Hi Sue,

You ask:  How do you acheive increasing levels with a pill which is designed to flush itself out gradually. The pill is doing the opposite of what the body does. Is my understanding right ?

Your understanding is just right, and this is the reason the 3am dose needs to be a good sized one.  The other doses decrease as the body’s need decrease, but this one is opposite. 

To do better, you’d need a couple of sleeptime doses that build on one another.  At some point, though, you need to accept that this is pretty darn good and stay in bed!  Giving the dose at 3am is a big improvement over the bedtime dose.  Giving the waking dose as soon as your sweetie awakens will have her cortisol levels back up in no time. 

You daughter is very young, so her rapidly changing levels are not surprising.  It’ll take some time for you and your endo to learn how she is best managed.  Just keep very good records of meds times and doses leading up to the bloodwork, the time of the bloodwork and whether or not meds were given beforehand, and her state of agitation at the time of the draw.  That way you can compare results with all these important factors in mind.

Sounds like you are doing a good job.  Hang in there.

LauraK