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What Causes Somogyi Effect?

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 - 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 >>

Regulating & Monitoring A Diabetic Cat Using Insulin

Regulating & Monitoring A Diabetic Cat Using Insulin

Not all cats with diabetes will need to be treated with insulin (some cats with mild diabetes may respond to and dietary change), but a majority of them will. The goal of treatment is to resolve the signs of the disease, maintain proper body weight, eliminate or reduce the likelihood of any complications, and provide the cat with a good quality of life. This can be accomplished by maintaining the blood glucose at an acceptable level (100-290 mg/dL; normal is 55-160 mg/dL). In addition to treating the diabetes, any other concurrent diseases such as pancreatic exocrine insufficiency, hyperthyroidism, Cushing's disease, and infections need to be treated as well. What should an owner know before trying to 'regulate' a cat with diabetes? Before treatment is started, it is important that the owner be well-informed and have the time necessary to make the correct decision since regulating a diabetic cat requires commitment. Owners should know: The cat will need to be hospitalized for a number of days and one or more blood glucose profiles (described below) will need to be performed. The initial regulation of a cat on insulin generally takes 2-8 weeks. The process of getting a cat regulated can be costly. Insulin must usually be given twice a day, every day at specific times, probably for the life of the cat. Insulin must be handled properly (refrigerated, not shaken, etc). There is a proper technique for administering insulin to a cat that must be followed. The type of insulin and insulin syringe that are used should not be changed unless under guidance by the veterinarian. The type and amount of food and when it is fed must be consistent. In most cases, foods high in protein and low in carbohydrates are recommended. These are usually canned foods. The cat will need to be caref Continue reading >>

Somogyi Effect – Can Overabundance Of Insulin Cause Rise In Blood Sugar Level ?

Somogyi Effect – Can Overabundance Of Insulin Cause Rise In Blood Sugar Level ?

The Somogyi effect or chronic Somogyi rebound is a phenomenon discovered by Dr. Michael Somogyi, a Hungarian-born professor of biochemistry at the Washington University and Jewish Hospital of St. Louis. He is credited with preparing the treatment of diabetes using insulin for the first time way back in October 1922 in the United States. Dr. Somogyi claimed that excess presence of insulin destabilize the blood sugar level in the body, publishing his finding in 1938. This phenomenon is well-known and controversial at the same time. Doctors and diabetic patients are well aware of this effect. It is controversial because there are very few scientific evidences to support its proposed theory. Latest research studies suggest that this effect can even by a false one. Controversies are often associated with interesting aspects per se. Moreover, knowledge of what is wrong is as important as the knowledge of what is right. This article tries to gain insight on the chronic Somogyi rebound phenomenon. Basics of Somogyi Effect: Type 1 diabetes is an auto-immune disorder. An ailment is called so when our body’s natural protection system (technically called the immune system) turns hostile and disrupts the normal functioning of the body. The food we eat gets converted to energy called glucose. This energy should either be transported to the cells which require energy to work properly or be stored for later use. A chemical called insulin hormone ensures that this objective is met. In the body of type 1 diabetes patients, there is a shortage of insulin hormone production. This results in rise of blood sugar level. It is an undesirable state with several associated complications. Type 1 diabetes patients have to take insulin injections manually on daily basis in order to meet the requi 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 >>

Somogyi Rebound

Somogyi Rebound

Somogyi rebound aka "Somogyi's phenomenon" is a common phenomenon in pet diabetes: When blood sugar levels drop too far or too fast, the animal will defensively dump stored glucose from the liver into their bloodstream, resulting in high blood sugar. It happens more often with pets than with humans, since humans check their own blood sugar more often and have a better idea of the right insulin dose. Because of the variability in a cat's response to insulin and that an individual cat's insulin needs can change greatly when not on a low-carb diet, they are more prone to having Somogyi episodes[1]. It's confusing but true: Too little insulin means pre-shot blood tests are too high; too much insulin often also means pre-shots are too high. This effect is often noted by those who test their pets' blood glucose at home. It means that even when blood glucose levels are too high, simply raising insulin dosage can make things worse instead of better. The blood sugar readings may go from a lowish number very suddenly to a high number, with a 'checkmark' shaped curve (see graph below). If overdose goes on for a few days, you may see few or no low readings, and just lots of very high and unpredictable readings that don't seem to correlate with feeding. Once in a while, a very low reading or even a symptomatic hypo may ensue. The reason: Anytime the glucose level drops too far or too fast, the cat or dog may defensively dump glucose into the blood by breaking down glycogen from the liver. Hormones epinephrine and cortisol, as well as growth hormone and glucagon,[2] causing temporary insulin-resistance, will also be released into the bloodstream[3]. (If these are insufficient, hypoglycemia ensues!)( See the nice tutorial on the insulin/glucagon equilibrium at the link below.)[4] Even Continue reading >>

Somogyi Effect Vs Dawn Phenomenon: Differences Worth Knowing

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 >>

Morning Highs? What Is The Somogyi Effect?

Morning Highs? What Is The Somogyi Effect?

Ok, so what’s up with this term that people keep throwing around called the dawn phenomenon? As type 1 diabetics we’ve all been there, up at 1:30 in the morning testing our blood sugars and come back with a perfect reading of 100 mg/dl only to wake up a couple of hours later with a glucose level of 400 mg/dl! Why is this? What’s happening to our bodies during that 2 1/2 hour period that sends sends our blood sugars into the stratosphere! Welcome to what is called, the dawn phenomenon. Lets take a closer look at what this is all about and what we can do to try and stabilize our blood sugars. What Causes The Dawn Phenomenon: The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrin. You may recognize these as they are the hormones involved in the “fight or flight response.” In this case, their job is more benign, to give you the energy to get up and moving. Besides giving you a burst of energy, these hormones raise blood sugar. You aren’t going to be able to make any kind of energetic response if you don’t have fuel, and after a long night’s sleep, the fuel your body turns to in order to get you going is the glucose stored in the liver. So once these hormones are secreted, typically around 5:30 am, plasma glucose and insulin can start to rise. Though a non diabetic will automatically get a rise in insulin to help cells use this morning glucose, as type 1’s, we know that’s not always the case and instead of giving our cells a dose of morning energy, all we get is a rise in our blood sugars. Dawn Phenomenon vs Somogyi Effect? The somogyi effect (first discovered my Dr. Michael Somogyi) is caused by nighttime hypoglycemia, which leads to a rebound hypergl Continue reading >>

The Dawn Phenomenon – T2d 8

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 >>

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 >>

Diabetes Mellitus Nclex Review Notes Medications & Nursing Management

Diabetes Mellitus Nclex Review Notes Medications & Nursing Management

Below are review notes for Diabetes Mellitus to help you study for the NCLEX exam or your nursing lecture exams. As the nurse taking care of the diabetic patient, you must know how to properly care for them, especially newly diagnosed diabetics. The nurses role include educating, assessing, planning, administering medications, and evaluating treatment. These NCLEX review notes will cover: Diet Exercise Oral Diabetic Medications Insulin Mnemonics After reviewing these notes, don’t forget to take the Diabetes NCLEX quiz. Lecture on Diabetes Mellitus for NCLEX Review Diabetes Nursing Management Nurse’s role: educating, monitoring, and administering (medications) Teach patient to follow the Triangle of Diabetes Management **Diet, medications, and exercise all work together while monitoring blood glucose Example: Patient wants to make sure their diet is balanced with their medication (insulin/oral meds) and they use exercise to manage glucose levels (doing all this while monitoring blood glucose). As the nurse you will be educating the diabetic…so for the NCLEX know education pieces like: Diet, exercising, oral medications, giving insulin (peak times), drugs that increase blood glucose and lower glucose etc. DIET: Diets are individualized due to physical activity and medication therapy (they always need tweaking)…recommend following American Diabetic Association Diet (ADA) Limitation of the following: Carbs (45-60%) grains, vegetables with starches potatoes, corn, sweets…cookies, soda, dried beans, milk) Fats (<20 %)….limit unhealthy fats saturated, trans fats, cholesterol: lard, gravies, whole milk, bologna, hot dogs, sausage, processed foods hydrogenated oils…concentrate on mono & polyunsaturated avocadoes, olives, peanuts, nuts Proteins (15-20%) meats don’ Continue reading >>

High Blood Sugar And Dizziness In The Morning

High Blood Sugar And Dizziness In The Morning

A high blood sugar level due to diabetes or other situations can cause a variety of symptoms such as dizziness, and it can even lead to blindness, nerve damage, heart disease and other chronic problems. Morning can be a common time for high blood sugar levels. Understanding what causes a spike in blood glucose and knowing what steps to take to lower it can help you to prevent complications. If your blood sugar level is high in the morning most of the time, it is important to speak with your physician. Video of the Day Your blood sugar level naturally fluctuates throughout the day. The foods you eat, your level of physical activity, stress, illnesses and medications can make your blood sugar levels rise and fall. In general, a normal fasting blood glucose level is below 100 mg/dL, the National Diabetes Education Program says. Once your level reaches between 100 mg/dL and 125 mg/dL, you may be diagnosed with prediabetes. If your level climbs over 125 mg/dL on more than one testing occasion, you may have diabetes. The medical term for a high level of blood sugar is hyperglycemia. Depending on the cause, it can take hours or days for your blood sugar levels to become so high that you develop symptoms. Symptoms of high blood sugar include not only dizziness but dry mouth, thirst, frequent urination, blurry vision, fatigue, confusion and increased appetite, University of Iowa Hospitals and Clinics reports. In general, the more severe your symptoms, the higher your blood sugar levels are. If you are having strong dizzy spells, seek medical attention. Both those with and without diabetes can experience "dawn phenomenon," and those with diabetes can experience the "Somogyi effect." During the early evening, insulin -- whether produced by the body or taken as medication -- works Continue reading >>

How The Somogyi Effect Causes High Morning Blood Sugar

How The Somogyi Effect Causes High Morning Blood Sugar

is one type of morning high blood sugar (hyperglycemia) caused by very low blood sugar (hypoglycemia) during the night. It is also called the rebound effect or rebound hyperglycemia. It's a very rare phenomenon and most often occurs in people with type 1 diabetes. How the Somogyi Effect Works Your body tries to keep your blood sugar levels stable. When blood glucose levels drop during sleep, your body releases hormones that trigger the liver to release glucose. This influx of glucose into the bloodstream can then raise your blood sugar levels beyond what's normal for fasting glucose levels, leading to a high-fasting glucose reading the next morning. Causes The Somogyi effect results from having extra insulin your body before bedtime. Insulin is a hormone produced by the beta cells of the pancreas that permits glucose to enter cells and helps the body use glucose for energy. Insulin controls the amount of glucose in the blood. There are a couple ways you could have too much insulin at bedtime: Not having a bedtime snack (which would give the insulin some glucose to work on) Taking long-acting insulins. Because it's often an effect of long-acting insulins, the Somogyi effect mainly occurs in people with type 1 diabetes. How the Somogyi Effect Differs from the Dawn Phenomenon The Somogyi effect is similar to the dawn phenomenon in that both can cause high morning blood glucose readings as a result of a hormone triggering the liver to release glucose into the blood. Unlike the Somogyi effect, however, the dawn phenomenon is not caused by hypoglycemia, but by a random release of the triggering hormones. The only way to know for sure whether you're experiencing the dawn phenomenon or the Somogyi effect is to test your blood sugar in the middle of the night. Wake up sometime b Continue reading >>

Diabetes

Diabetes

Sort What is metabolic syndrome and how does this relate to Type 2 Diabetes? A cluster of abnormalities that increase risk for cardiovascular disease and diabetes, characterized by insulin resistance. Individuals with metabolic syndrome are at increased risk for Type 2 diabetes. They will have: Elevated insulin levels Elevated triglycerides Elevated LDLs Low HDLs Hypertension How is insulin stored? -Do not heat/freeze it -In-use vials may be left at room temperature up to 4 weeks (Lantus only for 28 days) -Extra insulin should be refrigerated -Avoid exposure to direct sunlight -Pt can pre-fill syringes and store in fridge, up to 1 week -Store so needle is pointing up -Before given, gently roll in palm Continue reading >>

Somogyi Effect And Dawn Phenomenon In Diabetes

Somogyi Effect And Dawn Phenomenon In Diabetes

So I read a lot of interesting things today and I'm formulating questions based on it. A person took too much insulin at night and went to sleep. He checks his morning blood sugar levels and it's elevated. Why? It's because stress hormones were released while he was asleep which caused the hyperglycemia. (This is called Somogyi effect!) Now, a person took his appropriate dose of insulin at night and went to sleep. He checks his morning blood sugar levels and it's elevated. What happened this time? There is a normal hormone surge at 7 am (Growth hormone, cortisol, glucagon and epinephrine) which caused the hyperglycaemia. This is called dawn phenomenon. How will you differentiate Somogyi effect from dawn phenomenon? Why is this clinically relevant? I guess the person with Somogyi effect will have certain signs and symptoms related to hypoglycemia. For instance, night terrors. Right? People with hypoglycemia don't wake up but have nightmares. The 3 am glucose levels to be precise. It is low in Somogyi effect and maybe normal or high in dawn phenomenon. You'll decrease NPH insulin at night in the former and increase the NPH insulin dose in the latter. NPH is an intermediate acting insulin. NPH insulin is usually taken at night. Duration of action 7- 14 hours! In Somogyi, the excess insulin caused hyperglycemia. So you'll decrease the dose. And similarly, in dawn phenomenon, the inadequate dosing caused the hyperglycaemia, so you'll increase NPH insulin. If you're under the impression that is inadequate insulin and if you increase the dose of insulin, you can put the patient into a hypoglycemic coma! This is why, recognising Somogyi effect is very important. I didn't get the management.. How is the adequacy of insulin assessed? If a patient comes with morning hyperglycemia, Continue reading >>

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