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What Is The Difference Between The Somogyi Effect And Dawn Phenomenon?

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ANSWERS Case 1: Staphylococcus aureus is the most common agent causing purulent cellulitis. Consequently, when a diagnosis of purulent cellulitis is made, it is important to consider a patient’s risk factors for methicillin-resistant S aureus (MRSA), including nasal colonization, prior MRSA infection, recent hospitaliza- tion, and/or antibiotic use. Because JM has purulent cellulitis and has had re- cent exposure to an antibiotic (levofloxacin for her UTI), empiric therapy should include an antibiotic with MRSA coverage (ie, trimethoprim-sulfamethoxazole, doxycycline or minocycline, linezolid or clindamycin). As the pharmacist, you might recommend doxycycline 100 mg taken orally twice daily. Case 2: The pharmacist should explain to the resident that it would be best to collect more information before increasing TO’s insulin dose because there are multiple reasons why she could have morning hyperglycemia. Specifically, TO could be experiencing a “Dawn phenomenon” or a “Somogyi effect.” The Dawn phenomenon occurs due to insufficient basal insulin administration overnight, and the Somogyi effect occurs because of too much basal insulin overnight, causing hypoglycemia and r 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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Dawn Phenomenon (liver Dump)

Tweet Dawn phenomenon is the term given to an increase in blood sugar in the morning caused by the body's release of certain hormones. It is a relatively common phenomenon amongst diabetics. Although often confused, Dawn Phenomenon is different from Chronic Somogyi Rebound, because it is not brought on by nocturnal hypoglycemia. How is dawn phenomenon caused? Dawn effect occurs when hormones (including cortisol, glucagon, epinephrine) are released by the body, causing the liver to release glucose. The dawn effect therefore describes abnormally high early morning increases in blood glucose: Usually abnormally high blood glucose levels occur between 8 and 10 hours after going to sleep for people with diabetes Why does the dawn phenomenon occur? Researchers think that the release of the above-mentioned hormones may give rise to a brief period of insulin resistance which would also explain a rise in blood glucose levels. How is dawn phenomenon treated? Typically dawn phenomenon is treated by avoiding intake of carbohydrates at bedtime, adjusting how much insulin or medication is administered, switching to other medications or using an insulin pump. I have high morning blood sugar, do I Continue reading >>

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  1. DrVirgo

    What is the difference between the Dawn Effect and the Somogyi Phenomenon?

  2. xenopus

    Somogyi phenomenon has been discredited as a cause of morning hyperglycemia. In turn, Dawn's phenomenon has been reproduced by infusiion of Growth Hormone as detailed in the study of Campbell et al. Further details see my post

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Dawn Phenomenon, Somogyi Effect & Honeymoon Phase

Dawn phenomenon Somogyi effect Honeymoon phase However, some of the patient may not need the exogenous insulin (insulin not produced within the body) during this phase. But then, the destruction of beta-cell is still occurred. Therefore, this period might come to an end. In addition, the honeymoon period is varied for different individuals. This phase may last for weeks, months and even years. 2 comments: Reading your article is such a privilege. It does inspire me, I hope that you can share more positive thoughts. Visit my site too. The link is posted below. n8fan.net www.n8fan.net Each year, 11,000 People Saw Their Diabetes Mysteriously REVERSED, But Even Their Doctors Couldn’t Say Why Until a rogue diabetes researcher solved this decades-old medical mystery… Start using his natural, at-home treatment to reverse your Diabetes without medication. For more info please click on the following link: How To Heal Diabetes. Talk soon. Continue reading >>

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  1. bangbong2000

    I guess they have to give us tips in the question like in case of somogyi pt morning hyperglycemia not improving with restriction of carbohydrate food before bed... Anyone can give me more idea?

  2. sonu.agarwall

    i read abt it somewer man....not sure wer....sum wer in my final year texts.....will post as soon as i find it....somogyi is sumthing in middle of night due to medications n dawn phenomenon is in early mrng related to counter regulatory hormones...sumthing like that

  3. docnas

    somogyi = rebound hyperglycemia due to hypoglycemia because of too much insulin given before sleeping
    dawn phenom is due to homones being released according to circadian rhythm main hormone noted is GH. this causes a hyperglycemic state.

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