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Dawn Phenomenon And Somogyi Effect

How To Control The Dawn Phenomenon

How To Control The Dawn Phenomenon

If you had asked me a year ago how to control the dawn phenomenon in Type 2 diabetes you’d have stumped me. Why? Well because even though I was helping folks online through health forums, I wasn’t coaching anyone “live” because it really makes a huge difference between what you know versus what actually works for the client. Once I started coaching folks live – getting on the phone with them, talking with them through Skype, emailing them and texting them via WhatsApp, looking through and scrutinizing their food journals and daily blood glucose readings week after week, I began to realize that many of them have what is known as the dawn phenomenon i.e. high fasting blood glucose in the mornings with lower blood glucose readings the rest of the day. What is the Dawn Phenomenon? Many folks with both Type 1 and Type 2 diabetes find that their fasting blood glucose spikes in the morning and are much harder to control than their post-grandial (post meal) blood glucose. And sometimes they find that when they eat the same foods during breakfast, lunch and dinner, they find their post grandial readings after breakfast higher than before. This isn’t limited to just folks with Type 1 and Type 2 diabetes. It seems that some healthy people also get it but their blood sugar spikes are much less pronounced and stay within the normal range so it doesn’t get picked up by the blood glucose monitor. What Causes the Dawn Phenomenon? According to WebMD, the dawn phenomenon or dawn effect is the result of several natural body changes that happen while you’re asleep. Between 3 am and 8 am, your body starts to ramp up the amounts of certain hormones that work against insulin’s action to drop blood sugar levels. These hormones are the growth hormone, cortisol, glucagon and ad Continue reading >>

Diabetes: Somogyi Effect And The Dawn Phenomenon

Diabetes: Somogyi Effect And The Dawn Phenomenon

Diabetes is an illness that the patient must live with the rest of their lives. The key to living with diabetes successfully is tight glycemic control, or controlling blood sugar levels. Blood sugar levels can vary from time to time depending on several factors such as stress levels, amount of food consumed, type of food consumed, amount of insulin used or insufficient insulin coverage and the time of day. The human being responds to Circadian Rhythms. These are regular changes in mental and physical characteristics that occur in the course of a day. This term may be more familiar as the, “biological clock”. A good example is that of someone working midnights for the first time. They find it very difficult to sleep during the day and stay awake all through the night. It is as if their body has a mind of its own. In fact, there is some truth to that statement. Bears hibernate because of their biological clock. Circadian Rhythms combined with the above mentioned factors can produce wide fluctuations in the blood glucose levels of diabetics while they sleep. A diabetic’s blood glucose level may be at 135 mg/dL prior to bedtime and at two A.M. may drop to 40 mg/dL, causing a severe state of hypoglycemia. The body responds to such a drop by producing glucose from alternate sources, since there is no source of ingested food. The only sources of glucose come from the liver via gluconeogenesis, lipolysis (break down of lipids) and glycogenolysis. The body’s hormones stimulate this cascading response to dangerously low blood sugar. The results of such a response, is that of high blood sugar. This rebound hyperglycemia can in turn causes ketosis. Ketosis occurs because the body is fooled into thinking that there is not enough glucose, since the cells are starved, and the Continue reading >>

Somogyi Phenomenon

Somogyi Phenomenon

Overview In the 1930s, Dr. Michael Somogyi speculated that hypoglycemia during the late evening induced by insulin could cause a counterregulatory hormone response (see the image below) that produces hyperglycemia in the early morning. [1] This phenomenon is actually less common than the dawn phenomenon, which is an abnormal early morning increase in the blood glucose level because of natural changes in hormone levels. [2, 3, 4] Debate continues in the scientific community as to the actual presence of this reaction to hypoglycemia. Shanik et al, for example, suggested that the hyperglycemia attributed to the Somogyi phenomenon actually is caused by an insulin-induced insulin resistance. [5] The causes of Somogyi phenomenon include excess or ill-timed insulin, missed meals or snacks, and inadvertent insulin administration. [6, 7, 8] Unrecognized posthypoglycemic hyperglycemia can lead to declining metabolic control and hypoglycemic complications. Although no data on frequency are available, Somogyi phenomenon is probably rare. It occurs in diabetes mellitus type 1 and is less common in diabetes mellitus type 2. With proper identification and management, the prognosis for Somogyi phenomenon is excellent, and there is no evidence of long-term sequelae. Instruct patients in proper identification of symptoms of hypoglycemia, insulin dose, timing of meals, and insulin administration. For patient education information, see Insulin Reaction. Practice Essentials Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. See the image below. See Clinical Findings in Diabetes Mellitus, a Critical Imag Continue reading >>

Somogyi Effect: Causes And Prevention

Somogyi Effect: Causes And Prevention

The Somogyi effect, also known as the rebound effect, occurs in people with diabetes. Hypoglycemia or low blood glucose in the late evening causes a rebound effect in the body, leading to hyperglycemia or high blood glucose in the early morning. This phenomenon, known as the Somogyi effect, is widely reported but remains controversial due to a lack of scientific evidence. It is reported more by people with type 1 diabetes than by people with type 2 diabetes. Contents of this article: What is the Somogyi effect? Named after Michael Somogyi, a Hungarian-born researcher who first described it, the Somogyi effect is the body's defensive response to prolonged periods of low blood sugar. A dose of insulin before bed that is too high can be a cause. When insulin reduces the amount of glucose in the blood by too much, it causes hypoglycemia. In turn, hypoglycemia makes the body stressed, triggering the release of the stress hormones epinephrine (adrenaline), cortisol, and growth hormone. The endocrine hormone glucagon is also released. Glucagon triggers the liver to convert stores of glycogen into glucose, which can send blood glucose levels into a rebound high. The stress hormones keep the blood glucose levels raised by making the cells less responsive to insulin. This is known as insulin resistance. Controversy The Somogyi effect is widely cited among doctors and people with diabetes, but there is little scientific evidence for the theory. For example, one small study found that hyperglycemia upon waking is likely to be caused by not enough insulin before bed. Researchers also found that participants who appeared to have rebound hyperglycemia did not have higher levels of growth hormone, cortisol, or glucagon than others. A 2007 study of 88 people with type 1 diabetes using c Continue reading >>

What Is The Somogyi Effect?

What Is The Somogyi Effect?

When you use insulin therapy to control your diabetes, you need to measure your blood sugar levels several times a day. Depending on the results, you might take insulin to lower your blood sugar levels or have a snack to raise them. This sort of blood sugar troubleshooting can be thrown off when something like the Somogyi effect comes into play. Also known as the Somogyi phenomenon, the Somogyi effect happens when you take insulin before bed and wake up with high blood sugar levels. When insulin lowers your blood sugar too much, it can trigger a release of hormones that send your blood sugar levels into a rebound high. The Somogyi effect is rare. It’s more common in people with type 1 diabetes than type 2 diabetes. If you notice inconsistencies or large changes in your blood sugar levels, speak with your doctor. If you wake up with high blood sugar levels in the morning, and you don’t know why, you may be experiencing the Somogyi effect. Night sweats may be a symptom of this phenomenon. If you have diabetes, you may use insulin injections to manage your blood sugar levels. When you inject too much insulin, or you inject insulin and go to bed without eating enough, it lowers your blood sugar levels too much. This is called hypoglycemia. Your body responds to hypoglycemia by releasing hormones, such as glucagon and epinephrine. In turn, this raises your blood sugar levels. This is why the Somogyi effect is sometimes referred to as the “rebound effect.” Although the Somogyi effect is widely reported, there’s little scientific evidence to confirm its existence. Somogyi Effect vs. Dawn Phenomenon The dawn phenomenon is similar to the Somogyi effect, but the causes are different. Everyone experiences the dawn phenomenon to some extent. It’s your body’s natural r Continue reading >>

Somogyi Effect And Dawn Phenomenon In Diabetes

Somogyi Effect And Dawn Phenomenon In Diabetes

So I read a lot of interesting things today and I'm formulating questions based on it. A person took too much insulin at night and went to sleep. He checks his morning blood sugar levels and it's elevated. Why? It's because stress hormones were released while he was asleep which caused the hyperglycemia. (This is called Somogyi effect!) Now, a person took his appropriate dose of insulin at night and went to sleep. He checks his morning blood sugar levels and it's elevated. What happened this time? There is a normal hormone surge at 7 am (Growth hormone, cortisol, glucagon and epinephrine) which caused the hyperglycaemia. This is called dawn phenomenon. How will you differentiate Somogyi effect from dawn phenomenon? Why is this clinically relevant? I guess the person with Somogyi effect will have certain signs and symptoms related to hypoglycemia. For instance, night terrors. Right? People with hypoglycemia don't wake up but have nightmares. The 3 am glucose levels to be precise. It is low in Somogyi effect and maybe normal or high in dawn phenomenon. You'll decrease NPH insulin at night in the former and increase the NPH insulin dose in the latter. NPH is an intermediate acting insulin. NPH insulin is usually taken at night. Duration of action 7- 14 hours! In Somogyi, the excess insulin caused hyperglycemia. So you'll decrease the dose. And similarly, in dawn phenomenon, the inadequate dosing caused the hyperglycaemia, so you'll increase NPH insulin. If you're under the impression that is inadequate insulin and if you increase the dose of insulin, you can put the patient into a hypoglycemic coma! This is why, recognising Somogyi effect is very important. I didn't get the management.. How is the adequacy of insulin assessed? If a patient comes with morning hyperglycemia, Continue reading >>

Self-monitoring Of Blood Glucose To Assess Dawn Phenomenon In Chinese People With Type 2 Diabetes Mellitus

Self-monitoring Of Blood Glucose To Assess Dawn Phenomenon In Chinese People With Type 2 Diabetes Mellitus

Copyright © 2017 Wen Wu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims. We investigated whether self-monitoring of blood glucose could be used to assess dawn phenomenon in Chinese people with type 2 diabetes mellitus (T2DM). Methods. A total of 306 people with T2DM underwent continuous glucose monitoring and self-monitoring of blood glucose for 72 h. A linear model was used to fit the optimal linear formula of the magnitude of dawn phenomenon (ΔDawn) and self-monitoring of blood glucose values. Results. The prevalence of dawn phenomenon was similar within different oral antidiabetic drug groups (42.5%, 31.5%, and 40.9%, ). Multiple variable linear regression showed that prebreakfast, prelunch, and predinner glucose measurements were independently and significantly correlated with ΔDawn. The linear formula between ΔDawn and blood glucose was as follows: (adjusted , ). Conclusions. Dawn phenomenon could be partly assessed by blood glucose self-monitoring in Chinese people with T2DM using the abovementioned formula. The incidence of dawn phenomenon was similar among patients in different oral antidiabetic drug groups. 1. Introduction “Dawn phenomenon,” first proposed by Schmidt in 1981, describes a spontaneous increase in blood glucose concentration or insulin requirements during the early morning that occurs in the absence of hypoglycaemia [1]. Continuous glucose monitoring system (CGMS), which has been widely used for decades, effectively improves the qualitative and quantitative detection of dawn phenomenon. Using CGMS, dawn phenomenon is determined using the absolute differences betwe Continue reading >>

Morning Highs? What Is The Somogyi Effect?

Morning Highs? What Is The Somogyi Effect?

Ok, so what’s up with this term that people keep throwing around called the dawn phenomenon? As type 1 diabetics we’ve all been there, up at 1:30 in the morning testing our blood sugars and come back with a perfect reading of 100 mg/dl only to wake up a couple of hours later with a glucose level of 400 mg/dl! Why is this? What’s happening to our bodies during that 2 1/2 hour period that sends sends our blood sugars into the stratosphere! Welcome to what is called, the dawn phenomenon. Lets take a closer look at what this is all about and what we can do to try and stabilize our blood sugars. What Causes The Dawn Phenomenon: The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrin. You may recognize these as they are the hormones involved in the “fight or flight response.” In this case, their job is more benign, to give you the energy to get up and moving. Besides giving you a burst of energy, these hormones raise blood sugar. You aren’t going to be able to make any kind of energetic response if you don’t have fuel, and after a long night’s sleep, the fuel your body turns to in order to get you going is the glucose stored in the liver. So once these hormones are secreted, typically around 5:30 am, plasma glucose and insulin can start to rise. Though a non diabetic will automatically get a rise in insulin to help cells use this morning glucose, as type 1’s, we know that’s not always the case and instead of giving our cells a dose of morning energy, all we get is a rise in our blood sugars. Dawn Phenomenon vs Somogyi Effect? The somogyi effect (first discovered my Dr. Michael Somogyi) is caused by nighttime hypoglycemia, which leads to a rebound hypergl Continue reading >>

Dawn Phenomenon And Somogyi Effect In Iddm

Dawn Phenomenon And Somogyi Effect In Iddm

We examined the clinical relevance of a rise in fasting blood glucose (BG) between 0300 and 0600 in 97 patients with insulin-dependent diabetes mellitus (IDDM) receiving sequentially conventional (CT) and basal-bolus (BBIT) insulin therapies and assessed the impact of one potential causal factor, i.e., posthypoglycemic hyperglycemia, with 231 BG profiles (97 during CT, 134 during BBIT) in which BG was measured every 3 h over a 24-h period. A rise in BG between 0300 and 0600 occurred in 157 of 231 (68%) profiles. The mean magnitude of this rise was 56 ±39 mg/dl and was lower (P < .05) during BBIT (48 ± 35 mg/dl, n = 97) than CT (62±43 mg/dl, n = 97). A dawn rise (between 0300 and 0600) >50 mg/dl occurred in 40 of 97 (41%) profiles during CT and 26 of 97 (27%) during BBIT (P < .05). When all profiles were grouped according to the magnitude of this rise in BG, the mean daytime BG (from 0900 to 1800) was higher (P < .05) after an 0300–0600 BG rise >50 mg/dl compared with groups of profiles showing either a fall in BG or a rise <50 mg/dl; a rise in BG between 0300 and 0600 correlated (r = .38, P < .0001) with the subsequent mean daytime BG. Nocturnal hypoglycemia (BG <60 mg/dl) recorded at 2400 and/or 0300 occurred in 57 of 231 (25%) profiles. After nocturnal hypoglycemia, the highest BG recorded before breakfast was only 215 mg/dl, and the mean BG at 0600 was considerably lower (P < .0001) in profiles showing at least one episode of nocturnal hypoglycemia (116 ± 45 mg/dl, n = 57) compared with all profiles in which no nocturnal hypoglycemia was detected (174 ± 85 mg/dl, n = 174). In addition, postbreakfast BG levels at 0900 were lower (P < .0001) after nocturnal hypoglycemia (171 ± 87 mg/dl, n = 57) than when no nocturnal hypoglycemia was detected (211 ± 91 mg/dl, Continue reading >>

Dawn Phenomenon And The Somogyi Effect

Dawn Phenomenon And The Somogyi Effect

Overview The dawn phenomenon and the Somogyi effect cause high blood sugar levels, especially in the morning before breakfast, in people who have diabetes. The dawn phenomenon is a normal rise in blood sugar as a person's body prepares to wake up. In the early morning hours, hormones (growth hormone, cortisol, and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar. If the body doesn't produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). Somogyi effect If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. An example of the Somogyi effect is: A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night. The person's body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning. How can you tell the difference? The Somogyi effect can occur any time you or your child has extra insulin in the body. To sort out whether an early morning high blood sugar level is caused by the dawn phenomenon or Somogyi effect, check blood sugar levels at bedtime, around 2 a.m. to 3 a.m., and at your normal wake-up time for several nights. A continuous glucose monitor could also be used throughout the night. If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's li Continue reading >>

A Simple Trick To Lower Morning Blood Sugar

A Simple Trick To Lower Morning Blood Sugar

If you’re type 2 diabetic, you may be wondering why your blood sugar is so high in the morning. Every other time you test, your levels seem to be within range… But those morning levels, sometimes they are sky high and it puts you in a panic, questioning what on earth you may be doing wrong. Firstly, stop panicking — morning rises are a common occurrence in diabetics. However, it is important to understand why it happens and what you can do about it… The dawn phenomenon Logically you’d think that your blood sugar reading should be at it’s lowest in the morning. After all, you’ve eaten nothing and done nothing but sleep. But regardless of whether you eat, glucose production continues anyway… The reason for this is your body’s cells need fuel for your heart to beat, your brain to work and your organs to keep functioning. When you don’t eat, or when you’re asleep, the body can break down stores of available glucose (glycogenolysis) or enter a process called gluconeogenesis — a process that can use non-carbohydrate stores such as amino acids to produce glucose. Various hormones such as glucagon, growth hormone and cortisol, are also involved in raising glucose levels. To wake you up every morning, your body naturally activates these hormones from around 3 am onwards, which explains why it’s called the dawn phenomenon. In people without diabetes, insulin would normally counteract these hormones to prevent excessive glucose production. But since the insulin response and insulin sensitivity are altered in diabetes, your body may not compensate effectively. The Somogyi effect There is another phenomenon called the “Somogyi effect” or “rebound hyperglycemia.” This is when your body’s glucose levels decrease during the night (nocturnal hypoglyce Continue reading >>

Somogyi Effect In A Patient Of Type 2 Diabetes Mellitus

Somogyi Effect In A Patient Of Type 2 Diabetes Mellitus

Department of Biochemistry, Hi-Tech Medical College and Hospital, Odisha, India Citation: Brijesh M (2015) Somogyi Effect in a Patient of Type 2 Diabetes Mellitus. J Diabetes Metab 6:493. doi: 10.4172/2155-6156.1000493 Copyright: ©2015 Brijesh M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Morning hyperglycemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycemic control. The dawn phenomenon is a normal rise in blood sugar as a person’s body prepares to wake up. In the early morning hours, hormones (growth hormone, cortisol and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. If the body doesn’t produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). Somogyi effect occurs in a person who takes insulin doesn’t eat a regular bedtime snack, and the person’s blood sugar level drops during the night. The person’s body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning. The dawn phenomenon is more common than the Somogyi Continue reading >>

Somogyi Effect Vs Dawn Phenomenon: Differences Worth Knowing

Somogyi Effect Vs Dawn Phenomenon: Differences Worth Knowing

Have you ever gone to sleep with a relatively normal glucose reading and woke up with a much higher value? If Yes! Then you must be wondering why glucose numbers swing during sleep or during pre-dawn hours? Well! In the current article we will talk about the two possibilities namely the Somogyi Effect and The Dawn phenomenon. We will know about the differences between the two possibilities in the following sections. Before we talk about the differences between Somogyi Effect and the Dawn Phenomenon, we would mention that both these phenomenon can raise your fasting blood glucose levels during the morning hours, but for different reasons. Somogyi Effect is also known as "Rebound Hyperglycemia". The Somogyi Effect is a pattern of undetected hypoglycaemia or low blood glucose values of less than 70, followed by hyperglycemia or high blood glucose levels of more than 200. This effect generally happens in the middle of the night, though it can also occur when too much insulin is circulating in the system. During hypoglycaemia period, the body releases hormones which cause a chain reaction to release the stored glucose. The end result is that the level of glucose can swing extremely high in the other direction, causing hyperglycemia. The Dawn effect is named after the time of the day it occurs. This phenomenon is the body's response to hormones released in the early morning hours. Such an effect occurs for everyone. When we sleep, hormones are released in order to help maintain and restore cells within our bodies. These counter-regulatory hormones like growth hormones, catecholamines, and cortisol cause the rise in glucose level. There is a high glucose reading in the morning for those people with diabetes who do not have enough circulating insulin for keeping this increase o Continue reading >>

Dawn Phenomenon And The Somogyi Effect

Dawn Phenomenon And The Somogyi Effect

There are several reasons for a high fasting blood glucose reading in the morning. Some common reasons include taking the wrong dose of a medication or eating foods such as carbohydrates before bedtime. Some things that are not as common and not always recognized are the dawn phenomenon and the Somogyi effect. The dawn phenomenon is an increase in blood sugar due to the body producing hormones, which happens just before waking between the hours of 4:00am and 8:00am. These hormones (growth hormones, epinephrine, cortisol or glucagon) cause the liver to release large amounts of glucose (sugar) into the blood. The hormones may also partially stop the effect of insulin, either insulin that is made in the body or that was injected the night before. According to the American Diabetes Association, the increase in sugar in the bloodstream is due to the fact that the body is making less insulin and more of a hormone called glucagon. Glucagon is a substance in your body that increases blood glucose levels by telling the liver to break down something called glycogen into glucose. Glycogen is a very large structure that is made up of a lot of glucose that get broken down into smaller pieces, this causes a rise of glucose in the blood. The dawn phenomenon is unpredictable because it affects some people with diabetes but not others. Some things you can do to prevent or manage the dawn phenomenoncan be by either eating dinner earlier in the evening, avoiding eating carbohydrates before bedtime, adjusting the dose of diabetes medications or exercising after dinner. The Somogyi effect, like the dawn phenomenon, involves having high fasting blood glucose levels in the morning. The difference however is that with the Somogyi effect, oral medications or insulin are working too strongly at Continue reading >>

The Dawn Phenomenon – Why Are Blood Sugars High In The Morning?

The Dawn Phenomenon – Why Are Blood Sugars High In The Morning?

Getting high blood sugars after a period of fasting is often puzzling to those not familiar with the Dawn Phenomenon. Why are blood sugars elevated if you haven’t eaten overnight? This effect is also seen during fasting, even during prolonged fasting. There are two main effects – the Somogyi Effect and the Dawn Phenomenon. Somogyi effect The Somogyi effect is also called reactive hyperglycaemia and happens in type 2 diabetic patients. The blood sugar sometimes drops in reaction to the night time dose of medication. This low blood sugar is dangerous, and in response, the body tries to raise it. Since the patient is asleep, he/she does not feel the hypoglycaemic symptoms of shakiness or tremors or confusion. By the time the patient awakens, the sugar is elevated without a good explanation. The high blood sugar occurs in reaction to the preceding low. This can be diagnosed by checking the blood sugar at 2am or 3am. If it is very low, then this is diagnostic of the Somogy Effect. Dawn phenomenon The Dawn Effect, sometimes also called the Dawn Phenomenon (DP) was first described about 30 years ago. It is estimated to occur in up to 75% of T2D patients although severity varies widely. It occurs both in those treated with insulin and those that are not. The circadian rhythm creates this DP. Just before awakening (around 4am), the body secretes higher levels of growth hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP. These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver to start p Continue reading >>

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