Podcast Summary

Episode Overview

Title: Hypercortisolism – The Overlooked Condition Behind “Uncontrollable” Diabetes
Hosts: Dr. Steve Edelman (Dr. Jeremy Pettus absent)
Guests: Phil (patient living with hypercortisolism and diabetes) & Clarice (Phil’s wife, family/lifestyle medicine provider)
Date: October 7, 2025

This episode explores the “invisible” yet surprisingly common endocrine disorder hypercortisolism—more commonly known as Cushing’s syndrome—and uncovers its significant impact on blood sugar control and the lives of those who often struggle fruitlessly to manage “uncontrollable” type 2 diabetes. Through Phil’s personal story and Clarice’s medical insights, Dr. Edelman takes listeners through the frustrating diagnostic journey, reveals the telltale signs healthcare providers frequently miss, and advocates for persistent self-advocacy when the numbers just don’t add up.

Key Discussion Points and Insights

What is Hypercortisolism?

• Definition and Context
  • Hypercortisolism refers to excessive cortisol levels, usually from adrenal gland dysfunction or tumors elsewhere in the body ([01:10]).
  • Chronic high cortisol wreaks havoc: causes difficult-to-control diabetes, high blood pressure, heart/kidney/liver issues, muscle weakness, fatigue ([01:25]).
  • Often undiagnosed for years; frequently misattributed to “uncontrolled” type 2 diabetes.

“Cortisol levels stay high over an extended period of time and wreak havoc with the body...Difficult to control diabetes, difficult to control high blood pressure, heart disease, liver disease, kidney disease, and many other symptoms like weakness, fatigue.”
– Dr. Edelman [01:14]

Phil’s Journey: The Patient Perspective

Diagnosis and Early Struggles

• Surprised by type 2 diabetes diagnosis in 2008, despite being fit and active Navy veteran ([03:23]).
• Blood sugar was 180+ mg/dL when tested while fasting.
• Felt “hit with a hammer emotionally” by the diagnosis ([03:50]).
• Initial control with diet and meds, but diabetes quickly became harder to manage, requiring more and more medications ([05:50]).
• Persistent, inexplicable fatigue and mood changes:
  • “I was overwhelmed...just too tired to get up and go eat it”—Phil [06:35]
  • Despite sleep studies and treating sleep apnea, fatigue remained unresolved ([07:55]).

The Clues and Missed Red Flags

• Despite exercise and strict diet, blood sugars worsened; doctors kept escalating meds ([05:50], [08:30]).
• Symptoms broadened: bone pain, kidney stones, severe anxiety/irritability, profound sleeping disorders (multiple naps a day, no restorative sleep) ([09:23]).
• “No two patients present alike”—misleading clinical picture ([09:23]).
• Sleep apnea therapy provided no relief—a diagnostic hint often missed.

“He was just a stress bomb inside. Although he never let anyone see it.”
– Clarice [10:35]

The Turning Point: Clarice’s Advocacy

• Clarice, Phil’s fiancee and a family/lifestyle medicine provider, recognized constellation of symptoms:
  • Thin arms, moon face, “buffalo hump” (fat at the back of neck).
  • Chronic fatigue, kidney stones, mood changes, recalcitrant blood sugars ([09:23], [11:30]).
• Attempted to rule out other disorders, e.g., latent autoimmune diabetes; all negative ([10:50]).
• Ordered tests suspecting hypercortisolism ([13:25]).

Diagnosis: The Medical Details

• Confirmatory Testing
  • The 1mg overnight dexamethasone suppression test is the standard; if cortisol remains high in the morning, it strongly suggests hypercortisolism ([14:02]).
  • Phil’s results “grossly positive”—abnormally high cortisol post-test ([13:59]).
• Finding the Source
  • Imaging (scans) did not show a tumor; sometimes the cause remains elusive, but therapy can be started if cortisol is high ([15:12], [16:07]).

“When you don’t find [a tumor] anywhere, that’s where these medications can really help.”
– Dr. Edelman [16:13]

Recovery: Treatment and Results

• Therapy Makes a Difference
  • With targeted medication, Phil’s sleep improved—“I had REM sleep last night...for the last couple months...that’s all coming back.”
  • Blood sugars dropped to 90–110 mg/dL; A1C fell to 6.1% (from high 8–9%) ([16:04]).
  • Reduced to just metformin for diabetes; blood pressure meds also cut ([17:47]).
  • Muscle mass and body composition improved: “He does look like a trained athlete with no effort” ([18:11]).

Notable Quotes & Memorable Moments

• When fatigue ruled Phil’s life:

  “I was so tired. I look at the kitchen thinking, oh, hey, you know, there’s a nice roast beef sandwich in there. I was just too tired to get up and go eat it.”
  – Phil [06:35]

• Persistence and advocacy:

  “If you are struggling and you know that you are following all the rules…the diet, and it’s not adding up…and you’re like, this is me—get someone to listen to you. Absolutely.”
  – Clarice [20:27]

• Diagnosis is too often missed:

  “A lot of people are accused of being non-compliant with their medications or they’re accused of being crazy, they’re sent to a psychiatrist. So it is a frustrating condition for sure.”
  – Dr. Edelman [12:30]

• Advice for patients:

  “You have to be your own best advocate, be smart and be persistent, and take control of your diabetes.”
  – Dr. Edelman [20:43]

Timeline of Key Segments

| Timestamp | Segment | |-----------|------------------------------------------------| | 00:55 | Introduction to hypercortisolism: symptoms, why it is overlooked | | 03:23 | Phil’s story: initial diagnosis, surprising results as a fit Navy veteran | | 05:50 | Disease progression: increasing fatigue, repeated medication increases | | 08:24 | Clarice describes attempts at lifestyle intervention and red flags | | 09:23 | Clarice identifies classic signs and symptom cluster (“buffalo hump,” chronic fatigue, mood changes) | | 13:25 | How the diagnosis was made: labwork and screening logic | | 14:01 | Dr. Edelman describes the dexamethasone suppression test | | 15:14 | Phil and Clarice discuss challenges in finding (or not finding) the hormonal source | | 16:03 | Phil’s improved health: normalization of sleep, glucose, reduction in meds | | 18:11 | Physical transformation after treatment | | 19:01 | Advice for listeners: self-advocacy, provider awareness, and access hurdles | | 20:39 | Dr. Edelman’s summary: be your own best advocate | | 22:39 | Phil’s wisdom: the importance of awareness and education for patients and providers | | 23:02 | Closing comments: hypercortisolism is not a new condition, just often unrecognized |

Lessons & Takeaways

• Be Persistent:
  Chronic uncontrollable diabetes (or hypertension) despite aggressive management may signal a hidden culprit—advocate for further evaluation.
• Broad, Variable Symptoms:
  No two people with hypercortisolism look the same; physicians must put the full picture together.
• Ask for the Right Tests:
  The 1mg overnight dexamethasone suppression test is a simple first step if suspicion is high.
• New Hope for Patients:
  Modern therapies can dramatically improve energy, blood sugar, blood pressure, and quality of life—even when the precise source of cortisol remains elusive.
• Self-Advocacy is Critical:
  Educate yourself, persist, and don’t settle if “it just doesn’t add up.”
• Providers Must Think Outside the Box:
  Chronic uncontrolled symptoms aren’t always “bad compliance.” Rare conditions like hypercortisolism are more common than previously assumed.

Closing Thoughts

This episode shined a light on the struggles patients face when an underlying condition masquerades as “bad diabetes.” Phil and Clarice’s story is a testament to the need for curiosity, compassion, and collaborative care when things don’t make sense.
Dr. Edelman and the TCOYD team encourage listeners to “take control” and push for answers—a message that resonates for those living with diabetes and their advocates alike.