Somogyi Effect & Dawn Phenomenon – Treatment of Diabetes Mellitus

by Carlo Raj, MD

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    00:01 Couple of effects that you want to be familiar with, this is somogyi effect.

    00:04 This comes back to understanding your patho-physio.

    00:09 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 dropping.

    00:24 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.

    00:35 Thus, the way to prevent somogyi effect where your blood sugar levels become low will be to take a bedtime snack.

    00:45 You want to be very clear about this effect versus what we’ll take a look at next known as the dawn effect.

    00:50 With dawn effect, the counter-regulatory hormones often peak around dawn.

    00:56 We know that already, for example, cortisol; cortisol is highest.

    00:59 Remember the diurnal pattern.

    01:00 It will be highest in the morning… cortisol is.

    01:05 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.

    01:22 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.

    01:35 Remember glargine? Not only could it cover you for a day, maybe a little bit more or by insulin pump, different from somogyi.

    01:43 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.

    02:08 Other strategies for type I diabetes… insulin pump, continuous subcutaneous insulin infusion CSII.

    02:18 Used buffered regular insulin and perhaps islet cell transplantation, if at all possible… a lot of research on that particular method.

    About the Lecture

    The lecture Somogyi Effect & Dawn Phenomenon – Treatment of Diabetes Mellitus by Carlo Raj, MD is from the course Pancreatic Disease and Diabetes.

    Included Quiz Questions

    1. Increased insulin requirement during the night
    2. A drop in blood sugar during the night
    3. Increased release of cortisol
    4. Can be addressed by eating before bed
    5. Hyperglycemia upon waking in the morning
    1. Insulin glargine
    2. Insulin aspart
    3. Insulin lispro
    4. Regular insulin
    5. Buffered regular insulin

    Author of lecture Somogyi Effect & Dawn Phenomenon – Treatment of Diabetes Mellitus

     Carlo Raj, MD

    Carlo Raj, MD

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