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Rebound hyperglycemia

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Steff said:
Was not aware of this until i got an email this morning from diabetes.co.uk.Looks like its diabetics on insulin only.Had not heard of Somogyi Phenomenon either http://www.diabetes.co.uk/blood-glucose/somogyi-phenomenon.html.
Nice to get imformative emails for once .
Click to expand...

yea heard of those, but dont ask me to spell the overnight one! That one is contraversial i believe and is thought to wear off over time, ie doesnt happen when you have been diabetic for some time.

Not to be confused with dp, for example if i test immediately on waking and dont eat by 1 hour later my bg will rise by a few mmol generally. It can go up considerably over the early hours or early morning. Us on insulin have to deal with it by adjusting our basals, easier on a pump or ratios and timing at breakfast, can be very tricky! 🙂
 
Somogyi is familiar to many T1s here I would think.

One of the charming aspects of trying to get your overnight basal insulin working properly.

If you find your fasting BG levels suddenly too high it indicates that your overnight basal is too low or insufficient to copr with Dawn Phenomenon causing an overnight rise

oooooooor...

It indicates that your overnight basal is too high causing you to have a hypo in the early hours that you are sleeping through and then rebounding into hyperglycaemia when your liver wades in as an emergency measure.

Marvellous. One symptom two completely opposite possible solutions. And if you guess wrong your levels are stuffed for days while you test/retest/check/monitor adjust.

Humph!
 
tracey w said:
yea heard of those, but dont ask me to spell the overnight one! That one is contraversial i believe and is thought to wear off over time, ie doesnt happen when you have been diabetic for some time.

Not to be confused with dp, for example if i test immediately on waking and dont eat by 1 hour later my bg will rise by a few mmol generally. It can go up considerably over the early hours or early morning. Us on insulin have to deal with it by adjusting our basals, easier on a pump or ratios and timing at breakfast, can be very tricky! 🙂
Click to expand...

I eat breakfast first thing for this reason. Always have done.🙂

Rob
 
Thanks everyone I am always interested in learning not only about my own diabetes and type 2 but also type 1

thanks
 
There was a study using continuous monitoring.
They found than unrecognised hypos in the night resulted in low glucose rather than high levels in the morning and 'no evidence to suggest that high fasting morning blood glucose values indicate that silent nocturnal hypoglycaemia has occurred'
ie no evidence for the Somogyi effect.
they had 139 incidents where there was a hypo at night. Most of the night time hypos didn't cause symptoms and they weren't 'severe'. The average glucose level in the morning for these people was around 6mmol and no 'dump' occured.
http://www.springerlink.com/content/yk834253q741g156/fulltext.html

This fits in with what I found when I used a GGM for a couple of weeks.
I had been going to bed quite low, waking up quite low (not much change at all overnight) yet I felt perhaps I was having hypos. Sometimes I woke and thought I might have had one but when I tested I was fine.

The CGM showed I was in fact, going down to the 3s but then recovering. One night it happened twice, and I didn't even wake for the second alarm on the CGM. I was never low for very long so must have a very good (so far) counter regulatory system..my doc , quite rightly still wanted me to lower my ratios for dinner so I went to bed a bit higher.
 
Very interesting Helen... and completely not what I seem to have observed (albeit without the benefit of CGM).

For example... occasional overnight basal tests suggest I can fall anything up to 4-6mmol/L from suppertime reading to around 3-4am without there being any apparent bolus active and where levels in the evening have been fairly steady. Basal tests during the day seem to confirm that daytime basal is pretty much bang-on too - one of the reasons I might consideer moving to Levemir (but that's another story)

On some evenings where I have had added alcohol into the mix (and therefore increased supposed risk of overnight hypo) I have sometimes woken high and then battled relentless highs all morning requiring bolus doses at more than double usual ratio AND corrections on top (exactly as if there were some additional source of glucose feeding in as I was not eating carbs following the BG test, merely waiting for the insulin to start working... and neither do I have DP to that extent) When I read about Somogyi a few years ago it seemed to fit with these events, and (while I know it is still a bit controversial) still seems to match experience of bouncing back out of nastier lows even during the daytime.

I guess I've latched on to the idea because it matches what I observe (or think I observe).

Makes me want to push for CGM all the harder.
 
Before going on the pump I slept through a lot of hypo overnight, can't say that I suffered the somogyi effect..

When I woke up my BG would be within range but I would feel hung over, my vision would be shoot, It was like looking through very thick heavy dirty net curtains and this effect would take 20 minutes to a couple of hours to reslove itself😱

I do suffer dawn phen, as can be seen by my pump settings

But the main difference between whether it's DP's or somogyi effect, DP's will have a constant raise to bg what ever the starting point, somogyi is going to happen intermittantly with an irregular raise in BG from one eposide to the next!
 
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