, please input the time in the format of HH:MM AM/PM. For all other browsers, please use military time. Confused about military time? For anything in the PM, add 12 to the number. 8:00 PM + 12 becomes 20:00. For anything in the AM, the time remains the same. You do not need to label AM or PM.

Limitations of This Tool

This tool plots the theoretical cortisol curve based off of mathematical formulas for each steroid. It is assumed that the value in the blood stream increases in a linear fashion until the medicine "kicks in." It will then exponentially decay according to the biological half life. All values are given in terms of equivalent hydrocortisone. The following properties were used:

Steroid Type
"Kick In"
Biological Half Life
HC Equivalent
Hydrocortisone
30 minutes
1.5 hours
1 mg
Prednisone
2 hour
4 hours
4 mg
Dexamethasone
4 hours
36 hours
26.67 mg

Please note that these are theoretical values. Each individual absorbs and clears medicine at different rates and absorption is effected by many different factors. Additionally, your body does not absorb all of the medicine that you take. Dusty over at Addison's Support Advocacy has an excellent blog post explaining more about this. This tool does not currently take into account the systematic availability of hydrocortisone.

You will also note that there is no scale on the y-axis. This tool is designed to only provide a rough idea of a curve and not actual numerical data.

Also realize that blood work does not provide an accurate representation for oral steroid replacements. Please consult with your doctor and base your individual steroid treatment off of your symptoms and what works best for you. We are all incredibly different. This is definitely not a one-size-fits-all disease.

The purpose of this tool is to start conversations that can perhaps improve your quality of life. We don't have to live miserably with Adrenal Insufficiency. We can be Clearly Alive.

Shout Outs and Thank You's

This project has been over two years in the making and I definitely did not complete this by myself. I have some awesome engineering friends who were willing to use their technical knowledge so that my dream could be turned into a reality. Thank you M. Galland, J. Pawula, W. Toth, and A. Vera.

Medical Disclaimer

All content found on this website, including: text, images, audio, or other formats were created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 

Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.

By using the Tool, you acknowledge and agree to and accept these Terms of Service, including all policies and terms linked to or otherwise referenced herein.

Reliance on any information provided by this website and this tool is solely at your own risk.

17 comments:

  1. Thank you. It is great to be able to show Derek why he is feeling better by splitting his dose into 4 and taking it no more than 4 hours apart.

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    1. Yay! Sometimes it helps to be able to just see things visually.

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  2. This is awesome in the best case senerio what should the graph look like?

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    1. Hi Brooke, there isn't really a "best case" but ideally, you should be attempting some sort of circadian rhythm curve. This image shows "Circadian rhythm of cortisol in 33 individuals with 20-minute cortisol profiling." : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475279/figure/fig1-2042018810380214/

      It was taken from this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475279/

      This tool is only designed to start conversations with your medical team in order to help you achieve a higher quality of life. The closer we get to mimicking what a real adrenal gland would produce, the higher quality of life we can achieve.

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  3. I love that you're using your skills to better your world and those around you! You're more clearly alive than a lot of people I know :)

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  4. Hi Amber,
    Thanks for creating such a useful tool.
    I wanted to use the tool but there's a blank rectangle where I'm guessing the tool should be.
    All the best
    Soph

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    Replies
    1. Oh no! Thank you for pointing this out to me. I'll look into what happened and hopefully get it fixed quickly.

      ~ Amber

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    2. Hi Soph,

      The backend technical difficulties have been resolved! :) The tool is live again.

      ~ Amber

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  5. Hi Amber. I wanted to let you know that I've been using your tool again as a guide to work out a series of dosing schedules to trial. I'm going to bite the bullet and try waking at 5am to take my first dose of pred. This tool was helpful in working out when to try the 2nd dose of the day. I'm planning on taking copies of these graphs to show my endo. Despite talking about circadian rhythm dosing, she's of the school of thought that pred once a day is sufficient for most people and overnight steroid coverage is unnecessary. However she is also open to following how my body responds. I'm keen to show her this tool and hopefully get some change happening with her approach. Thanks for your time on developing this tool.

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    1. Hi Charlie,

      I'm so glad this tool is useful for you! This is a few years old, but have you seen it yet?

      http://cahisus.co.uk/pdf/TRANSCRIPT%200F%20MEETING%2014%20JUNE%202014.pdf

      It has excellent information about overnight steroid coverage and circadian rhythm dosing. It might help your endo change her school of thought.

      ~ Amber

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  6. I've been working on something similar on and off the last couple months! So glad it's already been done! Can't wait to try it on my laptop. Thanks for putting it together!

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    1. Glad you found it! This was definitely multiple years in the making.

      ~ Amber

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    2. Can't see the whole thing onbmy smartphone. Is there another link to see the whole thing?

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    3. You can either rotate your phone sideways, but honestly, if you are having problems on your mobile device, please switch to a computer.

      ~ Amber

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  7. I see you are using the pump. Do you remember your dosage before the pump?

    It would seem to me based on this curve calculator, that people who dose with HC may want to consider some pred, or Dex for overnight.

    Plus, although a hassle to some extent, based on this curve calculator, dosing every 2 hours or even less throughout the day would keep cortisol from spiking too high and avoid the roller coaster ride.

    Interested to hear your thoughts. If I put it in 3 hour dosing (some recommend 4 hour) and I do a 10-8-6-4 for 28mg starting at 8AM it looks like I would be dosed too high for much of the day with wild swings and little left overnight.

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    1. I do! And I highly recommend pred or dex for overnight coverage.

      I started mixing dex and HC in 2009. The last dose I was on before the pump was...

      8AM - 15 mg HC
      12PM - 10 mg HC
      4PM - 5 mg HC
      Bed - 0.25 mg dex

      I loved taking that 0.25 mg of dex at night, right before bed. It allowed me to sleep better, and in the mornings I was no longer waking up mid seizure. Some people prefer 1 mg of pred at night, it accomplishes essentially the same thing.

      The more frequently the doses for HC, the better. The issue just becomes compliance. It gets really difficult to swallow pills ever 2-4 hours. So there's a trade off between Quality of Life and convenience. You have to find the balance that works best for you.

      ~ Amber

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