When a person has adrenal insufficiency, they are unable to produce: cortisol, aldosterone, DHEA, testosterone (women), progesterone (some women). If you can't maintain a good blood sugar, blood pressure and muscle mass, you can't do much. Sometimes, people die from lack of cortisol and aldosterone.
I replace all of these hormones and thyroid hormones. Replacing hormones while on a long run is challenging. Knowing how to replace them takes study of medical journals, understanding of human physiology and listening to other's experiences. Next, there's a LOT of trial and error. Years of it.
Most of my pills are round and white. Quite annoying because they all look the same after they've been in a back pack for a week and have been jiggled around for 250+ miles. Good thing I can tell some apart by taste or I'd be pretty screwed taking DHEA instead of hydrocortisone.
The first three days, I did what I've done in training runs:
- 10 mg HC, .1 mcg florinef (I usually take .075 but splitting the pills that little was too much work), 12.5 mcg T3, 12.5 DHEA and probiotics
- One hour into running, I took 5 mg HC and 2 salt supplements/hour, T3 at regular times (11 am and 2:30 pm), 6.25 DHEA at 11 am also
- The last dose of T3 and DHEA were questionable because the pills crumbled up and I couldn't tell what they were for certain.
- On the really rainy day, I only took one sodium supplement/hour
- 100 mcg of T4
On the third day, I started having trouble with nausea, crying and inappropriate muscle soreness. The third night a light bulb went off in my head, I was under replaced! The fourth through ninth day, I took 10 mg of HC/hour for a total of 100 - 150 mg/day. I needed it. I did have some trouble sleeping but I do whenever I get a lot of exercise and also did on the first three nights when I was taking 50-75 mg of HC so I don't think it was the HC.
When I had my breakdowns on the road, it was almost always due to needing to eat and needing more HC.
I was very careful to stay hydrated. On the hot days, I drank about two gallons of water. No Gatorade. I didn't want to drink hot Gatorade, it was just not appealing to me. I had a few Icees. One root beer and one gingerale. Ice water was a treat.
If I had to do this all over again, I'd start out my adventure with 10 mg/hour of HC. For any race under two days in duration, I'd stick to 5 mg/hour.
I was also careful to eat when I was hungry during and after the race. When I finished my other multiday run, which was half the distance, I returned home feeling very hypothyroid. After doing some research, I discovered that the body needs food post race to stay out of the hypothyroid state. During my international travels immediately post race, I didn't eat much because I was too dumb to convert my money into Euros so I had no money to eat. I bought a huge bar of chocolate and that's all I had for about 24 hours. Gross. I suffered when I returned home. I took the eating thing to heart and have not felt hypo.
If you've got any questions, please ask.