Couple of effects that you want to be familiar
with, this is somogyi effect.
This comes back to understanding your patho-physio.
Think about what happens in the middle of
the night and if your patient with diabetes
has been taking insulin and maybe perhaps
two or three o’clock in the morning, your
or the patient’s blood sugar levels start
If the blood sugar levels start dropping,
then you’re going to expect there to be
stressed hormones that kick in and when this
occurs, you wake up in the morning and the
sugar levels are high.
Thus, the way to prevent somogyi effect where
your blood sugar levels become low will be
to take a bedtime snack.
You want to be very clear about this effect
versus what we’ll take a look at next known
as the dawn effect.
With dawn effect, the counter-regulatory hormones
often peak around dawn.
We know that already, for example, cortisol;
cortisol is highest.
Remember the diurnal pattern.
It will be highest in the morning… cortisol
Therefore, leading to high blood sugars, a
little bit different from somogyi... somogyi
is a-is a story, meaning to say that you had
decreased blood glucose around two to three
and so, therefore, the counter-regulatory
hormones kicked in therefore resulting in
high blood sugar in the morning.
With the dawn effect, you wake up, you have
those high levels of counter-regulatory hormones
such as cortisol resulting in high blood sugar,
minimized by using long-acting insulin that
provides steady levels such as glargine.
Not only could it cover you for a day, maybe
a little bit more or by insulin pump, different
If you’re confused between the two, what
it basically means is that the dawn phenomenon
is the fact that you’re trying to control
how much counter-regulatory hormone is being
released in the morning resulting in that
spike of glucose perhaps and somogyi would
mean that you need a bedtime snack so that
you do not drop your glucose levels and become
hypoglycemic in the middle of the night.
Other strategies for type I diabetes… insulin
pump, continuous subcutaneous insulin infusion
Used buffered regular insulin and perhaps
islet cell transplantation, if at all possible…
a lot of research on that particular method.