This phenomenon is actually less common than the dawn phenomenon, which is an abnormal early morning increase in the blood glucose level because of natural changes in hormone levels.[2, 3, 4] Debate continues in the scientific community as to the actual presence of this reaction to hypoglycemia.
The causes of Somogyi phenomenon include excess or ill-timed insulin, missed meals or snacks, and inadvertent insulin administration.[6, 7, 8] Unrecognized posthypoglycemic hyperglycemia can lead to declining metabolic control and hypoglycemic complications.
Instruct patients in proper identification of symptoms of hypoglycemia, insulin dose, timing of meals, and insulin administration. The ability to suppress insulin release is an important physiologic response that people with insulin-requiring diabetes cannot carry out, as displayed in the image below. Studies have cast doubt on the importance of counterregulatory hormones in mediating glycemic rebound. Choudhary and associates have cast further doubt on the frequency of the Somogyi effect by studying nocturnal hypoglycemia with continuous glucose monitoring.
Patients with Somogyi phenomenon present with morning hyperglycemia out of proportion to their usual glucose control.
Patients may experience falling insulin levels due to absorption or dose issues from the previous evening. Laboratory studies for identifying Somogyi phenomenon include fasting blood glucose, nocturnal blood glucose, hemoglobin A1C (Hgb A1C), and frequent glucose sampling.
The fasting blood glucose level is expected to be inappropriately elevated due to hormonally induced rebound. Obtaining an Hgb A1C level may be helpful if it is within the reference range or low despite an elevated fasting glucose level. Frequent glucose monitoring may be necessary to confirm the diagnosis and look for other periods of hypoglycemia that may lead to rebound hyperglycemia.
Somogyi phenomenon should be suspected in patients presenting with atypical hyperglycemia in the early morning that resists treatment with increased insulin doses. If nocturnal blood sugar is confirmatory or if suspicion is high, reduce evening or bedtime insulin. Substitution of regular insulin with an immediate-acting insulin analog, such as Humulin lispro,[11, 12] may be of some help, but this has not been firmly established.
Continue glucose monitoring with special attention to hypoglycemia in patients with Somogyi phenomenon. Medscape's clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices. The clinical information represents the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the United States and worldwide. More than 6000 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions and to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. More than 1000 clinical procedure articles provide clear, step-by-step instructions and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have performed previously.
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All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. Diabetes prevention is as basic as eating more healthfully, becoming more physically active and losing a few extra pounds — and it's never too late to start. Research shows that both aerobic exercise and resistance training can help control diabetes, but the greatest benefit comes from a fitness program that includes both. Although it's not clear why, whole grains may reduce your risk of diabetes and help maintain blood sugar levels.
Low-carb diets, the glycemic index diet or other fad diets may help you lose weight at first, but their effectiveness at preventing diabetes isn't known nor are their long-term effects. If you're older than age 45 and your weight is normal, ask your doctor if diabetes testing is appropriate for you.


Lets Fight Against Diabetes, as this is the last day of Diabetes month, I am glad to post this update, hope this will be useful information to the public. Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar.
Rather than a restrictive diet, a diabetes diet or MNT is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories, with an emphasis on fruits, vegetables and whole grains. If you have diabetes or prediabetes, your doctor will likely recommend that you see a dietitian to guide you on dietary changes that can help you control your blood sugar (glucose) level and manage your weight. When you eat excess calories and fat, your body responds by creating an undesirable rise in blood glucose.
Making healthy food choices and tracking your eating habits can help you manage your blood glucose level and keep it within a safe range. For most people with type 2 diabetes, losing pounds also can make it easier to control blood glucose and offers a host of other health benefits. Diabetes increases your risk of heart disease and stroke by accelerating the development of clogged and hardened arteries.
A sample menu :Your daily meal plan should take into account your size as well as your physical activity level.
Knowing how diabetes affects your body can help you look after your body and prevent diabetic complications from developing.
Many of effects of diabetes stem from the same guilty parties, namely high blood pressure, high cholesterol levels and a lack of blood glucose control. Diabetes affects our blood vessels and nerves and therefore can affect any part of the body. Diabetic complications will usually take a number of years of poorly controlled diabetes to develop. These can all be helped by keeping to a healthy diet, avoiding cigarettes and alcohol, and incorporating regular activity into your daily regime in order to keep blood sugar levels within recommended blood glucose level guidelines. Diabetes contributes to high blood pressure and is linked with high cholesterol which significantly increases the risk of heart attacks and cardiovascular disease. Similar to how diabetes affects the heart, high blood pressure and cholesterol raises the risk of strokes.
Retinopathy is caused by blood vessels in the back of the eye (the retina) swelling and leaking.
Hypoinsulinemia (waning of the insulin dose), insulin resistance, and hypersensitivity to the effects of the counterhormones also may play a role.
Nocturnal hypoglycemia is missed or asymptomatic, and posthypoglycemic hyperglycemia is not considered or is confused with the dawn phenomenon.
Patients have an increased need for insulin in the early morning primarily due to the release of growth hormone, which antagonizes insulin action. This occurs as the insulin requirement is rising (dawn phenomenon) and results in a rapid rise of blood sugar at 4-8 AM. A glucose reading in the middle of the night will disclose hypoglycemia as a result of insulin therapy.
It supports the concept of a rebound fasting hyperglycemia in the face of normal glucose control. Frequent hypoglycemia is responsible for hypoglycemic unawareness, which may cause the typical symptoms of hypoglycemia to be missed.
Clinical signs, including weight gain, normal daytime blood sugar levels, and relatively low Hgb A1C, suggest overtreatment. The "dawn phenomenon"--a common occurrence in both non-insulin- dependent and insulin-dependent diabetes mellitus. Glucose counterregulation and waning of insulin in the Somogyi phenomenon (posthypoglycemic hyperglycemia). Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis.
Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images. The articles assist in the understanding of the anatomy involved in treating specific conditions and performing procedures.
Check mild interactions to serious contraindications for up to 30 drugs, herbals, and supplements at a time. Plus, more than 600 drug monographs in our drug reference include integrated dosing calculators. My focus is always on helping others to understand how to adopt health, fitness and a nutrient-rich clean eating diet as a lifestyle rather than a quick fix”. It's especially important to make diabetes prevention a priority if you're at increased risk of diabetes, for example, if you're overweight or have a family history of the disease.


Making a few simple changes in your lifestyle now may help you avoid the serious health complications of diabetes down the road, such as nerve, kidney and heart damage.
And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients. He or she will applaud your efforts to keep diabetes at bay, and perhaps offer additional suggestions based on your medical history or other factors. Here's help getting started, from meal planning to exchange lists and counting carbohydrates.
If blood glucose isn't kept in check, it can lead to serious problems, such as a dangerously high blood glucose level (hyperglycemia) and chronic complications, such as nerve, kidney and heart damage. If you need to lose weight, a diabetes diet provides a well-organized, nutritious way to reach your goal safely. During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. High-fat dairy products and animal proteins such as beef, hot dogs, sausage and bacon contain saturated fats. These types of fats are found in processed snacks, baked goods, shortening and stick margarines and should be avoided completely. Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, shellfish, liver and other organ meats. Pasta primavera prepared with broccoli, carrots, zucchini, yellow squash and Parmesan cheese, 1 cup of low-fat milk. Complications are not a certainty and can be kept at bay and prevented by maintaining a strong level of control on your diabetes, your blood pressure and cholesterol. As with all complications, this condition is brought on by a number of years of poorly controlled or uncontrolled diabetes.
The best way to do this is to attend a retinopathy screening appointment, provided free on the NHS, once each year. This can lead to loss of sensation or feeling (usually starting in the toes) or pain and burning of the feet.
Keeping your diabetes under control, seeing your dentist regularly, and taking good daily care of your teeth can prevent gum disease and tooth loss. Disease of the large blood vessels in your legs may cause problems with blood circulation, leading to leg cramps, changes in skin color, and decreased sensation. With proper identification and management, the prognosis for Somogyi phenomenon is excellent, and there is no evidence of long-term sequelae.
They compared fasting capillary glucose levels following nights with nocturnal hypoglycemia.
Accelerated glucose production and impaired glucose utilization due to nocturnal surges in growth hormone secretion. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. Many foods made from whole grains come ready to eat, including various breads, pasta products and many cereals.
Focus on the healthiest carbohydrates, such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products. They found that capillary fasting glucose was more likely to be lower following nocturnal hypoglycemia with only 2 instances of fasting glucose greater than 180 mgm%.
Easily compare tier status for drugs in the same class when considering an alternative drug for your patient. Look for the word "whole" on the package and among the first few items in the ingredient list. In one study, overweight adults reduced their diabetes risk by 16 percent for every kilogram (2.2 pounds) of weight lost. Foods high in fiber include vegetables, fruits, nuts, legumes (beans, peas and lentils), whole-wheat flour and wheat bran.
Cod, tuna and halibut, for example, have less total fat, saturated fat and cholesterol than do meat and poultry.
Fish such as salmon, mackerel and herring are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. However, avoid fried fish and fish with high levels of mercury, such as tilefish, swordfish and king mackerel.




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