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Dawn Phenomenon with Case

by Michael Lazarus, MD

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      Slides 02-03 Diabetes Melitus part 1.pdf
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    00:00 Let's go on to another case. A 42-year-old man comes to his primary care physician for a follow-up visit. He has type 1 diabetes for 19 years for which he takes insulin. He complains of frequent episodes of waking up in the middle of the night. When he wakes up, he feels excessive sweating, hand tremors, and weakness. His morning blood glucose is high on repeated measurements. What is the optimal intervention for this patient's condition? This patient has longstanding type 1 diabetes. He is awoken at night with symptoms of hypoglycemia. The symptoms of excessive sweating, tremor, and weakness are closely correlated with low blood glucose. The conclusion here is that the patient has the Somogyi effect or the dawn phenomenon. Ask the patient to have a small carbohydrate snack before bedtime to mitigate the drop in glucose that he is experiencing in the middle of the night and this will reduce the symptoms of hypoglycemia and take care of the dawn phenomenon. Hypoglycemia while the patient is sleeping due to a high insulin dose at night stimulates the release of counter-regulatory hormones. These generally come from the adrenal gland in the form of cortisol, glucagon, and cathecholamines. This leads to morning hypoglycemia which is a rebound post the hypoglycemic effect of these counter-regulatory stress hormones.

    01:29 A simple way to detect this is also the treatment. You ask the patient to have a small carbohydrate snack at bedtime to keep the blood glucose up overnight and in the morning the blood glucose levels have normalized and the Somogyi effect can be diagnosed. Daily insulin doses based on this should be reduced in the long term.


    About the Lecture

    The lecture Dawn Phenomenon with Case by Michael Lazarus, MD is from the course Diabetes Mellitus. It contains the following chapters:

    • Case: 42-year-old Man with Type 1 DM
    • Dawn Phenomenon

    Included Quiz Questions

    1. Recommend that the patient have a small carbohydrate snack before bedtime
    2. Recommend that the patient consume more calories throughout the day
    3. Recommend that the patient lower his nightly insulin dose
    4. Recommend that the patient administer his insulin dose 2 hours earlier
    5. Recommend that the patient increase his dose of long-acting insulin at night
    1. Excessive bedtime insulin load causes nighttime hypoglycemia, stimulating hormones such as cortisol that cause morning hyperglycemia.
    2. Excessive bedtime insulin load causes morning hypoglycemia.
    3. Excessive bedtime carbohydrates cause nighttime hyperglycemia, followed by morning hypoglycemia.
    4. Insufficient bedtime insulin causes nighttime hyperglycemia, followed by morning hypoglycemia.
    5. Insufficient carbohydrates at bedtime cause nighttime hypoglycemia, which persists through the morning.

    Author of lecture Dawn Phenomenon with Case

     Michael Lazarus, MD

    Michael Lazarus, MD


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