NHS Borders 

Borders Diabetes team

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Steroids are natural hormones produced in the body. One of the most important of these is cortisol produced by the adrenal glands; under the control of the pituitary gland (all part of the endocrine system).

Hydrocortisone tablets contain cortisol.

Cortisol is very important as it helps with the control of blood sugar, blood pressure and the immune system. It is needed in order for the body to deal with physical stress (e.g. infections, injuries, other illnesses).

Why do I need to take steroids?

You will have undergone tests while attending the Endocrine Clinic which have shown you are deficient in the steroid hormone called cortisol. There are several different causes of this. For more information about your condition please ask you endocrine nurse or doctor who will be happy to discuss this with you.

As you are deficient in cortisol which is essential for life, a replacement needs to be given. The most common
way to replace cortisol is to take Hydrocortisone tablets. (Occasionally other tablets are prescribed as an alternative to Hydrocortisone. These include Prednisolone or Dexamethasone).

When should I take them?

Hydrocortisone tablets are usually prescribed to be taken twice a day; in the morning and evening. This is to
mimic the natural release of cortisol from the adrenal glands. It is recommended you take the morning dose with your breakfast and the evening dose with your evening meal.

What if I miss a dose?

If you miss a dose and remember before your next dose is due then take the missing dose as soon as possible. It is very important that you take your steroid hormones regularly. Your pharmacist may be able to provide a dose dispensing aid if remembering to take your tablets is a problem. Missing one dose may not matter but missing two or more doses could be serious.

What if I’m ill?

Under normal circumstances if you become ill your body would produce extra cortisol to help you cope. In your situation you will not be able to produce sufficient cortisol and in some instances this could be life threatening. It is therefore very important that you increase your dose of hydrocortisone or other steroid quickly. If in doubt it will not do any harm to take an extra dose.

If you have mild illness (e.g. head cold) with little or no fever then no change in steroids is necessary.

If you have a fever (as in flu like illness) then double your daily dose until you are well again. You should arrange to see you GP during this period. If you are more seriously ill and especially if you suffer vomiting or diarrhoea; then your steroids may not be effective. Contact your GP straight away because you may need a hydrocortisone injection. It takes about an hour for oral hydrocortisone to be absorbed, so if you have vomited within one hour of taking a dose the repeat the dose.

Under the following circumstances your normal steroid dose may need to increase:

• major dental procedures
• surgical operations
• Prior to any of the above, discuss your steroid requirements with your Doctor.
• What are the signs and symptoms that my steroid levels are too low?
• You may feel exceptionally tired; have poor concentration, aching muscles, increased perspiration, nausea or feel faint.

Finally, be prepared:

• always carry a steroid card and/or wear a medic alert necklace or bracelet to warn other health professional that you are taking steroid replacement therapy. This will alert them to the fact that you will require additional steroid replacement during an illness
• always carry an extra supply of steroid tablets when you leave home in case of emergencies. If you are
  going abroad discuss your medication requirements with your GP or endocrinologist including the need for injectable hydrocortisone and the amounts to take in an emergency. It is useful to know how to self-inject in case this is ever necessary

NHS Borders Endocrinology Team