Diabetes Morning Hyperglycemia - Dawn Phenomenon vs Somogyi Effect
When patients FBG's are elevated each morning despite attempts at adjusting medication therapy, it's a good idea to assess the situation to determine if patient is experiencing the normal dawn phenomenon, or if they are actually experiencing Somogyi effect. Both are characterized by morning hyperglycemia, but they are for opposite reasons. All patients (even those without diabetes) experience dawn phenomenon, where the natural changes in growth hormones and insulin levels causes a natural hyperglycemia in the mornings. In patients without diabetes, the pancreas can adjust and release insulin to control the blood sugar. Although rare and not strongly evidenced, it's still good to know about the idea of Somogyi effect. This is when patients experience hypoglycemia in the late nights, and wake up with hyperglycemia as the body's overcompensating response to the hypoglycemia. If a patient actually does experience this, it's important to adjust or decrease the medication to prevent the night hypoglycemia, which would then resolve the morning hyperglycemia. ----
Although there is evidence disproving the Somogyi effect, I have had a patient in which I found them to be experiencing what I think was Somogyi effect. I ended up decreasing their evening insulin dose which actually ended up decreasing their morning FBG. This could have been from other reasons unknown to me since they did not have a CGM at the time for me to fully assess, but maybe? Have you experienced this in your practice?
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
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