Dr. Michael Somogyi predicted in the 1930s that insulin-induced hypoglycemia in the late evening would trigger a hormone counterregulatory response that results in hyperglycemia in the morning.
Compared to the dawn phenomenon which is an unusual rise in blood glucose levels caused by regular fluctuations in hormone levels is less frequent.
The existence of this sensitivity to hypoglycemia is still up for debate in the scientific community.
Insulin resistance linked to the metabolic syndrome and nocturnal growth hormone production are two other hypothesized causes of morning hyperglycemia.
Somogyi and dawn phenomena can be distinguished using continuous glucose monitoring (CGM).
CGM record the hypoglycemic episodes that occur at night and are linked to the Somogyi phenomenon.
Excessive or poorly timed insulin, missing meals or snacks, and unintentional insulin injection are the causes of the Somogyi phenomenon.
Ignored posthypoglycemic hyperglycemia might result in hypoglycemia consequences and deteriorating metabolic control.
Epidemiology
Anatomy
Pathophysiology
People who have diabetes that requires insulin are unable to block the release of insulin, which is a crucial physiological reaction.
The counterregulatory hormones that oppose the anabolic effects of insulin and promote gluconeogenesis and glycogenolysis are the defense against hypoglycemia.
Glucagon is the first and most significant hormone in the Somogyi phenomenon acts on the liver to promote gluconeogenesis and glycogenolysis.
By inhibiting the consumption of glucose and increasing the production of glucose by the liver, cortisol may help with severe and protracted instances of Somogyi phenomenon.
Etiology
Genetics
Prognostic Factors
Clinical History
Clinical History:
The morning hyperglycemia in patients with Somogyi phenomenon is out of proportion to their normal glucose control.
The dawn phenomena are mistaken for posthypoglycemic hyperglycemia, while nocturnal hypoglycemia is either ignored or asymptomatic.
Hypoinsulinemia is the most frequent cause of morning hyperglycemia.
Because growth hormone counteracts the effects of insulin those patients have a greater demand for insulin in the morning.
Insulin levels may drop in patients because of problems with absorption or dosage from the night before.
Blood sugar levels rise sharply between 4 and 8 AM because of the increasing need for insulin. Both type 1 and type 2 diabetics frequently experience this problem.
Laboratory Studies:
Hemoglobin A1C (Hgb A1C), nocturnal blood glucose, fasting blood glucose, and frequent glucose sampling are laboratory tests used to detect the Somogyi phenomenon.
Hormonally induced rebound is likely to cause an unwarranted elevation of the fasting blood glucose level.
Insulin treatment will reveal hypoglycemia if a glucose level is taken in the middle of the night.
Finding out if the Hgb A1C level is low or within the reference range despite an increased fasting glucose level may be useful.
Normal glucose management supports the idea of rebound fasting hyperglycemia. The Somogyi phenomenon is not ruled out by an increased Hgb A1C.
Regular glucose checks required to verify the diagnosis and search for any hypoglycemic episodes that could result in rebound hyperglycemia.
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Patients who exhibit unusually high blood sugar levels in the morning and do not respond to higher insulin dosages suspected of having the Somogyi phenomenon.
Reduce evening or bedtime insulin if nocturnal blood sugar is confirming or if suspicion is high.
Clinical indicators of overtreatment include weight gain, normal blood sugar levels during the day, and low Hgb A1C.
It has not been proven that using an immediate-acting insulin analog, such Humulin Lispro in place of normal insulin may help.
Consult a diabetic or endocrine specialist for challenging or uncommon situations.
In patients with Somogyi phenomenon, continue to monitor blood sugar levels, paying particular attention to hypoglycemia.
Dr. Michael Somogyi predicted in the 1930s that insulin-induced hypoglycemia in the late evening would trigger a hormone counterregulatory response that results in hyperglycemia in the morning.
Compared to the dawn phenomenon which is an unusual rise in blood glucose levels caused by regular fluctuations in hormone levels is less frequent.
The existence of this sensitivity to hypoglycemia is still up for debate in the scientific community.
Insulin resistance linked to the metabolic syndrome and nocturnal growth hormone production are two other hypothesized causes of morning hyperglycemia.
Somogyi and dawn phenomena can be distinguished using continuous glucose monitoring (CGM).
CGM record the hypoglycemic episodes that occur at night and are linked to the Somogyi phenomenon.
Excessive or poorly timed insulin, missing meals or snacks, and unintentional insulin injection are the causes of the Somogyi phenomenon.
Ignored posthypoglycemic hyperglycemia might result in hypoglycemia consequences and deteriorating metabolic control.
People who have diabetes that requires insulin are unable to block the release of insulin, which is a crucial physiological reaction.
The counterregulatory hormones that oppose the anabolic effects of insulin and promote gluconeogenesis and glycogenolysis are the defense against hypoglycemia.
Glucagon is the first and most significant hormone in the Somogyi phenomenon acts on the liver to promote gluconeogenesis and glycogenolysis.
By inhibiting the consumption of glucose and increasing the production of glucose by the liver, cortisol may help with severe and protracted instances of Somogyi phenomenon.
Clinical History:
The morning hyperglycemia in patients with Somogyi phenomenon is out of proportion to their normal glucose control.
The dawn phenomena are mistaken for posthypoglycemic hyperglycemia, while nocturnal hypoglycemia is either ignored or asymptomatic.
Hypoinsulinemia is the most frequent cause of morning hyperglycemia.
Because growth hormone counteracts the effects of insulin those patients have a greater demand for insulin in the morning.
Insulin levels may drop in patients because of problems with absorption or dosage from the night before.
Blood sugar levels rise sharply between 4 and 8 AM because of the increasing need for insulin. Both type 1 and type 2 diabetics frequently experience this problem.
Laboratory Studies:
Hemoglobin A1C (Hgb A1C), nocturnal blood glucose, fasting blood glucose, and frequent glucose sampling are laboratory tests used to detect the Somogyi phenomenon.
Hormonally induced rebound is likely to cause an unwarranted elevation of the fasting blood glucose level.
Insulin treatment will reveal hypoglycemia if a glucose level is taken in the middle of the night.
Finding out if the Hgb A1C level is low or within the reference range despite an increased fasting glucose level may be useful.
Normal glucose management supports the idea of rebound fasting hyperglycemia. The Somogyi phenomenon is not ruled out by an increased Hgb A1C.
Regular glucose checks required to verify the diagnosis and search for any hypoglycemic episodes that could result in rebound hyperglycemia.
Patients who exhibit unusually high blood sugar levels in the morning and do not respond to higher insulin dosages suspected of having the Somogyi phenomenon.
Reduce evening or bedtime insulin if nocturnal blood sugar is confirming or if suspicion is high.
Clinical indicators of overtreatment include weight gain, normal blood sugar levels during the day, and low Hgb A1C.
It has not been proven that using an immediate-acting insulin analog, such Humulin Lispro in place of normal insulin may help.
Consult a diabetic or endocrine specialist for challenging or uncommon situations.
In patients with Somogyi phenomenon, continue to monitor blood sugar levels, paying particular attention to hypoglycemia.
Endocrinology, Reproductive/Infertility
Patient should reduce evening or bedtime insulin dose if excessive.
Avoid long-acting insulin peaks at night by using basal analogs with flatter profiles.
Prevent nocturnal hypoglycemia by serving a well-balanced snack before bed.
Detect nocturnal hypoglycemia via capillary glucose tests at 3 a.m. or by using continuous glucose monitoring (CGM).
Maintain regular sleep schedules since hormonal swings aggravated by stress and sleep deprivation.
Dr. Michael Somogyi predicted in the 1930s that insulin-induced hypoglycemia in the late evening would trigger a hormone counterregulatory response that results in hyperglycemia in the morning.
Compared to the dawn phenomenon which is an unusual rise in blood glucose levels caused by regular fluctuations in hormone levels is less frequent.
The existence of this sensitivity to hypoglycemia is still up for debate in the scientific community.
Insulin resistance linked to the metabolic syndrome and nocturnal growth hormone production are two other hypothesized causes of morning hyperglycemia.
Somogyi and dawn phenomena can be distinguished using continuous glucose monitoring (CGM).
CGM record the hypoglycemic episodes that occur at night and are linked to the Somogyi phenomenon.
Excessive or poorly timed insulin, missing meals or snacks, and unintentional insulin injection are the causes of the Somogyi phenomenon.
Ignored posthypoglycemic hyperglycemia might result in hypoglycemia consequences and deteriorating metabolic control.
People who have diabetes that requires insulin are unable to block the release of insulin, which is a crucial physiological reaction.
The counterregulatory hormones that oppose the anabolic effects of insulin and promote gluconeogenesis and glycogenolysis are the defense against hypoglycemia.
Glucagon is the first and most significant hormone in the Somogyi phenomenon acts on the liver to promote gluconeogenesis and glycogenolysis.
By inhibiting the consumption of glucose and increasing the production of glucose by the liver, cortisol may help with severe and protracted instances of Somogyi phenomenon.
Clinical History:
The morning hyperglycemia in patients with Somogyi phenomenon is out of proportion to their normal glucose control.
The dawn phenomena are mistaken for posthypoglycemic hyperglycemia, while nocturnal hypoglycemia is either ignored or asymptomatic.
Hypoinsulinemia is the most frequent cause of morning hyperglycemia.
Because growth hormone counteracts the effects of insulin those patients have a greater demand for insulin in the morning.
Insulin levels may drop in patients because of problems with absorption or dosage from the night before.
Blood sugar levels rise sharply between 4 and 8 AM because of the increasing need for insulin. Both type 1 and type 2 diabetics frequently experience this problem.
Laboratory Studies:
Hemoglobin A1C (Hgb A1C), nocturnal blood glucose, fasting blood glucose, and frequent glucose sampling are laboratory tests used to detect the Somogyi phenomenon.
Hormonally induced rebound is likely to cause an unwarranted elevation of the fasting blood glucose level.
Insulin treatment will reveal hypoglycemia if a glucose level is taken in the middle of the night.
Finding out if the Hgb A1C level is low or within the reference range despite an increased fasting glucose level may be useful.
Normal glucose management supports the idea of rebound fasting hyperglycemia. The Somogyi phenomenon is not ruled out by an increased Hgb A1C.
Regular glucose checks required to verify the diagnosis and search for any hypoglycemic episodes that could result in rebound hyperglycemia.
Patients who exhibit unusually high blood sugar levels in the morning and do not respond to higher insulin dosages suspected of having the Somogyi phenomenon.
Reduce evening or bedtime insulin if nocturnal blood sugar is confirming or if suspicion is high.
Clinical indicators of overtreatment include weight gain, normal blood sugar levels during the day, and low Hgb A1C.
It has not been proven that using an immediate-acting insulin analog, such Humulin Lispro in place of normal insulin may help.
Consult a diabetic or endocrine specialist for challenging or uncommon situations.
In patients with Somogyi phenomenon, continue to monitor blood sugar levels, paying particular attention to hypoglycemia.
Endocrinology, Reproductive/Infertility
Patient should reduce evening or bedtime insulin dose if excessive.
Avoid long-acting insulin peaks at night by using basal analogs with flatter profiles.
Prevent nocturnal hypoglycemia by serving a well-balanced snack before bed.
Detect nocturnal hypoglycemia via capillary glucose tests at 3 a.m. or by using continuous glucose monitoring (CGM).
Maintain regular sleep schedules since hormonal swings aggravated by stress and sleep deprivation.
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