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What Is The Difference Between The Dawn Phenomenon And The Somogyi Effect?

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 >>

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 >>

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 >>

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 >>

Dawn Phenomenon And The Somogyi Effect

Dawn Phenomenon And The Somogyi Effect

There are several reasons for a high fasting blood glucose reading in the morning. Some common reasons include taking the wrong dose of a medication or eating foods such as carbohydrates before bedtime. Some things that are not as common and not always recognized are the dawn phenomenon and the Somogyi effect. The dawn phenomenon is an increase in blood sugar due to the body producing hormones, which happens just before waking between the hours of 4:00am and 8:00am. These hormones (growth hormones, epinephrine, cortisol or glucagon) cause the liver to release large amounts of glucose (sugar) into the blood. The hormones may also partially stop the effect of insulin, either insulin that is made in the body or that was injected the night before. According to the American Diabetes Association, the increase in sugar in the bloodstream is due to the fact that the body is making less insulin and more of a hormone called glucagon. Glucagon is a substance in your body that increases blood glucose levels by telling the liver to break down something called glycogen into glucose. Glycogen is a very large structure that is made up of a lot of glucose that get broken down into smaller pieces, this causes a rise of glucose in the blood. The dawn phenomenon is unpredictable because it affects some people with diabetes but not others. Some things you can do to prevent or manage the dawn phenomenoncan be by either eating dinner earlier in the evening, avoiding eating carbohydrates before bedtime, adjusting the dose of diabetes medications or exercising after dinner. The Somogyi effect, like the dawn phenomenon, involves having high fasting blood glucose levels in the morning. The difference however is that with the Somogyi effect, oral medications or insulin are working too strongly at Continue reading >>

Dawn Phenomenon Or Somogyi Effect? What's The Difference?

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 >>

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 >>

Somogyi Effect Vs. Dawn Phenomenon: The Difference Explained

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 >>

The Dawn Phenomenon And The Somogyi Effect - Two Phenomena Of Morning Hyperglycaemia.

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 >>

The Somogyi Effect | Dawn Phenomenon | What Do They Mean | Diabetes

The Somogyi Effect | Dawn Phenomenon | What Do They Mean | Diabetes

Somogyi effect and the Dawn phenomenon: hyperglycemia on wake up hours omogyi effect and the Dawn phenomenon are conditions related todiabetes and blood sugar fluctuations.Somogyi effectinvolves hyperglycemia when you wake up,even though you might have increased insulin before going to sleep. This is sometimes called rebound hyperglycemia and it is counter intuitive since increased insulin would most likely result in low blood sugar and not high. A low around at 07:00 AM is usually followed by previous high at around 02:00 AM. The idea behindSomogyi is that too much insulin can cause low blood sugar during the night and asubsequent high in the morning hours; according to Somogyi this may becaused by an insulin atagonistic action created bysome hormones, such ashypothalmic-pituitary adrenal axis. The risk involved inthis condition is an increased by NPHinsulin use which reaches peak concentration in 4-5 hours after injection.You should suspect you have Somogyi effect if glucose levels are increasingly higher in the morning after increasing insulin units prior to going to bed. Also if you check you blood glucose at around 03:00 AM and it is low it could mean you might be having Somogyi effect by early morning. The Somogyi effect is more likely to happen with type I diabetics and less common with type II. The name Dawn is a simple reference to the time of the day this phenomena occurs. The main difference between Dawn phenomenon and Somogyi effect is that the down happens to everyone whether you have diabetes or not. Down is a spike in glucose due to hormonal responses in your body preparing you for the day. When we are sleeping, regulatory hormones such as growth hormone, cortisol and catecholamines are released in order to repair cells and that can increase your glucose 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 >>

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 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 >>

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 >>

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 >>

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