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study published in 2007 using continuous glucose monitoring showed that a low glucose during the night (nocturnal hypoglycemia) can be highly prevalent in type 1 diabetic treatments, but is associated rather with morning hypoglycemia, not hyperglycemia. Furthermore, many individuals with hypoglycemic episodes during the night do not wake due to a failure of release of epinephrine during nocturnal hypoglycemia. Thus, Somogyi's hypothesis is not assured and may be refuted.
170:. In practice, the difficulty for a diabetic person to aggressively dose insulin to keep blood sugars levels close to normal — while adjusting the insulin regimen to the demands of exercise, stress, and wellness — can practically assure occasional hyperinsulinemia. The pharmacokinetic imperfections of all insulin replacement regimens is a severe limitation.
45:, 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 US in October 1922. Somogyi showed that excessive insulin makes diabetes unstable and first published his findings in 1938.
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Although this hypothesis is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough. A
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Somogyi and others have claimed that if prolonged hypoglycemia is untreated, then stress due to low blood sugar can result in a high blood glucose rebound. The physiological mechanisms driving the rebound are defensive. When the blood glucose level falls below normal, the body responds by releasing
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after the insulin dosage has been raised, particularly in the morning. One simple way to determine if nocturnal hypoglycemia may be causing morning hyperglycemia is to have the patient have a high protein snack with a small amount of carbohydrates at bedtime. This will help keep the blood sugar up
90:. 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
150:. Waking with a night sweat (perhaps combined with a rapid heart rate) is a symptom of the adrenaline and rebound. Unfortunately, the evidence shows that patients with type 1 diabetes do not normally wake during nocturnal hypoglycemic episodes.
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Testing occasionally during the middle of the night is also important, particularly when high waking blood sugars are found, to determine if more insulin is needed to prevent hyperglycemia or if less insulin is needed to prevent such a rebound.
67:
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is the preferred method to detect and prevent the
Somogyi rebound, but this technology is far from universally used. Alternatively, testing blood sugar more often, 8 to 10 times daily with a traditional
118:. Glucagon facilitates release of glucose from the liver that raises the blood glucose immediately; the stress hormones cause insulin resistance for several hours, sustaining the elevated blood sugar.
351:
Schultes, Bernd; Jauch-Chara, Kamila; Gais, Steffen; Hallschmid, Manfred; Reiprich, Eva; Kern, Werner; Oltmanns, Kerstin M.; Peters, Achim; Fehm, Horst L.; Born, Jan (2007).
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overnight and prevent the
Somogyi effect. If the morning blood sugar decreases, this is indicative of the Somogyi effect and the daily insulin should be decreased.
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injections, this effect is counter-intuitive to people who experience high blood sugar in the morning as a result of an overabundance of insulin at night.
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While reviewing log data of blood glucose after the fact, signs of
Somogyi rebound should be suspected when blood glucose numbers seem
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can easily become chronic when the high morning blood sugar data is misjudged to be due to insufficient nighttime insulin delivery.
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is a contested explanation of phenomena of elevated blood sugars experienced by diabetics in the morning. Also called the
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461:"Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring?"
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Gerich, J. E. (1988). "Lilly lecture 1988. Glucose counterregulation and its impact on diabetes mellitus".
517:"Counterregulation during spontaneous nocturnal hypoglycemia in prepubertal children with type 1 diabetes"
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The first line of defense in preventing chronic
Somogyi rebound is additional blood glucose testing.
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353:"Defective Awakening Response to Nocturnal Hypoglycemia in Patients with Type 1 Diabetes Mellitus"
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should balance insulin delivery to manage their blood glucose level. Occasionally, insufficient
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use of appropriate types of insulin (long-acting, short-acting, etc.) in appropriate amounts.
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logging and review of blood glucose values, searching for patterns of low blood sugar values;
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Sometimes a person with diabetes will experience the
Somogyi rebound when awake and notice
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275:; Kirstein, M (1938). "Insulin as a cause of extreme hyperglycemia and instability".
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Gale EA, Kurtz AB, Tattersall RB (August 1980). "In search of the
Somogyi effect".
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Some practical behaviors which are useful in avoiding chronic
Somogyi rebound are:
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Matyka KA, Crowne EC, Havel PJ, Macdonald IA, Matthews D, Dunger DB (July 1999).
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Guillod L, Comte-Perret S, Monbaron D, Gaillard RC, Ruiz J (November 2007).
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awareness to hyperglycemia in response to increased delivery of insulin;
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and to consider adjusting the regimen to reduce insulin in the future.
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Theoretical elevated blood sugar for diabetics in the morning
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Michael
Cooperman, MD; Chief Editor: George T Griffing, MD.
30:, it is a rebounding high blood sugar that is a response to
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In theory, avoidance is simply a matter of preventing
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frequent blood glucose monitoring (8–10 times daily);
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Understanding
Diabetes a.k.a. The Pink Panther Book
70:The rebounding blood sugar following undetected
277:Weekly Bulletin of the St Louis Medical Society
302:(As of 2011-05-28, the electronic text is not
34:. When managing the blood glucose level with
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41:This theoretical phenomenon was named after
189:conservative increases in insulin delivery;
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192:awareness to the signs of hypoglycemia;
144:symptoms of the initial low blood sugar
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250:by H. Peter Chase, chapter 6 page 47.
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261:Michael Somogyi (www.whonamedit.com)
181:continuous blood glucose monitoring
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94:. The appropriate response is to
218:Idiopathic postprandial syndrome
106:as well as the stress hormones
28:posthypoglycemic hyperglycemia
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416:10.1016/s0140-6736(80)90233-0
128:Continuous glucose monitoring
480:10.1016/j.diabet.2007.03.007
370:10.1371/journal.pmed.0040069
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148:symptoms of the rebound
20:Chronic Somogyi rebound
102:the endocrine hormone
96:treat the hypoglycemia
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223:Reactive hypoglycemia
72:diabetic hypoglycemia
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133:blood glucose meter
570:Somogyi Phenomenon
289:2027/uc1.$ b721522
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304:open access
283:: 498–510.
203:Controversy
108:epinephrine
582:Categories
363:(2): e69.
273:Somogyi, M
234:References
62:Background
162:Avoidance
122:Detection
593:Diabetes
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488:17652003
389:17326710
318:Diabetes
297:11637296
212:See also
112:cortisol
104:glucagon
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380:1808097
338:3056759
84:insulin
36:insulin
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155:higher
464:(PDF)
428:S2CID
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334:PMID
293:OCLC
114:and
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
