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How Do You Assess For Somogyi Phenomenon?

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Which of the following hormones maintains adequate levels of glucose in the blood between meals? The client received NPH (Novolin ge) insulin at 0730. Based on an understanding of peak time, the nurse should assess the client for hypoglycemia at which of the following times? The client is scheduled to receive 5 units of Humalog and 25 units of glargine (Lantus) insulin prior to bedtime for a blood sugar of 14 mmol/L. What nursing intervention is most appropriate for this client? Make sure the client's snack is ready to eat before administering this insulin. Offer the client a high-carbohydrate snack in six hours. Hold the insulin if the blood glucose level is <100 mg/dl. Administer the medications in two separate syringes. During the assessment, the client states, "My blood glucose levels range between 4.5-5.5 mmol/L, but my early-morning blood glucose levels are 11 mmol/L." This phenomenon is best known as _________. The nurse is initiating discharge teaching with the newly diagnosed diabetic. Which of the following statements indicates that the client needs additional teaching? "If I am experiencing hypoglycemia, I should drink half a cup of apple juice." "My insulin needs might Continue reading >>

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  1. hannahtan

    Somogyi effect VS. Dawn Phenomenon

    As there are a lot of people asking what Dawn Phenomenon and Somogyi effect is... I feel Dlife.com gives a good explanation on it...below is the article...
    -----
    Somogyi effect VS. Dawn Phenomenon
    By Theresa Garnero, APRN, BC-ADM, MSN, CDE
    Have you ever gone to bed with a relatively normal glucose reading, only to wake up with a much higher value? Do you wonder why glucose numbers can swing during sleep or pre-dawn hours? This month’s column will address readers’ questions about the difference between two possibilities: the Somogyi effect and dawn phenomenon.
    What is the Somogyi effect?
    Also known as “rebound hyperglycemia” and named after the physician who first described it, the Somogyi effect is a pattern of undetected hypoglycemia (low blood glucose values of less than 70) followed by hyperglycemia (high blood glucose levels of more than 200). Typically, this happens in the middle of the night, but can also occur when too much insulin is circulating in the system. The cause of the Somogyi effect is said to be “man-made”—that is, a result of insulin or diabetes pills working too strongly at the wrong time.
    During periods of hypoglycemia, the body releases hormones which cause a chain reaction to release stored glucose. The end result is that the glucose level can swing too high in the other direction, causing hyperglycemia.
    How can you test for the Somogyi effect?
    This is the fun part. Set your alarm and wake up between 2 and 3 a.m. and test your blood glucose. Low blood glucose levels could signify the Somogyi effect is in action.
    Wouldn’t I know if I’m going too low?
    Not always. Sometimes the body has less of a reaction to low blood sugars, especially if you have had wildly fluctuating glucose values for years and can lead to a condition called autonomic neuropathy, which blocks the body’s ability to detect lows. This is more likely to occur during sleep hours—a frightening thought. One option is to ask your doctor or endocrinologist about a 3-day continuous glucose monitoring system (CGMS) exam. About the size of a pager, you would wear the device for 3 days. A little plastic tube taped gently beneath your skin allows the CGMS to read glucose readings several times a minute and can explain exactly when lows occur. Companies are competing to have “real-time” glucose values displayed in this device. Currently, the CGMS devices have to be downloaded at the physician or diabetes educator office for interpretation.
    What can I do to correct the Somogyi effect?
    The very best way is to prevent the low from happening in the first place. And that takes a little detective work to figure out what made the glucose plummet. You might try any of the following, with your physician or healthcare provider’s blessing:
    * Have a snack with protein before bedtime, like a piece of toast with peanut butter, or some cottage cheese, or yogurt, or some nuts and small piece of cheese.
    * Go to bed with a glucose level slightly higher than usual.
    * Wake up between 2 to 3 a.m. and test your blood glucose. Bring your logbook to your physician and ask if any medication adjustments are needed (like changing the type and/or amount of insulin, oral medication, or switching to an insulin pump). Do not skip or change your medications without your physician’s input!
    * Ask your doctor about having the CGMS test (see above description).
    What is the dawn phenomenon?
    Named after the time of day it occurs, not some high brow researcher, the dawn phenomenon is the body’s response to hormones released in the early morning hours. This occurs for everyone. When we sleep, hormones are released to help maintain and restore cells within our bodies. These counterregulatory hormones (growth hormone, cortisol and catecholamines) cause the glucose level to rise. For people with diabetes who do not have enough circulating insulin to keep this increase of glucose under control, the end result is a high glucose reading in the morning. For pregnant women, the dawn phenomenon is even more exaggerated due to additional hormones released in the night.
    How can I treat the high fasting glucose readings caused by the dawn phenomenon?
    Several options are worth considering:
    * Exercise later in the day, which may have more of a glucose-lowering effect in the night.
    * Talk with your doctor about a possible medication adjustment to control the higher fasting readings.
    * Limit bedtime carbohydrates and try more of a protein/fat type of snack (nuts, peanut butter, cheese, or meat).
    * Eat breakfast to limit the dawn phenomenon’s effect. By eating, your body will signal the counterregulatory hormones to turn off. This concept can be a little perplexing, as people often say, “But if I don’t eat, shouldn’t my sugar go down?” The opposite is true. By not eating, or skipping meals, it is fairly common to see higher glucose values as a result.
    No matter how we label high glucose values, whether caused by the Somogyi effect or dawn phenomenon, we must figure out their cause. Maybe we can start a dawn phenomenon chat room with everyone who will be setting their alarm clocks to awaken at 2 to 3 a.m. for blood sugar checks! One of the keys of diabetes management is identifying glucose patterns and trends over time. Monitoring is the best way to help solve these situations. Researchers are working diligently on newer systems to help unveil glucose patterns with relative ease. So in the meantime, Test! Don’t Guess – And let me know what you discover!

  2. jwags

    Thanks for the explanation. The only thing I do find is that I need to eat some carbs late at night, not just protein. I think it is the lack of carbs early in the morning that signals DP to start.

  3. Lloyd

    Originally Posted by hannahtan
    How can I treat the high fasting glucose readings caused by the dawn phenomenon?
    Several options are worth considering:
    * Exercise later in the day, which may have more of a glucose-lowering effect in the night.
    * Talk with your doctor about a possible medication adjustment to control the higher fasting readings.
    * Limit bedtime carbohydrates and try more of a protein/fat type of snack (nuts, peanut butter, cheese, or meat).
    * Eat breakfast to limit the dawn phenomenon’s effect. By eating, your body will signal the counterregulatory hormones to turn off. This concept can be a little perplexing, as people often say, “But if I don’t eat, shouldn’t my sugar go down?” The opposite is true. By not eating, or skipping meals, it is fairly common to see higher glucose values as a result.
    No matter how we label high glucose values, whether caused by the Somogyi effect or dawn phenomenon, we must figure out their cause. Maybe we can start a dawn phenomenon chat room with everyone who will be setting their alarm clocks to awaken at 2 to 3 a.m. for blood sugar checks! One of the keys of diabetes management is identifying glucose patterns and trends over time. Monitoring is the best way to help solve these situations. Researchers are working diligently on newer systems to help unveil glucose patterns with relative ease. So in the meantime, Test! Don’t Guess – And let me know what you discover! The methods suggested for treatment of Somogy effect are often effective.
    The methods suggested for treatment of Dawn Phenomenon are almost never effective, unless you have a very mild case.
    An insulin pump can be 100% effective in stopping DP in its tracks, as long as it occurs with regularity, by raising your basal rate to whatever is needed at a given time.
    My fasting readings dropped 100+ points on the first night of using a pump.
    -Lloyd

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Two ladies in the same meeting both healed of diabetes. The first is located by the Holy Spirit. When she declared her faith in Jesus, she experienced the power of God shaking the disease out of her. The second woman didn't mention her diabetes. When she got home she forgot to take her insulin, and discovered she was healed. To Jesus Christ be the glory. God loves you, and may He bless your life as you follow Jesus, Mark Hemans Encounter Ministries Join the Encounter Ministries group at https://www.facebook.com/groups/35456... Subscribe to Youtube For meeting schedule, prayer, or donate... www.jesusencounterministries.com

Dictionary (what Does That Mean?!) - She Sugar

Acanthosis Nigricans is the browning or darkening of the skin in the folds of the neck, back, chest and groin area. This can occur in healthy people but is associated with certain disease processes, namely diabetes. Most commonly acanthosis nigricans occurs in people with hyperinsulinemia (high insulin levels). [Read more...] Whoa. Not so fast, increase nighttime insulin because you or your child wake up with high Think again, first wake yourself and get a early morning blood sugar to see whats going on. As a person living with Type 1 for 29 years I have heard of this and experienced it first hand throughout my life. I have always wondered where this unique name originated though. With a little research I found the answer to this inane question- Dr. Michael Somogyi, of course. Sounds a little star treky, I know. [Read more...] January 25, 2012 By jewels Leave a Comment When you picture a Honeymoon this is not where your mind initially goes, right? However, it is THE best and longest honeymoon ever when you are speaking about the honeymoon period after diagnosis with Type 1 Diabetes. [Read more...] Feeling like you just didnt fit the mold? Many people talk about their struggle prio Continue reading >>

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  1. Nicole2010

    "response tp excessive dose of insulin. is a hypoglycemic condition that usually occurs in the predawn hrs of 2-4am. there is a rapid decrease in blood glucose which stimulates a release of hormones (eg cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, & glycogenolysis. blood sugars must be monitored between 2-4 am & reduce the bedtime insulin level"
    this is straight from the pharm book

  2. missjennmb

    that sounds like another language lol
    wonder what it means in English

  3. ghillbert

    Basically means rebound hyperglycemia. Your blood glucose level drops too low overnight, and to compensate the body over-reacts by releasing a whole bunch of chemicals which result in elevated blood sugar in the morning.
    Way to avoid the rebound is to avoid the hypo - may mean timing or dosing the night time insulin differently.

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Pubpdf - Find Full Text Journal Articles About Somogyi Phenomenon

Orv Hetil 2017 Aug;158(34):1323-1330 Jnos Szabad Cells feel good and carry on perfect functions when they contain the right types of proteins in the right concentration, at the right time and sites. There are mechanisms that ensure the right level of gene expression in the different cell types: the formation of protein molecules based on the DNA-encoded genetic information. Gene expression can also be regulated through the compactness of chromatin, i. View Full Text PDF Listings View primary source full text article PDFs. J Feline Med Surg 2016 Aug 4;18(8):587-96. Epub 2015 Jun 4. Kirsten Roomp , Jacquie Rand Rebound hyperglycaemia (also termed Somogyi effect) is defined as hyperglycaemia caused by the release of counter-regulatory hormones in response to insulin-induced hypoglycaemia, and is widely believed to be common in diabetic cats. However, studies in human diabetic patients over the past quarter century have rejected the common occurrence of this phenomenon. Therefore, we evaluated the occurrence and prevalence of rebound hyperglycaemia in diabetic cats. View Full Text PDF Listings View primary source full text article PDFs. PLoS One 2014 18;9(3):e91541. Epub 2014 Mar 18. Continue reading >>

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  1. Nicole2010

    "response tp excessive dose of insulin. is a hypoglycemic condition that usually occurs in the predawn hrs of 2-4am. there is a rapid decrease in blood glucose which stimulates a release of hormones (eg cortisol, glucagon, epinephrine) to increase blood glucose by lipolysis, gluconeogenesis, & glycogenolysis. blood sugars must be monitored between 2-4 am & reduce the bedtime insulin level"
    this is straight from the pharm book

  2. missjennmb

    that sounds like another language lol
    wonder what it means in English

  3. ghillbert

    Basically means rebound hyperglycemia. Your blood glucose level drops too low overnight, and to compensate the body over-reacts by releasing a whole bunch of chemicals which result in elevated blood sugar in the morning.
    Way to avoid the rebound is to avoid the hypo - may mean timing or dosing the night time insulin differently.

  4. -> Continue reading
read more

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