The 40:1 dex-hydrocortisone conversion is the anti-inflammatory rate. The replacement cortisol rate should be 80:1, as stated by Carol.  When you were told your blood work was ’normal’, I would assume they mean that your adrenals are well suppressed (and not producing excess androgens) which is not the same as good control.  I agree with Carol, your dose should have been decreased at a slower rate, in order to hopefully prevent the problems you are now experiencing.