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Somogyi Effect Complications

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 >>

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 >>

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

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 >>

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 >>

Somogyi Effect

Somogyi Effect

Ads by Google Fasting can elevate cortisol levels, which in turn raises blood sugar. So, for someone with blood sugar regulation issues such as diabetes, fasting may make their blood glucose worse. What is Somogyi effect? Somogyi phenomenon is due to your body’s reaction to midnight hypoglycemia. Since the patient is sleeping, they don’t feel the hypoglycemic symptoms such as tiredness, shakiness, tremors, or confusion. This low blood sugar is undesirable. Thus your body reacts to this with an overshoot of counterregulatory hormones such as glucagon, epinephrine, growth hormone, and cortisol. It makes the liver to dump hepatic glucose, which raises morning blood glucose level even up to 300s. Additionally, counter-regulatory hormones may cause insulin resistance for about 12 to 48 hours. Fasting blood sugar level is elevated in reaction to the preceding low. Thus Somogyi effect is also called as rebound hyperglycemia. The patient is succumbed to increase the insulin dose still more; this leads to further more hypoglycemic episodes. A vicious circle leads to increase, and increased insulin doses occur with extremely unstable and brittle diabetes. High dose insulin / Missed meals --> Hypoglycemia at midnight --> Body adjusts by releasing cortisol, glucagon, etc. --> Hyperglycemia in the morning --> Treatment is by insulin dose modification. What causes Somogyi phenomenon? Causes of Somogyi phenomenon may include wrong insulin treatment (dose or timing) or missed meals/snacks. What are the symptoms of Somogyi rebound? At night, if you wake up few times sweaty with rapid heart rate indicates adrenaline shoot-up and rebound hyperglycemia. But, unfortunately, evidence shows type 1 diabetes do not wake during hypoglycemia episodes. When & who discovered Somogyi effect? In Continue reading >>

Somogyi Effect In A Patient Of Type 2 Diabetes Mellitus

Somogyi Effect In A Patient Of Type 2 Diabetes Mellitus

Department of Biochemistry, Hi-Tech Medical College and Hospital, Odisha, India Citation: Brijesh M (2015) Somogyi Effect in a Patient of Type 2 Diabetes Mellitus. J Diabetes Metab 6:493. doi: 10.4172/2155-6156.1000493 Copyright: ©2015 Brijesh M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Morning hyperglycemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycemic control. 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 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. If the body doesn’t produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). Somogyi effect occurs in 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 dawn phenomenon is more common than the Somogyi 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 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 >>

Hypoglycemia And Hyperglycemia

Hypoglycemia And Hyperglycemia

To offset nocturnal hypoglycemia, the body secretes counter-regulatory hormones, such as glucagon and adrenaline, which raises morning blood glucose levels (glycemia). Based on his scientific observations, Michael Somogyi, a biochemist and professor at the University of Washington, hypothesized in the 1950s that “hypoglycemia” could cause “hyperglycemia.” Today, we talk about the “Somogyi effect,” which is characterized by elevated blood sugar in the morning following an undetected and untreated night-time hypoglycemia in diabetics who inject insulin. To offset the hypoglycemia, the body secretes counter-regulatory hormones, such as glucagon and adrenaline. This is also called “rebound hyperglycemia.” Although this hypothesis has never been scientifically proven, professionals working in the field of diabetes suspect that the Somogyi effect is involved when in a person whose insulin dosage at bedtime is being gradually increased has constant hyperglycemia in the morning. If your diabetes is being treated with insulin, and if your blood sugar is elevated when you awake in the morning (above 7 mmol/L), you should measure your blood glucose around 3 a.m., or during the peak insulin action from your bedtime injection. Do this for at least two consecutive nights. If you find that your measured blood glucose is less than 4 mmol/L, you are in a state of hypoglycemia and the Somogyi effect could account for your morning hyperglycemia. Identify the cause of the hypoglycemia to prevent rebound hyperglycemia Here are a few causes of nocturnal hypoglycemia: The dose of insulin at bedtime is too high A problem related to your insulin-injection technique Drinking alcohol on an empty stomach or excessively When you find the cause, discuss with your physician whether yo Continue reading >>

Diabetes? Dont Let Dawn Phenomenon Raise Your Blood Sugar

Diabetes? Dont Let Dawn Phenomenon Raise Your Blood Sugar

As morning approaches, your sleeping body begins preparing to rise. Your body releases a surge of hormones, and they can work against insulin to cause blood sugar to rise slightly. When this happens, it is known as dawn phenomenon. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy In most people, dawn phenomenon is typically harmless; the body creates a small amount of insulin to correct the problem. However, for those with diabetes , it can become a bigger challenge, says endocrinologist Sana Hasan, DO . If you have diabetes, here’s what you need to know about regulating your blood sugar at night so you don’t have to worry about managing it first thing in the morning. For people with diabetes , dawn phenomenon is problematic because your body isn’t able to naturally correct for insulin changes during the night. This often creates consistently high blood glucose levels in the morning. Estimates show that dawn phenomenon occurs in about 50 percent of people who have type 2 diabetes. If you find that your blood sugar is consistently high when you wake up, you can help diagnose the issue by checking your blood sugar levels during the night. Dr. Hasan suggests that you set your alarm for 2 or 3 a.m. for a few nights in a row to see what the levels are like during that time. If they’re high then, that’s probably a sign of dawn phenomenon, she says. Low blood sugar at night — a different problem But if you find low blood sugar levels during the night, that is another issue altogether. If this is the case, you likely have what is known as the Somogyi effect, or rebound hyperglycemia . This happens when blood sugar drops during the ni Continue reading >>

Rocky Morning Highs?

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 >>

Diabetic Complications

Diabetic Complications

Diabetes mellitus is a disease of glucose dysregulation secondary to relative insulin resistance (non-insulin dependent diabetes mellitus) or an absolute insulin deficiency (insulin dependent diabetes mellitus). The pathophysiology and management of uncomplicated diabetes mellitus is too involved to describe here. Most veterinarians feel comfortable diagnosing diabetes mellitus in dogs and cats, and the diagnostics are straightforward and easy to interpret. Currently the options for long acting insulin include glargine, humulin N, detemir, porcine zinc (Vetsulin™) and protamine zinc (ProZinc™). Most of these products are human recombinant insulins. No insulin type has been definitively shown to be better than another in a single species. Several small studies within the last 4 years have suggested, however, that glargine and detemir may achieve better glycemic control and remission rates in cats when compared to humulin N and protamine zinc insulins. Several excellent resources to turn to for more information include Feline Internal Medicine (August JR 2010), Textbook of Veterinary Internal Medicine (Ettinger SJ, Feldman EC 2010), Current Veterinary Therapy XIII, XIV (Bonagura JD, Twedt DC 2009). Table 1 compares the most commonly used long acting insulins in dogs and cats. Table 1. Comparison of different types of insulin most commonly used in dogs and cats. Insulin Syringe Source Dose Humulin N u-100 Human recombinant Dogs and cats 0.1-0.2 u/kg q 12 hr Protamine Zinc, ProZinc™ u-40 Human recombinant Cats only 0.2 – 0.7 u/kg q 12 hr Glargine, Lantus ™ u-100 Synthetic 0.25 – 0.5 u/kg q12 hr Detemir , Levemir ™ u-100 Human recombinant Cats 0.25 – 0.5 u/kg q 12hr Dogs 0.1 – 0.2 u/kg q 12 hr Porcine Zinc, Vetsulin ™ u-40 Porcine Cats 1 – 2 u/kg q 12hr Continue reading >>

Dawn Phenomenon

Dawn Phenomenon

Go to: Introduction The “dawn phenomenon” refers to periodic episodes of hyperglycemia occurring in the early morning hours before, and to some extent after, breakfast. Originally described in the early 1980’s by Schmidt, et al., the dawn phenomenon differs from the Somogyi effect in that it is not preceded by an episode of hypoglycemia. Understanding and differentiating between these two clinical entities become critical in the optimal management of diabetes. Go to: Etiology Diurnal variation in hepatic glucose metabolism has been well documented. The transient increase in both glycogenolysis and gluconeogenesis in the early morning hours can be responsible for hyperglycemia if unopposed by insulin. Go to: Epidemiology The dawn phenomenon, and more recently the extended dawn phenomenon (persistence of hyperglycemia into the later morning hours), have been studied extensively with numerous articles published on the subject. Both entities are responsible for morning glucose elevations which are difficult to control. The dawn phenomenon has been documented in both type 1 and type 2 diabetes and has been demonstrated in all age groups, even type 2 diabetics over 70 years of age. For both type 1 and type 2 diabetes mellitus, prevalence is estimated to exceed 50 percent. This obviously affects a large patient population over a wide age range, and the dawn phenomenon will be an important consideration for any clinician who manages diabetic patients. Go to: Pathophysiology Studies in nondiabetic populations have shown that blood glucose, and plasma insulin levels remain steady through the night, with only a small increase in insulin secretion before dawn, which serves to depress hepatic glucose production. Hyperglycemia is prevented by this physiologic surge of insulin. Continue reading >>

Why Do I Have High Blood Sugar Levels In The Morning?

Why Do I Have High Blood Sugar Levels In The Morning?

Some people experience very high blood sugar levels in the morning. But what implications does this have for a person’s health? There are two main causes of high blood sugar in the morning, the dawn phenomenon and the Somogyi effect This article explores these two causes of high blood sugar levels in the morning. It also discusses what risk factors may cause people to experience them and gives practical advice around how to better manage blood sugar levels. The dawn phenomenon The dawn phenomenon has to do with natural body changes that occur during the sleep cycle: Midnight – 3 a.m. While most people are sleeping, their body has little need for insulin. During this period, however, any insulin that may have been taken during the evening causes the blood sugar levels to drop off drastically. Between 3 – 8 a.m. The body automatically begins to dish out stored sugar (glucose) in preparation for the upcoming day. In addition, hormones that actively reduce the body’s sensitivity to insulin are also being released. During this time period, counter-regulatory hormones are being released. This can interfere with insulin, which may lead to a rise in blood sugar. These include growth hormones, such as: cortisol glucagon epinephrine These events are all happening simultaneously as bedtime levels of insulin are beginning to taper off. Each of these events ultimately plays a part in causing blood sugar levels to rise at “dawn” or in the morning. Who the dawn phenomenon affects Although people with diabetes are generally more aware of the dawn phenomenon, it actually happens to everyone. However, it affects people with or without diabetes differently. Typically, people who do not have diabetes tend not to notice these high blood sugar levels in the morning. This is becau Continue reading >>

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