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What Is The Meaning Of The Somogyi Effect?

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 >>

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 >>

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 >>

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 >>

Chronic Somogyi Rebound

Chronic Somogyi Rebound

The rebounding blood sugar following undetected diabetic hypoglycemia can easily become chronic when the high morning blood sugar data is misjudged to be due to insufficient nighttime insulin delivery. Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar.[1] When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night. This theoretical phenomenon was named after Michael Somogyi, a Hungarian-born professor of biochemistry at the Washington University and Jewish Hospital of St. Louis, who prepared the first insulin treatment given to a child with diabetes in the USA in October 1922.[2] Somogyi showed that excessive insulin makes diabetes unstable and first published his findings in 1938.[3] Compare with the dawn phenomenon, which is a morning rise in blood sugar in response to waning insulin and a growth hormone surge (that further antagonizes insulin). Background[edit] A person with type 1 diabetes should balance insulin delivery to manage their blood glucose level. Occasionally, insufficient insulin can result in hyperglycemia. The appropriate response is to take a correction dose of insulin to reduce the blood sugar level and to consider adjusting the insulin regimen to deliver additional insulin in the future to prevent hyperglycemia. Conversely, excessive insulin delivery may result in hypoglycemia. The appropriate response is to treat the hypoglycemia and to consider adjusting the regimen to reduce insulin in the future. Somogyi 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 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 >>

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 >>

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 >>

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 >>

Do High Fasting Glucose Levels Suggest Nocturnal Hypoglycaemia? The Somogyi Effect—more Fiction Than Fact?

Do High Fasting Glucose Levels Suggest Nocturnal Hypoglycaemia? The Somogyi Effect—more Fiction Than Fact?

Abstract Aims The Somogyi effect postulates that nocturnal hypoglycaemia causes fasting hyperglycaemia attributable to counter-regulatory hormone release. Although most published evidence has failed to support this hypothesis, this concept remains firmly embedded in clinical practice and often prevents patients and professionals from optimizing overnight insulin. Previous observational data found lower fasting glucose was associated with nocturnal hypoglycaemia, but did not assess the probability of infrequent individual episodes of rebound hypoglycaemia. We analysed continuous glucose monitoring data to explore its prevalence. We analysed data from 89 patients with Type 1 diabetes who participated in the UK Hypoglycaemia study. We compared fasting capillary glucose following nights with and without nocturnal hypoglycaemia (sensor glucose < 3.5 mmol/l). Fasting capillary blood glucose was lower after nights with hypoglycaemia than without [5.5 (3.0) vs. 14.5 (4.5) mmol/l, P < 0.0001], and was lower on nights with more severe nocturnal hypoglycaemia [5.5 (3.0) vs. 8.2 (2.3) mmol/l; P = 0.018 on nights with nadir sensor glucose of < 2.2 mmol/l vs. 3.5 mmol/l]. There were only two instances of fasting capillary blood glucose > 10 mmol/l after nocturnal hypoglycaemia, both after likely treatment of the episode. When fasting capillary blood glucose is < 5 mmol/l, there was evidence of nocturnal hypoglycaemia on 94% of nights. Our data indicate that, in clinical practice, the Somogyi effect is rare. Fasting capillary blood glucose ≤ 5 mmol/l appears an important indicator of preceding silent nocturnal hypoglycaemia. Continue reading >>

Differences Between Dawn Phenomenon Or Somogyi Effect

Differences Between Dawn Phenomenon Or Somogyi Effect

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

Somogyi Effect

Somogyi Effect

Also found in: Dictionary, Thesaurus, Legal, Encyclopedia. Related to Somogyi effect: diabetes, lipodystrophy, dawn phenomenon, diabetic ketoacidosis Somogyi effect (phenomenon) [so-mo´ gee] a rebound phenomenon occurring in diabetes mellitus; overtreatment with insulin induces hypoglycemia, which initiates the release of epinephrine, ACTH, glucagon, and growth hormone, which stimulate lipolysis, gluconeogenesis, and glycogenolysis, which, in turn, result in rebound hyperglycemia and ketosis. Indications that the Somogyi effect may be taking place include the following: (1) the appearance of strongly positive tests for sugar and acetone in the urine within a few hours after a period in which the urine had been negative for both tests, (2) a 2 per cent glycosuria all day preceded by nocturnal sweating, headaches, and other symptoms of hypoglycemia, (3) unresponsiveness of insulin during the period of rebound hyperglycosuria, (4) wide fluctuations in blood glucose levels, over several hours, and unrelated to meals, and (5) improved control of blood sugar levels and ketonuria with gradual reduction in the amount of insulin taken. Treatment consists of gradual reduction of the insulin dose until the optimum dose is reached. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved. So·mog·yi ef·fect (sō-mō'jē), in diabetes, a rebound phenomenon of reactive hyperglycemia in response to a preceding period of relative hypoglycemia that has increased secretion of hyperglycemic agents (for example, epinephrine, norepinephrine, glucagon, cortisol, and growth hormone); described in diabetic patients given too much insulin who developed unrecognized nocturnal hypogl Continue reading >>

Somogyi Effect: Between Hyperglycemia And Hypoglycemia

Somogyi Effect: Between Hyperglycemia And Hypoglycemia

The Somogyi effect is when a person takes insulin before bed and wakes up with high blood sugar levels. The Somogyi effect is rare; it often occurs in those who have type 1 diabetes. It is important to note; if you have diabetes and experience the Somogyi effect, you should talk with your doctor. Diabetes and insulin therapy Those who suffer from diabetes and use insulin therapy to control their diabetes, need to measure their blood sugar levels several times a day. Some may not know it; when insulin lowers your blood sugar too much, it can trigger a rush of hormones that send your blood sugar levels way too high. Symptoms of Somogyi are waking up in the morning and having high blood sugar levels. Another symptom with this effect is night sweats. In addition, there is also a term known as the Dawn Phenomenon. • The Dawn Phenomenon is your body’s natural reaction to hormones that are released as morning arrives. • Cortisol and catecholamine trigger the release of glucose from your liver. • Those who don’t have diabetes don’t have a problem with this because insulin is released. • However, when you have diabetes, not enough insulin is produced to calm the release of glucose; as a result, your blood sugar levels rise. Difference between the Somogyi effect and the Dawn phenomenon For those wanting to find out the difference between the Somogyi effect and the Dawn phenomenon, you can find out by checking your blood sugar several nights just before bed. Set an alarm to check it again at 2 in the morning. Then, test it again when you wake up. If you find that your blood glucose is low when you check I at 2:00 a.m., it is probably the Somogy effect. If you find that it is normal or high at this same time, then it is probably the Dawn phenomenon. If you have diabet Continue reading >>

The Somogyi Phenomenon Revisited Using Continuous Glucose Monitoring In Daily Life

The Somogyi Phenomenon Revisited Using Continuous Glucose Monitoring In Daily Life

, Volume 48, Issue11 , pp 24372438 | Cite as The Somogyi phenomenon revisited using continuous glucose monitoring in daily life Blood Glucose ConcentrationContinuous Glucose MonitoringNocturnal HypoglycaemiaContinuous Glucose Monitoring SystemBlood Glucose Profile These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. To the Editor: In 1959, Michael Somogyi reported that hypoglycaemia during the night was often followed by heavy glycosuria next morning [ 1 ]. Moreover, a high morning fasting blood glucose value was later attributed to nocturnal hypoglycaemia and the need to reduce the evening or bedtime dose of insulin. The Somogyi phenomenonhypoglycaemia begetting hyperglycaemiais believed to be due to the release of counterregulatory hormones in response to (nocturnal) insulin-induced hypoglycaemia. Despite the fact that experimental studies have rejected the existence of the Somogyi phenomenon [ 2 , 3 , 4 ], it is, in our experience, still widely believed to exist by health care professionals. Previous experimental research has been based on hospitalised patients using nocturnal blood glucose profiles or real life data with a single nocturnal blood glucose measurement. The sensitivity of the latter method for the detection of nocturnal hypoglycaemia is low [ 3 , 5 ], which may explain some of the reluctance to accept that the phenomenon does not exist. The recent development of continuous glucose monitoring systems has made it possible to monitor patients with type 1 diabetes in daily life. Using this technology, we tested the existence of the Somogyi phenomenon in daily life in a large cohort of type 1 diabetic subjects. All 262 patients with type 1 diabetes from Continue reading >>

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