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How Do You Assess For Somogyi Phenomenon?

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Here are some thoughts (10 minutes worth it seems) on what might be behind those sticky morning high blood sugars...including one about auto mode. I am not in any way disputing whether or not these phenomena exist (or whether or not they might be teaming UP with auto for full effect) but am only offering an alternative cause to the morning blood sugar surge. In my own case I see minimum delivery and lowered basal rates-a-plenty most nights, and using my c-factor, have begun to see the full effect of that insulin reduction. Since getting out of Auto a couple of hours in advance of waking up, I now see nice stable c-factors and blood sugars throughout my morning. Most mornings I even have a good bit of insulin remaining on board even after my morning coffee. I understand this wont fit everyones story. Wouldnt it be nice if we were all so simple? However it certainly might be worth consideration for someone who only recently has become consumed with the idea of dawn phenomenon or somogyi effect. You never know.

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 Continue reading >>

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  1. NAYPOOIE

    Still a problem. More of a problem because I just don't feel like eating in the morning.

    current weight: 208.0



    250

    221.25

    192.5

    163.75

    135

  2. NAYPOOIE

    I had an interesting experience a week ago. I got up and tested at 120, then, still fasting, tested again at the clinic (for a quick and dirty calibration of my meter against theirs) a couple hours later. It had jumped to 198! It disturbed me, but made me determine to eat breakfast more promptly in the future.

    current weight: 208.0



    250

    221.25

    192.5

    163.75

    135

  3. SARAH548

    Saille wrote: "Here is a good link with information about why blood glucose levels spike after excersising:"
    THANKS! I've been getting concerned that my blood glucose readings have started "spiking" after exercise; I'll mellow out about it now and will try having a protein/carb snack before.
    T2 diabetic; diagnosed 1/2007. Maintaining A1c of 5.1% - 5.4% for past 3+ years. No diabetic medication at this time; managing diabetes through carb restriction (40-50 grams carbohydrate per day) and moderate exercise.
    "Walking is the best possible exercise. Habituate yourself to walk very fast." - Thomas Jefferson


    Pounds lost: 6.5



    0

    1.75

    3.5

    5.25

    7

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Major Increases Between Pre- And Post-breakfast Glucose Levels May Predict Nocturnal Hypoglycemia In Type 2 Diabetes

The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( ). This article has been cited by other articles in PMC. Objective The aim of this study was to determine whether nocturnal hypoglycemia may be predicted according to morning glucose levels. Methods We retrospectively evaluated 106 patients with type 2 diabetes who underwent continuous glucose monitoring during admission. The pre-breakfast glucose level (Pre-breakfast level), highest postprandial glucose level within 3 hours after breakfast (Highest level), time from the start of breakfast to the highest postprandial glucose level (Highest time), difference between the pre-breakfast and highest postprandial breakfast glucose levels (Increase), area under the glucose curve (180 mg/dL) within 3 hours after breakfast (Morning AUC), post-breakfast glucose gradient (Gradient), and the increase-to-pre-breakfast ratio (Increase/Pre-breakfast) were calculated. The subjects were divided into hypoglycemic and non-hypoglycemic patients and compared for the above parameters using the t-test 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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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 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

  4. -> Continue reading
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