Somogyi Effect in Diabetes

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Early in the morning Before breakfast ( 7 am ), the blood glucose levels are high and this is attributed to low hypoglycemia in the middle of night ( 3 am) , which led to the body reacting by increasing hormones to increase Blood Glucose levels by 7 am.

Hormones which Decrease Blood Glucose Levels

  • Insulin

Hormones which Increase Blood Glucose Levels

  • Glucagon
  • Epinephrine
  • Growth Hormone
  • Cortisol

However, a more common cause for pre breakfast hyperglycemia is the waning of circulating insulin levels by the morning.

How do we know about the Somogyi Effect?

Patients are asked to check Blood Glucose levels at 3 am, in addition to the usual checking time at 7 am.

The Somogyi effect can be treated by removing the dose of intermediate insulin at dinner time or lowering the dose at bedtime or by eating more food at bedtime.

 Blood Glucose mg/dLFree Insulin(microunit/mL)
  10 pm  3 am  7 am 10 pm      3 am    7 am
Somogyi Effect 90        40         200 High     Slightly High  Normal
Dawn Phenomenon 110        110    150 Normal  Normal Normal

Blood Sugar converter from mg/dL into mmol/L is by know that,

1 mg/dL = 0.1 mmol/L

Whereas Dawn phenomenon occurring naturally in most people, is due to reduced tissue sensitivity to insulin between 5 am and 8 am, hence we see Increased Blood Glucose at 7 am, while the insulin levels are within normal range.

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