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How Do You Assess For Somogyi Phenomenon?

Ati Nutrition Practice A Flashcards - Cram.com

Ati Nutrition Practice A Flashcards - Cram.com

Age-related macular degeneration (AMD) nutritional change Found in foods : kale, spinach, collard greens and mustard TPN is empty, new bag not available - what should nurse infuse until new bag of TPN is available Dextrose 10% in water to prevent hypoglycemia Monitoring blood glucose levels at night. A fasting hyperglycemia that occurs in the morning in response to hypoglycemia during the nighttime Nutritional teaching for toddler w/ failure to thrive - behavioral interventions 2.stop feeding when negative behavior exhibits Green leaf veggies and wheat flour wirh vitman B , Chicken liver Nutritional need for pt who has a new colostomy. Proteins - to promote healing of the incision Caloric range recommended for women lactating Increase your caloric intake by 300- 400 calories per day What age does bone loss typically begin in women Between 30-35 afterwards more bone is lost than gained Prealbumin is a sensitive indicator of nutritional status 30mg/dL Client has new prescription for eternal nutrition by intermittent tube feeding. What action should nurse plan of care include? Increase then volume of formula over the first 4-6 feedings until the prescribed volume is achieved What indicates an effective plan of care for pt w/type 2 diabetes mellitus Increase what foods if diagnosed with beriberi? Whole grains are a good source of vitamin B Which food allergy is a contraindication to the flu vaccine? Infant has cleft lip and palate - Which position should nurse use when bottle feeding infant? Upright with nipple directed to the side of her mouth to prevent the formula from entering the nasal passage Client undergoing radiation therapy for cancer and is experiencing stomatitis. Which food choices is appropriate? Soft and nonirritating to the oral mucosa..such as scrambled eg Continue reading >>

Diabetes Glossary

Diabetes Glossary

Diabetes A to Z A1C - A blood test that measures average blood glucose over the past 2 to 3 months and is the best way to measure overall glucose control. It should be measured 2 to 4 times a year and the goal is less than 7%. Acanthosis nigricans - a thickening and darkening of the skin in patchy areas in the skin folds of the armpits, neck, or groin, ranging from tan to dark brown. This is usually a sign of insulin resistance. ACE inhibitor (angiotensin-converting enzyme) - a type of medication used to lower blood pressure and help treat kidney problems related to diabetes. Adult stem cell - a cell found in the different tissues of the body – such as blood, skin or muscle – that can renew itself and produce the specialized cells needed by that tissue (known as multipotency). Antibodies - proteins that the body makes to protect itself from foreign substances such as bacteria and viruses. ARBs (angiotensin receptor blocker) - a type of oral medication used to lower blood pressure. Atherosclerosis - a process that involves thickening of the blood vessel walls thought to be related to inflammation of the vessel wall, which then leads to formation of plaques, causing partial blockages. If these plaques rupture, clots form on that rupture site, causing a more acute, total blockage. If the blood vessel is providing blood to the heart, the result would be a heart attack. Autoimmune disease - disorder of the body’s immune system in which the immune system mistakenly attacks and destroys body tissue considered foreign. Basal insulin - the insulin that controls blood glucose levels between meals and overnight. It controls glucose in the fasting state. Beta cells - cells that produce insulin. They are located within the islets of Langerhans in the pancreas. Blood glucose (o Continue reading >>

The Somogyi Effect

The Somogyi Effect

Go to site For Pet Owners An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual—it is a life-saving response. The body attempts to counteract the decline in the blood glucose concentration through a chain of reactions: The blood glucose concentration falls rapidly, or approaches hypoglycemia (blood glucose concentrations of less than 65 mg/dL [2.8 mmol/L]) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the central nervous system, adrenaline and subsequently cortisol, glucagon, and growth hormone are released. These hormones bring about an increase in the blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen and increased peripheral resistance to insulin). The resultant hyperglycemia produces polyuria and polydipsia. This can easily be misinterpreted as caused by an inadequate insulin dose. If the morning polyuria is thought to be the result of an insufficient insulin dose and a higher dose is given, the problem will be aggravated. An even more pronounced Somogyi effect will follow. Eventually the counter-regulatory mechanisms may become exhausted resulting in severe hypoglycemia. Hyperglycemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycemic episode. As a result, blood glucose concentrations do not always normalize within a few days after lowering the insulin dose. When to suspect a Somogyi overswing Minimal glycemia: <65 mg/dL or 3.6 mmol/L Maximum glycemia: 400–800 mg/dL or 22–44 mmol/L Persiste 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 >>

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 >>

Taming & Controlling Your Morning Blood Sugar

Taming & Controlling Your Morning Blood Sugar

Guest Blogger: Dr. Jody Stanislaw Naturopathic Doctor Jody Stanislaw has spent decades successfully helping clients dramatically improve their lives via her E.A.S.Y. Lifestyle Transformation Formula. She can teach you simple strategies for how to improve your: E.ating, A.ctivity, S.leep, and Y.ou (mental health). Each one of these Four Essential Pillars of Health is necessary for creating a life overflowing with well-being—and best of all, a life you enjoy! Dr. Jody Stanislaw is a Type 1 Diabetic since 1980. You can visit her on the web at: www.DrJodyND.com You go to bed and your blood sugar level is perfect….Ahhh. Then you wake up and it’s awful?! What happened?? My name is Dr. Jody Stanislaw and I’ve had type 1 since I was 7 years old. When I was diagnosed in 1980, blood glucose testing didn’t even exist. I had to pee in a cup twice a day and test how much sugar was in it, which only told me if I had been high over the past few hours. There was no way to ever know what my glucose level was in the moment…we’ve come a long way! Being able to know what your glucose level is at any time is a fabulous advancement that allows you to have better care. But more information can lead to new frustrations. Back then, if I woke up and didn’t feel low, all was good. Today, we can know exactly where our level is at anytime and if it’s in good range we’re happy and smiling! But if it’s not, we’re likely frowning and not feeling so hot. Over the years via my own trial and error and through working with many others who have diabetes, I have learned life-changing tools. I’ve learned that a key part of achieving healthy management is thorough understanding why blood sugar levels do what they do. So here you go… 4 Reasons Why Blood Sugar Can Be High in the Morn 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 >>

The Problematic Diabetic - Wsava2013 - Vin

The Problematic Diabetic - Wsava2013 - Vin

World Small Animal Veterinary Association World Congress Proceedings, 2013 University of California-Davis, Davis, CA, USA The first step in the evaluation of the poorly controlled diabetic dog or cat is to critically assess the findings on history and physical examination to be certain a problem with diabetic regulation truly exists. Many of the diabetic dogs and cats referred to our hospital for poor diabetic control are actually reasonably well regulated. The basic objective of therapy is to eliminate the clinical signs of diabetes mellitus, while avoiding the common complications associated with the disease. The most important parameters for assessing diabetic control are the owner's subjective opinion of severity of clinical signs and overall health of their pet, findings on physical examination, and stability of body weight. If the owner is happy with results of treatment, the physical examination is supportive of good glycemic control, and the body weight is stable, the diabetic dog or cat is usually adequately controlled. Poor control of glycemia should be suspected if the owner reports clinical signs suggestive of hyperglycemia or hypoglycemia or peripheral neuropathy, the physical examination identifies problems consistent with poor control of glycemia or the dog or cat is losing weight. If the history, physical examination, change in body weight, and serum fructosamine concentration suggest poor control of the diabetic state, a diagnostic evaluation to identify the cause is warranted. Poor diabetic control is usually caused by problems with biologic activity of the insulin, problems with owner technique in administering insulin, problems with the insulin treatment regimen, or problems causing insulin resistance. The owner's insulin administration technique an Continue reading >>

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

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 prior to diagnosis with Type 1.5 Diabetes. Most people have heard of Type 1 and Type 2 Diabetes, while others are in the dark on this form of Diabetes. Type 1 Diabetes has more than a few names: T1D, Juvenile Diabetes, Insulin Dependent Diabetes Mellitus (IDDM), and Type 1 Diabetes Mellitus. T1D is an autoimmune disease, which is very different contextually from Type 2 diabetes. The body basically begins an all out warfare against its beta cells in the pancreas better known as the insulin producers. Its a rather quick process and essentially ends with little to no insulin production. Type 1 diabet Continue reading >>

Diabetes Support Information Exchange

Diabetes Support Information Exchange

One of the most frustrating things that diabetics deal with is an unexpected rise in blood glucose overnight. You go to bed with a BG of 100 mg/dL (5.6 mmol/L), and wake up with a BG of 130 (7.2)! You didn’t eat, so what happened? This results from two distinctly different processes: Dawn Phenomenon and Somogyi Effect. Here are some basics. DAWN PHENOMENON Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies’ circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a woolly behemoth for breakfast. Since most of us fast while sleeping, with teenagers a possible exception, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy. The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis. Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally “the creation Continue reading >>

The Somogyi Phenomenon Revisited Using Continuous Glucose Monitoring In Daily Life

The Somogyi Phenomenon Revisited Using Continuous Glucose Monitoring In Daily Life

, Volume 48, Issue11 , pp 24372438 | Cite as The Somogyi phenomenon revisited using continuous glucose monitoring in daily life Blood Glucose ConcentrationContinuous Glucose MonitoringNocturnal HypoglycaemiaContinuous Glucose Monitoring SystemBlood Glucose Profile These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. To the Editor: In 1959, Michael Somogyi reported that hypoglycaemia during the night was often followed by heavy glycosuria next morning [ 1 ]. Moreover, a high morning fasting blood glucose value was later attributed to nocturnal hypoglycaemia and the need to reduce the evening or bedtime dose of insulin. The Somogyi phenomenonhypoglycaemia begetting hyperglycaemiais believed to be due to the release of counterregulatory hormones in response to (nocturnal) insulin-induced hypoglycaemia. Despite the fact that experimental studies have rejected the existence of the Somogyi phenomenon [ 2 , 3 , 4 ], it is, in our experience, still widely believed to exist by health care professionals. Previous experimental research has been based on hospitalised patients using nocturnal blood glucose profiles or real life data with a single nocturnal blood glucose measurement. The sensitivity of the latter method for the detection of nocturnal hypoglycaemia is low [ 3 , 5 ], which may explain some of the reluctance to accept that the phenomenon does not exist. The recent development of continuous glucose monitoring systems has made it possible to monitor patients with type 1 diabetes in daily life. Using this technology, we tested the existence of the Somogyi phenomenon in daily life in a large cohort of type 1 diabetic subjects. All 262 patients with type 1 diabetes from Continue reading >>

Dawn Phenomenon Or Somogyi Effect? What's The Difference?

Dawn Phenomenon Or Somogyi Effect? What's The Difference?

You wake up in the morning and check your blood sugar before breakfast. And it's high. Higher than it usually is in the morning. What's going on? A random elevated blood sugar could be a result of a variety of things: perhaps you ate too many carbohydrates the night before, you took less medicine than you're supposed to or you forgot to take it altogether. Maybe you are getting sick or are very stressed? Or maybe it's none of those things, but what could be causing it to be high? If you've noticed a pattern of elevated blood sugars in the morning, it could be a result of something called the dawn phenomenon or the Somogyi effect. The dawn phenomenon and the Somogyi effect both can raise your fasting blood glucose levels in the morning, but for different reasons. What Causes the Somogyi Effect and Dawn Phenomenon? Both occurrences are very similar in some respects and have to do with hormones that tell the liver to release glucose into your blood stream while you sleep. The difference is why the hormones are released. The Somogyi effect is caused by having too much insulin in the blood during the night. This can happen to people who take long-acting insulin, or if you are required to eat a snack before bed to keep your blood sugars stable and you didn't. Because there is an abundance of insulin in the blood and not enough glucose, it causes the blood sugar to drop while you are sleeping. In response, your body releases hormones to counteract the drop. This is often referred to as "rebound hyperglycemia." The result? You wake up with a higher blood glucose that is out of target range. The dawn phenomenon, on the other hand, is not caused by low blood sugar. Rather, the dawn phenomenon is caused by a surge of hormones that the body puts out in the early morning hours. At t 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 >>

Crne Review

Crne Review

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 increase when I have an infection." "I must draw the NPH insulin first if I am mixing it with regular insulin." 'If my blood glucose levels are greater than 300mg/dl, I must check my urine for ketones." Which of the following medications prescribed for a type 2 diabetic client is needed to optimize the secretion of insulin, slows glucose absorption, and decreases action of glucagons? The client is newly admitted with clinical manifestations of type 1 diabetes ketoacidosis. Which of the following medications would the nurse anticipate administering to this client via IV access immediately? The Continue reading >>

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