Somogyi Effect

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The Somogyi effect is due to midnight hypoglycemia, which leads to a rebound hyperglycemia in the early morning.

Normal glucose metabolism

When you eat, the digested food is converts into glucose, which your body uses for energy needs. If any excess glucose available then it is stored in your liver for future use or converted to fat and stored in muscle cells.

Immediately after your liver senses any low blood sugar level, it dumps stored glucose into your blood stream to bring back normal glucose level. If your lever absent to do so, then your body would shut down and lead you to coma at some point. It is very rare phenomenon; however more likely to happen in the case of type 1 diabetes.

liver dumping

Liver is your friend, which do good thing to you by releasing glucose when needed. The problem in some diabetics is their liver, which is too helpful by releasing glucose without waiting until the blood sugar drops to 50 or below. In non-diabetic there is certain hormonal regulates their liver, which is not properly working in the case of diabetes. That is why diabetes is required to eat frequently, every 3 to 4 hours to keep the liver calm.

What is somogyi effect?

The Somogyi effect is due to midnight hypoglycemia, which leads to a rebound hyperglycemia in the early morning. During sleep when your blood sugar level drops, immediately liver has triggered to dump glucose into the blood stream. Thus, your blood glucose level rises in the next morning.

The Somogyi phenomenon, also known as post-hypoglycemic hyperglycemia, chronic Somogyi rebound is characterizing as a rebound high blood sugar level in response to hypoglycemia (low blood glucose).

Why rebound hyperglycemia is calling by the name Somogyi effect?

Dr. Michael Somogyi a Hungarian born professor, has first prepared insulin treatment to a diabetic child in the USA, he also demonstrates that high insulin dosage would make diabetes treatment unstable and very difficult.

How Somogyi Phenomenon occurs?

The Somogyi effect most commonly occurs among type 1 diabetes, it is due to having excess insulin in your body before going bed, may be due to long acting insulin or not having snacks before bedtime.

This phenomenon is a defense response by your body for low blood sugar level, by releasing endocrine hormone glucagon backing it with stress hormones cortisol and epinephrine.

Both Somogyi and dawn phenomenon both has a common similarity that leads to high morning blood sugar levels as a result of liver dumping glucose into the blood stream. However, the distinction between this two is Somogyi phenomenon is stimulates by hypoglycemia.

Diagnosis of Somogyi phenomenon

To diagnosis between Somogyi and dawn phenomenon (both have high blood sugar level during weak up); you need to wake up in the middle of the night at 2 to 3 a.m. to test your blood glucose. If the blood glucose level is low, then it can be due to Somogyi effect, otherwise dawn phenomenon.

If your HbA1C test result is within reference range or low despite an elevated fasting glucose level, may help to confirm Somogyi effect.  However, an elevated HbA1C does not totally rule out the role of Somogyi effect. Additionally, you can suspect Somogyi effect if you are having atypical hyperglycemia in the morning, which resists increased insulin dosage treatment.

Treatment & Management

The best treatment option is to prevent the hypoglycemia from happening. For this, you need to reduce evening or bedtime insulin dosage.

Additionally,

  • You can take bedtime snack high in protein, moderate in fat and low in carbohydrate to avoid midnight hypoglycemia. For example a piece of toast with peanut butter, or some cottage cheese, or yogurt, or some nuts and small piece of cheese.
  • Always manage your glucose level slightly higher before going bed.
  • Take blood glucose test between 2 to 3 a.m. and check how effective is your treatment and consult your doctor, if you need any changes such as type and/or dosage of insulin, oral medication.
  • Substitution your regular insulin with an immediate-acting insulin analog, such as Humulin lispro, may help you, still it is not firmly established.

Liver dump can also happens if you take insulin (or other insulin stimulating medications) without adequate amount of carb may end up with low blood sugar level. To stop hypoglycemia, liver dump stored glucose into the blood stream, thus blood glucose level rises. So it is important for you to balance medication with proper quantity of carbs, this usually requires testing to arrive right quantity for you.

Similar to medication, excess amount of exercise not balanced with adequate quantity of carb too end up with liver dumps. Carbohydrates are not enemies for diabetics, instead you should learn when and how to take them for beneficial results.

It looks complicated at the beginning but over time, you start learning to balance it correctly. You just need some testing with patience and interest to learn.

lipohypertrophy

For many diabetic’s insulin is not working to their optimal level; it is because if you are injecting insulin in the skin area affected by lipohypertrophy. It is a fat build-up develops mostly in the insulin injecting area, which is often used. Therefore, you must rotate your insulin-injecting site often.

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