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Somogyi Effect And A1c

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 >>

The Dawn Phenomenon And Somogyi Effect: What You Can Do

The Dawn Phenomenon And Somogyi Effect: What You Can Do

Waking up with a high blood sugar reading is not exactly the way you want to start off your day. Besides rushing to get ready for work or getting the kids off to school (or both), you now have to decide if and how you’ll deal with that reading on your meter. Maybe you decide to skip breakfast. If you take mealtime insulin, perhaps you inject a few extra units. Or you put in some additional time during your workout. Another option is to shrug it off and hope that your blood sugar comes down in a few hours. You might also ponder the reason your blood sugar is high. Could it be that you ate dinner later than usual last night? Or you ate too much carb at dinner? Or maybe it was your snack? While it’s normal to have high blood sugars when you have diabetes, it’s time to pay attention when the highs become the norm. Morning hyperglycemia (high blood sugar) is frustrating for many people; figuring out the cause is the first step in dealing with (and preventing) it. Dawn phenomenon: hormones that wreak havoc It’s easy to blame your morning high on the plate of pasta last night. But while that could certainly be a factor, chances are, your “highs” are a result of hormones. An imbalance of insulin, amylin (a hormone released by the pancreas), and incretins (hormones released by the gut) is the likely culprit. Other hormones get in on the act, too, including glucagon, growth hormone, cortisol, and adrenaline. Why? Overnight, the body gets this idea that it needs fuel (glucose). The witching hour seems to be around 3 AM or so. At this time, the liver and muscles obligingly respond to the signal for fuel and release glucose into the bloodstream. In someone without diabetes, insulin and its other hormone pals kick in to keep blood sugar levels on an even keel. In the case 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 Phenomenon: Overview, Pathophysiology, Patient History

Somogyi Phenomenon: Overview, Pathophysiology, Patient History

Author: Michael Cooperman, MD; Chief Editor: George T Griffing, MD more... 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 . The ability to suppress insulin release is an important physiologic response that people with insulin-requiring diabetes cannot carry out, as displayed in the image below. Defense against hypoglycemia involves counterregulatory hormones, which stimulate glucone 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 >>

Blood Sugar | Dlife

Blood Sugar | Dlife

Learn all about blood-sugar levels and how they affect your body. What are normal levels for children and adults? Find natural ways to lower blood sugar levels as part of your diabetes treatment plan. Get a little dLife delivered to your inbox every week. By clicking the "Sign Up" button, I agree to submit my information to dLife.com for the purpose of receiving the latest news and offers. Have a diabetes related question? Enter it below! If it's chosen by our expert, you'll get your answer within a week or two. 2018 LifeMed Media, Inc. All rights reserved. All information contained on dLife.com is intended for informational and educational purposes only. The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition. All content on dLife.com is created and reviewed in compliance with our Editorial Policy. Continue reading >>

Differences Between Dawn Phenomenon Or Somogyi Effect

Differences Between Dawn Phenomenon Or Somogyi Effect

The dawn phenomenon and the Somogyi effect increase fasting (aka morning) blood glucose levels for people with diabetes, but for different reasons. Both occurrences 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. Arandom 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 . But,if you've noticed a pattern of elevated blood sugars in the morning, it could be a result of the dawn phenomenon or the Somogyi effect. Find out what causes this hormonal hyperglycemia and how you can prevent and can treat it. The dawn phenomenon is caused by a surge of hormones that the body puts out in the early morning hours. According to the American Diabetes Association, "everyone has the dawn phenomenon if they have diabetes or not. People with diabetes don't have normal insulin responses to adjust for it and that is why their blood sugars go up." This happens because: During the evening hours the body is making less insulin. Hormones trigger the liver to put out more glucose. Lack of insulin results in a blood sugar rise in the a.m. The Somogyi effect (or rebound hyperglycemia)results in morning high blood sugar ( hyperglycemia ) as a result very low bloodsugar (hypoglycemia) during the night. It's a very rare phenomenon and most often occurs in people with Type 1 diabetes. It occurs: More commonly in people who take night-time insulin , as a result of taking too much; Or if you are required to eat a snack before bed to keep your blood sugars stable and you skip it. The abundance of insulin in the blood and lack of glucose, causes the b 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 >>

How To Fix High Morning Blood Sugars (dawn Phenomenon)

How To Fix High Morning Blood Sugars (dawn Phenomenon)

There are various possible causes of a high blood sugar level in the morning: The Dawn Phenomenon which is a natural rise in blood sugar due to a surge of hormones secreted at night which trigger your liver to dump sugar into your blood to help prepare you for the day. Having high blood sugar from the night before which continue through the night into the morning. Reactive hyperglycemia which is also called the Somogyi Effect. This is when a low blood sugar in the middle of the night triggers your liver to dump sugar into your blood in an attempt to stabilize your blood sugar. Why Are My Blood Sugars High in the Morning? There is a simple strategy for diagnosing the source of high blood sugars in the morning. Test your blood sugar before bed. Test your blood sugar in the middle of the night. Test your blood sugar in the morning. It takes a little bit of effort, but you only need to do it a few times to diagnose the issue. TheSomogyi Effect is less common than the Dawn Phenomenon, according to an article published by The Polish Journal of Endocrinology. To diagnose either of these phenomena, scientists recommend checking blood sugar levels for several nights specifically between 3 a.m and 5 a.m. or using a continuous glucose monitoring system (CGM). Many healthcare practitioners are now offering the use of a loan CGM for a few days which can be helpful to observe nighttime blood sugar activity. How to Fix High Blood Sugars in the Morning The Dawn Phenomenon refers to a surge of hormones excreted by your body in the early morning hours. These hormones rise each night around the same time to prepare your body to wake. Basically, your body is starting the engine, releasing some fuel, and prepping to go for the day. The Dawn Phenomenon occurs in all humans regardless of whet 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 >>

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 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 >>

Feline Diabetes Mellitus: The Somogyi Effect

Feline Diabetes Mellitus: The Somogyi Effect

Feline diabetes mellitus: The Somogyi effect An important reason for conducting a blood glucose curve, ie, evaluating blood glucose levels every 2 hours following the morning Vetsulin (porcine insulin zinc suspension) treatment is the possibility of Somogyi effect or rebound hyperglycemia. In cats, the Somogyi overswing occurs when the insulin dose is too high and the patients blood glucose plummets below 60 mg/dL. The Somogyi effect occurs when the body attempts to counteract the life-threatening 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 60 mg/dL [3.3 mmol/L]) following the injection of insulin. The cat becomes hungry and restless or lethargic. In response to a declining blood glucose concentration in the central nervous system, adrenaline and subsequently cortisol, glucagons, and growth hormone are released. These hormones increase blood glucose concentration (through gluconeogenesis, release of glucose from hepatic glycogen, and increased peripheral resistance to insulin). The resulting hyperglycemia produces polyuria and polydipsia. This can be mistakenly attributed to an inadequate insulin dose. If the morning polyuria is thought to result from 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. The Somogyi effect can occur in both cats and dogs, but cats are particularly prone to develop this rebound hyperglycemia. The appropriate corrective action is to decrease the patients insulin dose to prevent insulin-induced hypoglycemia. Min Continue reading >>

Somogyi Effect | Diabetic Connect

Somogyi Effect | Diabetic Connect

Okay friends, how is the best way to handle the Somogyi effect. Things have changed for me again and this resembles the dawn effect but they are not quite the same thing . And I am not sure how to handle this. I have been fasting each day through most of the daytime and eating only 1 meal in the afternoon. I had to back off on my daytime insulin dose to keep from going low because the fasting and black seed oil were lowering my glucose numbers during the day. Now, in the morning for the last two days my glucose has been elevated even though I took my nighttime insulin shot. This morning it was 136, yesterday it was 130 when I awoke, those numbers had been running great. I ate no nighttime snacks or meals. I don't make enough body insulin on my own so I have to take that nighttime insulin shot to cover for the next morning which has worked until now. During the day I have been more active in the last few weeks, so I had to back off on those doses to keep from going low. This LADA Type 1.5 makes things complicated to figure out. I am suspecting that this black seed oil may have changed the way my body was handling hormones during rest fasting. I don't know if this is a good thing or a bad thing yet. I have lost some weight again because of the fasting and physical activity and I know that changes things as well. So what do I do for this, never thought I would have to deal with this again. For those of you who don't know what Somogyi effect is the description is below. Give me some ideas, I am stumped. Somogyi effect is very high fasting blood glucose thought to be caused by the liver making a lot of excess glucose in response to hypoglycemia (low blood glucose) during the night. Somogyi effect is uncommon in type 2 diabetes. There's controversy as to whether it even exis Continue reading >>

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