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How To Assess For Somogyi Phenomenon

Blood Sugar: What Causes High Blood Sugar Levels In The Morning

Blood Sugar: What Causes High Blood Sugar Levels In The Morning

There are two reasons why your blood sugar levels may be high in the morning – the dawn phenomenon and the Somogyi effect. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows: Your body has little need for insulin between about midnight and about 3:00 a.m. (a time when your body is sleeping most soundly). Any insulin taken in the evening causes blood sugar levels to drop sharply during this time. Then, between 3:00 a.m. and 8:00 a.m., your body starts churning out stored glucose (sugar) to prepare for the upcoming day as well as releases hormones that reduce the body's sensitivity to insulin. All of these events happen as your bedtime insulin dose is also wearing off. These events, taken together, cause your body's blood sugar levels to rise in the morning (at "dawn"). A second cause of high blood sugar levels in the morning might be due to the Somogyi effect (named after the doctor who first wrote about it). This condition is also called "rebound hyperglycemia." Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. There are two potential causes. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin at bedtime is not enough and you wake up with a high morning blood sugar. How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sug Continue reading >>

Somogyi Phenomenon - Rebound Hyperglycemia

Somogyi Phenomenon - Rebound Hyperglycemia

Tweet The Somogyi phenomenon (also known as post-hypoglycemic hyperglycemia, chronic Somogyi rebound) describes a rebound high blood glucose level in response to low blood glucose. Amongst those people with diabetes who manage their blood glucose using insulin injections, this may take the form of high blood sugar in the morning due to an excess amount of insulin during the night. The Somogyi effect is controversial despite being widely reported. Why is rebound hyperglycemia called The Somogyi effect? The Somogyi phenomenon was named after a Hungarian-born professor called Dr. Michael Somogyi. He prepared the first insulin treatment given to a child with diabetes in the USA, and also showed that too much insulin would make diabetes management unstable and more difficult. Is Somogyi Phenomenon the same as Dawn Phenomenon? No, although they are often confused by healthcare professionals. The Dawn Effect (or Dawn Phenomenon) is a morning rise in blood sugar which occurs as a response to waning levels of insulin and a surge in growth hormones. How does Somogyi Phenomenon occur? Somogyi theorised that prolonged levels of untreated hypoglycemia could lead to stress (due to low blood sugar) and a high blood sugar levels rebound. This is a defensive response by the body as it released endocrine hormone glucagon, backed up by the stress hormones cortisol and epinephrine. This means an instant increase in blood glucose, and stress hormones cause insulin resistance for several hours, and this in turn leads to elevated blood sugar. How do I avoid Somogyi rebound? Somogyi phenomenom is avoidable in several ways. Firstly, intense blood glucose testing allows the individual experiencing Somogyi effect to detect and then prevent the circumstances leading to it. Testing blood sugar regu 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 >>

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 >>

Somogyi Effect

Somogyi Effect

The tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar. The Somogyi effect, also known as the “rebound” effect, was named after Michael Somogyi, the researcher who first described it. When blood glucose levels drop too low, the body sometimes reacts by releasing counterregulatory hormones such as glucagon and epinephrine. These hormones spur the liver to convert its stores of glycogen into glucose, raising blood glucose levels. This can cause a period of high blood sugar following an episode of hypoglycemia. The Somogyi effect is most likely to occur following an episode of untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning. People who wake up with high blood sugar may need to check their blood glucose levels in the middle of the night (for example, around 3 AM). If their blood sugar level is falling or low at that time, they should speak with their health-care team about increasing their food intake or lowering their insulin dose in the evening. The only way to prevent the Somogyi effect is to avoid developing hypoglycemia in the first place. 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 >>

Szkolenie Podyplomowe/postgraduate Education

Szkolenie Podyplomowe/postgraduate Education

Endokrynologia Polska/Polish Journal of Endocrinology Tom/Volume 62; Numer/Number 3/2011 ISSN 0423–104X The dawn phenomenon and the Somogyi effect — two phenomena of morning hyperglycaemia Zjawisko brzasku i efekt Somogyi — dwa zjawiska porannej hiperglikemii Malwina Rybicka, Robert Krysiak, Bogusław Okopień Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland Abstract Morning hyperglycaemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycaemic control. The dawn phenomenon occurs when endogenous insulin secretion decreases or when the effect of the exogenous insulin administered to the patient the day before disappears, together with a physiological increase in insulin-antagonistic hormones. The Somogyi effect is present in the case of excessive amounts of exogenous insulin. The dawn phenomenon is more common than the Somogyi effect. To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 3 a.m. and 5 a.m. or use a continuous glucose monitoring system. Although their treatment differs, the best way of preventing both the dawn phenomenon and the Somogyi effect is an optimal diabetes control with insulin therapy. (Pol J Endocrinol 2011; 62 (3): 276–283) Key words: morning hyperglycaemia, dawn phenomenon, Somogyi effect Streszczenie Poranna hiperglikemia wśród pacjentów z cukrzycą może być spowodowana zjawiskiem brzasku, efektem Somogyi lub złą kontrolą glikemii. Zjawisko brzasku pojawia się, gdy zmniejsza się wydzielanie endogennej insuliny lub gdy skończy się działanie podanej pa- cjentowi egzogennej insuliny łącznie z fizjologiczny Continue reading >>

The Dawn Phenomenon: What Can You Do?

The Dawn Phenomenon: What Can You Do?

What is the dawn phenomenon that some people with diabetes experience? Can anything be done about it? Answers from M. Regina Castro, M.D. The dawn phenomenon, also called the dawn effect, is the term used to describe an abnormal early-morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes. Some researchers believe the natural overnight release of the so-called counter-regulatory hormones — including growth hormone, cortisol, glucagon and epinephrine — increases insulin resistance, causing blood sugar to rise. High morning blood sugar may also be caused by insufficient insulin the night before, insufficient anti-diabetic medication dosages or carbohydrate snack consumption at bedtime. If you have persistently elevated blood sugar in the morning, checking your blood sugar once during the night — around 2 a.m. or 3 a.m. — for several nights in a row will help you and your doctor determine if you have the dawn phenomenon or if there's another reason for an elevated morning blood sugar reading. What you can do Your doctor may recommend a number of options to help you prevent or correct high blood sugar levels in the morning: Avoid carbohydrates at bedtime. Adjust your dose of medication or insulin. Switch to a different medication. Change the time when you take your medication or insulin from dinnertime to bedtime. Use an insulin pump to administer extra insulin during early-morning hours. Continue reading >>

Dawn Phenomenon And The Somogyi Effect - Overview

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). 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. 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 likely the dawn phenomenon. Continue reading >>

Chronic Somogyi Rebound

Chronic Somogyi Rebound

The rebounding blood sugar following undetected diabetic hypoglycemia can easily become chronic when the high morning blood sugar data is misjudged to be due to insufficient nighttime insulin delivery. Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar.[1] When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night. This theoretical phenomenon was named after Michael Somogyi, a Hungarian-born professor of biochemistry at the Washington University and Jewish Hospital of St. Louis, who prepared the first insulin treatment given to a child with diabetes in the USA in October 1922.[2] Somogyi showed that excessive insulin makes diabetes unstable and first published his findings in 1938.[3] Compare with the dawn phenomenon, which is a morning rise in blood sugar in response to waning insulin and a growth hormone surge (that further antagonizes insulin). Background[edit] A person with type 1 diabetes should balance insulin delivery to manage their blood glucose level. Occasionally, insufficient insulin can result in hyperglycemia. The appropriate response is to take a correction dose of insulin to reduce the blood sugar level and to consider adjusting the insulin regimen to deliver additional insulin in the future to prevent hyperglycemia. Conversely, excessive insulin delivery may result in hypoglycemia. The appropriate response is to treat the hypoglycemia and to consider adjusting the regimen to reduce insulin in the future. Somogyi Continue reading >>

Somogyi Effect (rebound Hyperglycaemia)

Somogyi Effect (rebound Hyperglycaemia)

An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycaemia. This can also be produced if blood glucose concentrations fall too rapidly. 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 hypoglycaemia (blood glucose concentrations of less than 5 mmol/l (90 mg/dl)) following the injection of insulin. The animal becomes hungry and either restless or lethargic. In response to a declining blood glucose concentration in the CNS, 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 hyperglycaemia produces polyuria and polydipsia. This can easily be misinterpreted as a result of 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 become exhausted resulting in severe hypoglycaemia. Hyperglycaemia due to a Somogyi effect can sometimes persist for as long as 3 days after a single hypoglycaemic episode. As a result blood glucose concentrations do not always normalise within a few days of lowering the insulin dose. If the Somogyi effect is suspected, an alternative approach is to decrease the dose by 20% and closely observe the clinical signs. If signs of polyuria or polydipsia worsen a few days following the dose adjustment, it is unlikely that the Somogyi effect was the cause of the regulat 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 >>

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 Effect As The Most Common Cause Of Fasting Hyperglycemia In T1d Patients

Somogyi Effect As The Most Common Cause Of Fasting Hyperglycemia In T1d Patients

Go to: Morning hyperglycemia in patients with type 1 diabetes (T1D) may be caused by the dawn phenomenon, the Somogyi effect or poor glycemic control, diagnoses that lead to different clinical management in each case. Previous reports considered the Somogyi effect as a rare entity in clinical practice. Go to: This study aimed to evaluate the frequency and characteristics of fasting hyperglycemia by continuous glucose monitoring system (CGMS) in patients with T1D. Go to: Materials and methods We analyzed the glycemic profile measured by 72h-CGMS in 85 patients with T1D (29 female), resulting in 255 overnight periods. We assessed the nocturnal glycemic profile and the accuracy of the CGMS sensor per night. Fasting hyperglycemia was categorized into dawn phenomenon when there was no nocturnal hypoglycemia followed by a minimum 10mg/dL rise plasma between 4: 00h-7: 00h; Somogyi effect when nocturnal hypoglycemia (< 70mg/dL) between 0: 00h-3: 00h was followed by morning hyperglycemia and poor glycemic control when there was sustained overnight hyperglycemia. Clinical data (age, diabetes duration, insulin regime, and HbA1c values) were obtained by chart review and compared to the different causes of fasting hyperglycemia. Go to: Results Mean age (SD) and disease duration of participants were 30.7 (15.6) yrs. and 15 (11.9) yrs., respectively. Mean HbA1c was 8.1% (1.97%). Mean sensor glucose value was 162.6mg/dL (46.5) and mean absolute difference (MAD%) was 10.8 (4.61; reference: <28), with a correlation coefficient (CC) of 0.92 (0.1). MAD% was similar between all nights but there was a significant difference in CC of night 1 vs. nights 2 (P=0.001) and 3 (P<0.001). Fasting hyperglycemia was observed in 82.4% of patients. Silent nocturnal hypoglycemia was observed in 61.2% of p Continue reading >>

Morning Highs

Morning Highs

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 slideshow will address readers’ questions about the difference between two possibilities: the Somogyi effect and the dawn phenomenon. Continue reading >>

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