Well basically the point that I am driving at is that it will take extra time to be absorbed ---longer than IV.  I must have got the logitics wrong and confused it with half life.  However, the interesting thisg is that when Laura sends me the chart--- an oral dose given at 8am does not peak in time to meet the one indicated on the chart where it should do.  I cannot paste the chart here as it will not let me.  That is why I moved the dose back 1 hour.  Yet the dose I give at 2am (when we had discussed should be 3am a while back and infact what I was doing) more than meets the demand and actually appears to be giving good coverage on time on the chart that Laura sent.  I wish I could post it here and illustrate.  It jjust seems that 2am was the better time to give it.  Since it clearly "oeaks" at 3am on that chart in folks with normal functioning adrenals, I have to ask the question shouldn't we be orally dosing earlier.  The other interesting thing was, (and this is the whole reason why I queried actually dosing at 3am) is that Paul Hofman our endo saw that regime and immediately said to dose at 2am.  His words were that he has two girls on that regime or similar and that they are dosed at 2am.  then I get confirmation of that in wiriting when he summarized Ashleys dose regime in a letter as they normally do.  It got me thinking that we need to bring the dose forward same.  It would be important to time it so the hgihest level that an hct dose can be in the blood is spot on where anticipating the rise in acth is concerned.  Otherwise the 17 OHP levels have the advantage and again we are chugging on that train again to catch it up.  Feel free to correct me if I am wrong on this one.   Guess I thought I would be on the safe side and on this particular occasion actually listen to the doctor!  LOL!!!  So my reasons for altering from 8 am to 7am where that as that is where the most would be demanded and it was crucial to have the supply to meet the demand not the other way around---as we know what happens when we do this in CAH---I re scheduled the timings of the pills. 

Hopefully this will work some and the next lot of bloods will be down from 88nmol.  Sorry if this is confusing folks, but I truly beleive that you have to be prepared to adjust these things if you make such discoveries and especially when the bloods are not exactly favorable.   

I know that momentum would not pick up until 4am, but my thinking is that if you have a deficit to start with and then acth is released, that in turn switches on the HPA and that is when you get the problem.  I am told time and time again that the object is to switch this process off, so I naturally assumed that an hour earlier would ensure that it was swithced off well and truly and avoiding any uneccesary hormone surges where 17 OHP is concerned. 

I'l e-mail you that chart then you can see where I am coming from and what would be happening if you left the dose to 3am to take it.  As laura worked it out on 2am you can see that it meets that rise beautifully, but the dose is just a little too high for that time that is all which suggests knocking it down to 2.50mg from 3.75mg.  I will wait to see how the profiling looks though first as it is difficult to know if 15mg is enough anyway and I beleive the percentages need to be adjusted too.

I still have that other abstract to study---I printed it off, but I was naturally curious as to whether they administered orally when they were doing the testing around circadian variation.