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, sometimes called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes. It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia. The dawn phenomenon can be managed in many patients by avoiding carbohydrate intake at bedtime, adjusting the dosage of medication or insulin, switching to a different medication, or by using an insulin pump to administer extra insulin during early-morning hours. In most of the cases, there is no need to change insulin dosing of patients who encounter the dawn phenomenon. See also Cortisol awakening response  External links Mayo Clinic - The 'dawn phenomenon': What causes it? Diabetes Self Management - Dawn Phenomenon Dawn Phenomenon (Liver Dump) Continue reading >>
Somogyi Effect Vs Dawn Phenomenon: Differences Worth Knowing
Have you ever gone to sleep with a relatively normal glucose reading and woke up with a much higher value? If Yes! Then you must be wondering why glucose numbers swing during sleep or during pre-dawn hours? Well! In the current article we will talk about the two possibilities namely the Somogyi Effect and The Dawn phenomenon. We will know about the differences between the two possibilities in the following sections. Before we talk about the differences between Somogyi Effect and the Dawn Phenomenon, we would mention that both these phenomenon can raise your fasting blood glucose levels during the morning hours, but for different reasons. Somogyi Effect is also known as "Rebound Hyperglycemia". The Somogyi Effect is a pattern of undetected hypoglycaemia or low blood glucose values of less than 70, followed by hyperglycemia or high blood glucose levels of more than 200. This effect generally happens in the middle of the night, though it can also occur when too much insulin is circulating in the system. During hypoglycaemia period, the body releases hormones which cause a chain reaction to release the stored glucose. The end result is that the level of glucose can swing extremely high in the other direction, causing hyperglycemia. The Dawn effect is named after the time of the day it occurs. This phenomenon is the body's response to hormones released in the early morning hours. Such an effect occurs for everyone. When we sleep, hormones are released in order to help maintain and restore cells within our bodies. These counter-regulatory hormones like growth hormones, catecholamines, and cortisol cause the rise in glucose level. There is a high glucose reading in the morning for those people with diabetes who do not have enough circulating insulin for keeping this increase o Continue reading >>
Rocky Morning Highs?
With a little sleuthing you can identify—and fight—the causes of those rises in waking blood glucose Sometimes diabetes doesn't make a whole lot of sense. Take those mornings when you wake up with blood glucose that's higher than it was when you went to sleep. You'd think that not eating for those seven or eight hours would give you lower blood glucose. But in fact, there are three reasons your blood glucose may be higher in the morning: the dawn phenomenon, the Somogyi effect, or waning insulin. The dawn phenomenon is a natural rise in blood glucose between the hours of 4:00 a.m. and 8:00 a.m., and it occurs because of hormonal changes in the body. "The body does several things to get ready for the day," says David S. Schade, MD, professor of medicine and chief of the Division of Endocrinology at the University of New Mexico School of Medicine in Albuquerque. "The body releases hormones like cortisol and growth hormone and the blood glucose rises. People without diabetes just secrete more insulin to handle the blood glucose, but for people with diabetes, the rise in blood glucose can be substantial." Schade notes that the effects of dawn phenomenon vary in each person, and your blood glucose may be higher on some mornings than on others. "You can do the same exercise and eat the same thing every day and have different blood glucose [levels] on different mornings because of dawn phenomenon," he says. "That makes it a little problematic." He adds that the scientific community is still figuring out the relationship between the release of these hormones and the rise in blood glucose. However, one thing scientists do know is that the liver produces glucose as part of the dawn phenomenon. Treatment for dawn phenomenon depends on how you treat your diabetes, says Stuart Continue reading >>
Somogyi Effect Vs. Dawn Phenomenon: The Difference Explained
For people who have diabetes , the Somogyi effect and the dawn phenomenon both cause higher blood sugar levels in the morning. The dawn phenomenon happens naturally, but the Somogyi effect usually happens because of problems with your diabetes management routine. Your body uses a form of sugar called glucose as its main source of energy. A hormone called insulin , which your pancreas makes, helps your body move glucose from your bloodstream to your cells. While you sleep , your body doesnt need as much energy. But when youre about to wake up, it gets ready to burn more fuel. It tells your liver to start releasing more glucose into your blood . That should trigger your body to release more insulin to handle more blood sugar . If you have diabetes, your body doesnt make enough insulin to do that. That leaves too much sugar in your blood, a problem called hyperglycemia . High blood sugar can cause serious health problems, so if you have diabetes, youll need help to bring those levels down. Diet and exercise help, and so can medications like insulin. If you have diabetes, your body doesnt release more insulin to match the early-morning rise in blood sugar. Its called the dawn phenomenon, since it usually happens between 3 a.m. and 8 a.m. The dawn phenomenon happens to nearly everyone with diabetes. But there are a few ways to prevent it, including: Dont eat carbohydrates before you go to bed. Take insulin before bedtime instead of earlier in the evening. Ask your doctor about adjusting your dose of insulin or other diabetes medicines. Continue reading >>
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 >>
The Dawn Phenomenon And The Somogyi Effect - Two Phenomena Of Morning Hyperglycaemia.
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. Continue reading >>
Szkolenie Podyplomowe/postgraduate Education
Endokrynologia Polska/Polish Journal of Endocrinology Tom/Volume 62; Numer/Number 3/2011 ISSN 0423â€“104X The dawn phenomenon and the Somogyi effect â€” two phenomena of morning hyperglycaemia Zjawisko brzasku i efekt Somogyi â€” dwa zjawiska porannej hiperglikemii Malwina Rybicka, Robert Krysiak, BogusÅ‚aw OkopieÅ„ 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): 276â€“283) Key words: morning hyperglycaemia, dawn phenomenon, Somogyi effect Streszczenie Poranna hiperglikemia wÅ›rÃ³d pacjentÃ³w z cukrzycÄ… moÅ¼e byÄ‡ spowodowana zjawiskiem brzasku, efektem Somogyi lub zÅ‚Ä… kontrolÄ… glikemii. Zjawisko brzasku pojawia siÄ™, gdy zmniejsza siÄ™ wydzielanie endogennej insuliny lub gdy skoÅ„czy siÄ™ dziaÅ‚anie podanej pa- cjentowi egzogennej insuliny Å‚Ä…cznie z fizjologiczny Continue reading >>
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 >>
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 >>
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: 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 >>
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 >>
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 >>
The Dawn Phenomenon – T2d 8
The occurrence of high blood sugars after a period of fasting is often puzzling to those not familiar with the Dawn Phenomenon. Why are blood sugars elevated if you haven’t eaten overnight? This effect is also seen during fasting, even during prolonged fasting. There are two main effects – the Somogyi Effect and the Dawn Phenomenon. Somogyi Effect The Somogyi effect is also called reactive hyperglycaemia and happens in type 2 diabetic patients. The blood sugar sometimes drops in reaction to the night time dose of medication. This low blood sugar is dangerous, and in response, the body tries to raise it. Since the patient is asleep, he/she does not feel the hypoglycaemic symptoms of shakiness or tremors or confusion. By the time the patient awakens, the sugar is elevated without a good explanation. The high blood sugar occurs in reaction to the preceding low. This can be diagnosed by checking the blood sugar at 2am or 3am. If it is very low, then this is diagnostic of the Somogy Effect. Dawn Phenomenon The Dawn Effect, sometimes also called the Dawn Phenomenon (DP) was first described about 30 years ago. It is estimated to occur in up to 75% of T2D patients although severity varies widely. It occurs both in those treated with insulin and those that are not. The circadian rhythm creates this DP. Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP. These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver Continue reading >>