Nocturnal Hypo's

[DeusXM]

Testing throughout the night will help to understand whether it is DP or LA running out and the specific timing of this is paramount so the more tests the more information is provided. If its DP there may be a need for a pump - if LA there may be a need to alter the timings - so it is important and will make a difference to treatment.

I suspect it's very unlikely the basal is running out as the OP is already splitting their dose. I also don't think DP always requires a pump to treat (although granted, it makes it easier). I still think we need to rule out nypos though before we start messing around with insulin doses.

This is the point I was trying to make - saying that the liver 'saves' people is not always an accurate reflection of what actually happens as this ability is mostly lost the longer one has diabetes.

Hang on.

Your previous position is that the liver DOESN'T dump glucose into the blood in the event of an untreated hypo, and that this particularly affects young people.

Now you seem to be saying that actually the liver DOES dump glucose, but this ability fades the longer you have diabetes.

These statements contradict each other completely - if we now accept that that the liver does dump glucose in response to low BG levels AND this ability diminished the longer you have diabetes, then logically you can't then claim that teenagers are disproportionately affected by the failure of the liver to respond! Particularly as I'm not seeing a source for the original point the first place - simply saying "Diabetes UK say so" isn't actually good enough. I'm sorry, I know I'm coming across as rude and I really don't mean to. But what I want is facts, not hearsay and conjecture. Otherwise it sounds more like a diabetes myth. Let's base this discussion on evidence.

But now I'm interested - why would having diabetes for a certain length of time diminish the liver's ability to response to low glucose? What's the biological basis for this?

The best paediatric teams in the UK do not believe in somoghyi. If it existed why would Medtronic have made the VEO that cuts out if levels automatically rise?

Umm...that's very, very defective logic there. That's like saying 'why do cars come with impact bars and airbags?'. Relying on your liver to tackle nighttime hypoglycaemia is not safe and I don't think at any point I implied it was. All I was suggesting is that the liver has the capability to respond to low blood glucose levels while you sleep and this can and does happen. Having a pump that can respond to dropping BG levels is no bad thing - all it's doing is mimicking what a normal pancreas would do. Just because there is a pump that can reduce its insulin output in accordance with blood glucose levels is nowhere near proof that the liver has no ability to response to low blood glucose level. As for whether or not the best paediatric teams in the UK do not believe in the Somogyi effect, I think all of us here are familiar with knowing more than our doctors about the condition and in any case no paediatric team in the country could be seen to endorse such an effect as it might encourage irresponsible diabetes control. And this is before we even get to the elephant in the room which is that children have smaller livers and thus smaller glycogen stores than adults, which could mean that even if their livers do release glucose to combat a hypo, they might simply not have enough in the tank. This would also then explain your currently unsourced stat that young people are disproportionately affected by fatal nighttime hypoglycaemia.

Unfortunately, we're not talking about a child here. As you've pointed out before, I shouldn't necessarily apply to children what works for adults. Perhaps now would be a good time to make the point that this logically works both ways?

As the parent of a child who uses full-time CGMS it is clear to me that somogyi does not happen - at best levels will rise to 9ish - but not the 18's that is reported. There are hundreds of children on CGM's on the CWD list and their data shows no such effect either - we cant all be wrong?! The somogyi was named after its founder in 1938 and has not actually been proven with any studies to happen - the latest data does not support it.

And I guess I've now addressed this too - you can't apply children's data to adult circumstances. Where is this data anyway? Where is this data conclusively proving somogyi doesn't happen in adults?

the latest thinking by the worlds experts in Type 1 (who I have met) do not believe it happens and refer to it as a 'myth'.

And that's fine...but can we at least test to rule it out first? Most 'world experts' in T1 are still pedlding the line that we need to stuff ourselves with carbs every day - they can and do get things wrong. I know Bernstein doesn't believe in it but there are also plenty of T1s out there (myself included, I must stress) who have experienced this. Statistically, that's just as valid as you saying because it doesn't happen in your child, it never happens.

 

[bev]

Hi DeusXM,

Clearly we have different opinions on this subject.🙂I am not particularly interested in using my energies to prove to you what I know to be right - there is little point as we are all on the same side trying to battle this condition daily. If you choose to believe that somoghyi exists then that is your choice - I dont believe it does (apart from newly diagnosed and those who are in the honeymoon period) and is so infrequent that it cannot be relied on to save anyone. I think we should agree to differ.😉🙂Bev

 

[Adrienne]

Interesting discussion. Leaving night time aside... Is the suggestion that low blood glucose never results in a release of glycogen from the liver/muscles? I have read impassioned posts from parents before (following a DUK article about nocturnal hypos), but does the liver NEVER dump under CGM observation? I only ask because I believe I have seen it happen in myself (albeit without the benefit of CGM) and consequently would not basal test if I had been hypo that day. Indeed I think that was a Scheiner recommendation in the basal test sticky in the pumping section.

If it is thought to happen at some times of day, why not at night? Or is it just never thought to happen by some experts/specialists now?

Confused!

Hiya how's you?

I think the word 'never' cannot be applied. It is proven (and I'm ill so can't be bothered to go and get any studies etc sorry 😉 that generally the Somghiyklshfd (can't spell it so added a few letters of my own here) is not relied upon anymore and has been dispelled as good thinking. I imagine the liver does in some people dump some lovely stuff every so often and that is fab for some. But others, using CGM, can see very clearly that no it does not happen.

There are also studies that show out of x amount of kids that the majority will not wake up when hypo at night, it is nothing to do with their bodies getting used to hypos, they just don't wake up. I was actually talking to the real live consultant who was part of this particular study just the other week funnily enough.

My thoughts (and these are purely my thoughts) that if the said 'dumping liver' worked well and indeed rose anyone up to 18 then this would happen day and night and there would be absolutely no need to treat hypos day or night. Makes sense doesn't it. With my daughter it never happens and I can see this with the CGM.

I think someone said CGM was overkill - mmmmm not my take it on it but each to their own. The nearest thing on the market to a fully working normal pancreas is, at this moment in time, the Medtronic VEO with fully integrated full time use of CGM with its low suspend. This low suspend function does save lives, there can be no argument on this. Where I have been obviously far too knackered to hear my alarm clock the low suspend has kicked in twice now for the full 2 hours and one of those times it suspended again for a further two hours so that my daughter's levels rose slowly out of a hypo. Phew. I thank my lucky stars that we live in the right postcode to get full time CGM.

Anyway hope you are well and now I must get on being ill 😛

 

[Robster65]

A very interesting thread and one that makes me want to learn more.

My education on this is about 30 years out of date so not a bad thing to find out what my liver may or may not do. I wonder if it has a minimal effect in us oldies, in that it squirts a little bit of glucose out to get us out of (or into) trouble sometimes.

One of the problems with getting hold of CGM is whether your support team actually have one to lend you. I tried and was met with a resounding no. They don't use them because they didn't find them reliable (I presume this meant they didn't know how to calibrate/interpret result).

Best thing as always is to test when there's a grey area and see what you find out. I've had some surprising results from late meals and delayed spikes that show in the mornings. It's one reason why i'm always cautious about dawn phenomenon. It does happen but sometimes it's just caused by what we eat the night before.🙂

Rob

 

[DeusXM]

But Bev, all I'm asking for is evidence for your opinion. As you say, we're fighting against the same enemy, diabetes. At the moment, the evidence I've seen suggests to me that the Somogyi effect happens, and this influences how I manage my diabetes. If you have evidence that demonstrates the Somogyi effect doesn't happen, I'd really appreciate it if you could share it as this would have a significant affect on how I manage my personal battle with diabetes. Agreeing to disagree isn't enough. This is our health and lives at stake here. I'm still trying to work out whether we fundamentally disagree on whether the effect happens or not because your position keeps changing - on the one hand, you say it doesn't exist. Then you say it only affects the newly dxed and honeymooning. And then you say it's just infrequent and can't be relied to save people - the latter part being exactly my position all along. So at the risk of drawing more of your energy, what is it? I'm now pretty confused.

My thoughts (and these are purely my thoughts) that if the said 'dumping liver' worked well and indeed rose anyone up to 18 then this would happen day and night and there would be absolutely no need to treat hypos day or night. Makes sense doesn't it.

To an extent. My thoughts (and these are purely my thoughts) is that any liver dump is your body's inequivalent of the Alamo - after all else fails, this is the last gasp to try and resolve the situation and would only happen after the individual has lost consciousness. My feeling is it's similar to your body's response to hypothermia - just because your body can shut off vital parts of your body to retain temperature doesn't mean there's no need to keep warm!

 

[everydayupsanddowns]

Hi Adrienne

Lovely to hear from you 🙂 Sorry to hear that you are feeling a bit under the weather.

I think someone said CGM was overkill - mmmmm not my take it on it but each to their own. The nearest thing on the market to a fully working normal pancreas is, at this moment in time, the Medtronic VEO with fully integrated full time use of CGM with its low suspend. This low suspend function does save lives, there can be no argument on this. Where I have been obviously far too knackered to hear my alarm clock the low suspend has kicked in twice now for the full 2 hours and one of those times it suspended again for a further two hours so that my daughter's levels rose slowly out of a hypo. Phew. I thank my lucky stars that we live in the right postcode to get full time CGM.

I'm almost always a non-waker myself for nocturnal lows so I know just what you mean (not that I've had a full on night hypo for years). My interest in the discussion is partly fired by that. When I get an unusually high reading in the morning I know I need to evaluate whether it is post hypo or general rise. For me that means waking and testing. Of course I would not dream of blithely assuming my liver would 'fix' any hypo automatically (no one is suggesting that) but I am another person who has seen weirdly elevated levels in the hours/day after a lower low. Not always immediately by any means, not very predictably and sometimes not at all but if I'm having lots of highs, one of the first things I look to fix (if it exists) is an increase in hypos (even just mild ones in the mid 3's). More hypos tends to equal more highs for me - and not, I hasten to add, just because of overtreatment. Learning about the liver being prompted to release glucose to regulate BG levels (which happens in non-Ds too I believe) was a lightbulb moment for me. It explained a lit of seemingly bonkers BG chaos in my D experience up to that point.

As far as I can see from reading the thread, when Deus said he thought that CGM was 'overkill' it was more from a point of view that while CGM would of course offer additional detail, it was not necessarily the only way forward - and that to do *nothing* while waiting for a clinic to arrange a stint of CGM was not a good plan.

Personally I would LOVE access to a CGM, but as many times as I have requested it from my hospital, I have always been turned down. And self funding is not a viable option. I am pleased that you and Bev have access to the technology, but you do need to remember that for most of us any CGM at all let alone full time coverage is simply not going to happen. We can only look on with a few pangs of envy 😛

In that sense I think the suggestion to run a couple of overnight tests to rule out a hypo rebound was entirely sensible.

 

[DeusXM]

Deus said he thought that CGM was 'overkill' it was more from a point of view that while CGM would of course offer additional detail, it was not necessarily the only way forward - and that to do *nothing* while waiting for a clinic to arrange a stint of CGM was not a good plan.

Thanks Mike for putting it far better than I did!

Yes, I'd love a CGMS and the VEO system too...I just don't think it's essential for solving the OP's problem. Incidentally Grainger, how's your detective work going?

 

[bev]

Hi Adrienne

Lovely to hear from you Sorry to hear that you are feeling a bit under the weather.



I'm almost always a non-waker myself for nocturnal lows so I know just what you mean (not that I've had a full on night hypo for years). My interest in the discussion is partly fired by that. When I get an unusually high reading in the morning I know I need to evaluate whether it is post hypo or general rise. For me that means waking and testing. Of course I would not dream of blithely assuming my liver would 'fix' any hypo automatically (no one is suggesting that) but I am another person who has seen weirdly elevated levels in the hours/day after a lower low. Not always immediately by any means, not very predictably and sometimes not at all but if I'm having lots of highs, one of the first things I look to fix (if it exists) is an increase in hypos. More hypos tends to equal more highs for me - and not, I hasten to add, just because of overtreatment. Learning about the liver being prompted to release glucose to regulate BG levels (which happens in non-Ds too I believe) was a lightbulb moment for me. It explained a lit of seemingly bonkers BG chaos in my D experience up to that point.

As far as I can see from reading the thread, when Deus said he thought that CGM was 'overkill' it was more from a point of view that while CGM would of course offer additional detail, it was not necessarily the only way forward - and that to do *nothing* while waiting for a clinic to arrange a stint of CGM was not a good plan.

Personally I would LOVE access to a CGM, but as many times as I have requested it from my hospital, I have always been turned down. And self funding is not a viable option. I am pleased that you and Bev have access to the technology, but you do need to remember that for most of us any CGM at all let alone full time coverage is simply not going to happen. We can only look on with a few pangs of envy 😛

In that sense I think the suggestion to run a couple of overnight tests to rule out a hypo rebound was entirely sensible.

Hi EDUAD,

I have not said not to do any testing! In fact I suggested it as that is the only way to find out what is happening so not sure where the wires have got crossed.🙂 I did say a CGM would be helpful as a temporary measure and the OP should ask at next clinic but nowhere have I said not to test.

As far as CGM's is concerned - it really does give us so much more information than normal testing which is probably why both Adrienne and myself can see what is really happening - testing every couple of hours just isnt enough as you cant get the full picture so we speak from years of experience. I did pass a link to DeusXM but it has been dismissed as its too old. What I would say is that can someone show me a link that categorically proves that somoghyi does exist? Giving BG results isnt enough - seeing a graph or data that shows it would be helpful. I could show you thousands of graphs that show that Alex and hundreds of other children dont have the luxury of the liver dump and I dont rule it out completely because we have also been told by a top chap that it does happen just after diagnosis - but it does also start to fail after a year or so - sometimes longer it depends on the person - but I asked him point blank 'DUK tell me that my child wont die in the night because the liver will save him - can you confirm this happens'? His reply was 'the liver initially will play ball and kick out glucose - but after a while it gets a bit fed up of doing that because it was never geared up to do on an on-going basis so it will one day stop and for some people it never happens and for others it might be months or a couple of years at most but eventually it gets tired and just stops'.

I cant remember his name as this was over 4 years ago at a JDRF talk and he was guest speaker. I remember feeling devastated all over again because DUK had promised me that children dont die in their sleep at a DUK weekend - and they were talking nonsense.

I wish everyone had access to CGM - it really isnt fair - but the knowledge that parents like Adrienne and myself have gained should not be dismissed as we can see much more using CGM and have no reason to be making any of this up - clearly we would love our childrens livers to dump when needed - but they just dont - and not because they have bad control - it just simply doesnt happen for the reasons mentioned above. DeusXM - as I said earlier I think its best we agree to disagree and accept that we have different ways of managing this condition and what suits one person wont necessarily suit another - but we are all on the same side - diabetes is such a drain and I dont want to waste anymore time debating this issue as you clearly dont accept my view.🙂Bev

 

[Adrienne]

A very interesting thread and one that makes me want to learn more.

My education on this is about 30 years out of date so not a bad thing to find out what my liver may or may not do. I wonder if it has a minimal effect in us oldies, in that it squirts a little bit of glucose out to get us out of (or into) trouble sometimes.

One of the problems with getting hold of CGM is whether your support team actually have one to lend you. I tried and was met with a resounding no. They don't use them because they didn't find them reliable (I presume this meant they didn't know how to calibrate/interpret result).

Best thing as always is to test when there's a grey area and see what you find out. I've had some surprising results from late meals and delayed spikes that show in the mornings. It's one reason why i'm always cautious about dawn phenomenon. It does happen but sometimes it's just caused by what we eat the night before.🙂

Rob

Hiya Rob

I agree always test, its in theory the only thing we have (except CGM) to know what is going on. However even those meters can be 20% out, we've just changed to the One Touch Verio IQ which is fabulous so far and boasts to only ever (if ever) being a maximum of 15% out !

It does make me laugh when I hear about old school consultants (generally) who say catergorically that CGM doesn't work or isn't accurate enough. mmmm wish I could do a presentation to all these people. They don't know because they don't use them. Using one for a week when you have neither the experience nor wherewithal to read the reports (talking about consultants here by the way not you) is not going to give you any sort of indication.

It is soooo hard for an adult to get CGM at all, although I do know a few with full time funding for CGM and they wouldn't give it up for anything. Neither would any parent and this is because we all (collectively all, parents and adults) know it works and know how to use it and know that most of the time it is accurate. Who knows whether the CGM is right or the glucometer ! I mean if the glucometer is allowed (by law or whatever it is) to be up to 20% inaccurate, who says that the CGM reading is not closer to a true blood reading, food for thought eh ! I think an open mind by some of these consultants is needed.

I don't necessarily think it is adults that maybe the liver dumping process may or may not work for. It certainly doesn't work for many children (which their parents can see by using a CGM). For many once they are low, they stay low until user intervention. Its frightening stuff. When I say children I am talking up to about the age of 20 odd here as well.

Anyway who knows, as with everything diabetes it is not all clear cut. 🙂

 

[Adrienne]

Hi Adrienne

Lovely to hear from you 🙂 Sorry to hear that you are feeling a bit under the weather.



I'm almost always a non-waker myself for nocturnal lows so I know just what you mean (not that I've had a full on night hypo for years). My interest in the discussion is partly fired by that. When I get an unusually high reading in the morning I know I need to evaluate whether it is post hypo or general rise. For me that means waking and testing. Of course I would not dream of blithely assuming my liver would 'fix' any hypo automatically (no one is suggesting that) but I am another person who has seen weirdly elevated levels in the hours/day after a lower low. Not always immediately by any means, not very predictably and sometimes not at all but if I'm having lots of highs, one of the first things I look to fix (if it exists) is an increase in hypos (even just mild ones in the mid 3's). More hypos tends to equal more highs for me - and not, I hasten to add, just because of overtreatment. Learning about the liver being prompted to release glucose to regulate BG levels (which happens in non-Ds too I believe) was a lightbulb moment for me. It explained a lit of seemingly bonkers BG chaos in my D experience up to that point.

As far as I can see from reading the thread, when Deus said he thought that CGM was 'overkill' it was more from a point of view that while CGM would of course offer additional detail, it was not necessarily the only way forward - and that to do *nothing* while waiting for a clinic to arrange a stint of CGM was not a good plan.

Personally I would LOVE access to a CGM, but as many times as I have requested it from my hospital, I have always been turned down. And self funding is not a viable option. I am pleased that you and Bev have access to the technology, but you do need to remember that for most of us any CGM at all let alone full time coverage is simply not going to happen. We can only look on with a few pangs of envy 😛

In that sense I think the suggestion to run a couple of overnight tests to rule out a hypo rebound was entirely sensible.

Hiya

Absolutely I agree, test test test test always, even with CGM to be honest. I have no idea what the NICE guidance is on CGM for adults, I only know about kids and young adults as its the same and its they need to be offered the use of one for a week ish or so, or something like that.

Self funding if possible is a must as well in my view but only of course if you can afford it, it is not cheap. I do know some parents who go without other things (like a social life 🙂) to just buy a kit as they know it works. Hard if you are providing for a family.

In the absence of CGM then of course test test test, absolutely 100% agree. just don't agree that CGM and overkill can ever be put in the same sentence in regard to anything as it isn't, plain and simple, it is the best tool on the market but I absolutely appreciate that most cannot afford it and that it is a postcode lottery as tor funding for children let alone for adults. Nightmare really.

Right have to leave the computer now as I seem to have a house full of pre teens wanting to play the Wii so I am escaping upstairs with my bedroom door firmly shut whilst they have the run of downstairs, mistake ? Possibly

 

[Adrienne]

Thanks Mike for putting it far better than I did!

Yes, I'd love a CGMS and the VEO system too...I just don't think it's essential for solving the OP's problem. Incidentally Grainger, how's your detective work going?

I agree it is not essential or the only way as it is not possible to get it for many many people.

(it is not overkill though 🙂 and if someone does have it, it is absolutely the only way forward as it works).

For the original poster the only answer for now is the test and to test probably hourly for 3 nights if possible (or 2 hourly) to establish what is happening or even better if the original poster has an other half then to get them to test whilst asleep as that way you would know what is going on whilst asleep. Not sure how possible that would be though.

 

[AlisonF]

While randomised controlled trials are always the best evidence to work from, in the absence of an up to date one, I find anedotal experience a useful help in informing decisions.

Having used CGM for the past 6 years, I have seen no evidence at all of me experiencing the Somogyi effect either at night or during the day. That's not to say it categorically doesn't exist, but it certainly doesn't seem to for me.

 

[Adrienne]

Hi EDUAD,

hahahahaha this made me laugh to myself. Took me ages to work out that your name wasn't Eduad, thought it was unusual but that it was the initials of your Everydayupsanddowns. !!! What a numpty eh ! 😱

 

[Adrienne]

While randomised controlled trials are always the best evidence to work from, in the absence of an up to date one, I find anedotal experience a useful help in informing decisions.

Having used CGM for the past 6 years, I have seen no evidence at all of me experiencing the Somogyi effect either at night or during the day. That's not to say it categorically doesn't exist, but it certainly doesn't seem to for me.

Hiya Alison

Well my friend you were one of the adults I was of course talking about. Hope all ok with you x

 

[DeusXM]

I did pass a link to DeusXM but it has been dismissed as its too old. What I would say is that can someone show me a link that categorically proves that somoghyi does exist?

Well, it's not categorically proven to exist, but at the very least, it's not a closed case that it doesn't.

Endokrynol Pol. 2011;62(3):276-84.
The dawn phenomenon and the Somogyi effect - two phenomena of morning hyperglycaemia.
http://www.endokrynologia.polska.viamedica.pl/en/zamow_art_pdf.phtml?id=43&indeks_art=607

Research supporting the existence of the Somogyi effect includes the experiment carried out by Matyka et al. [42]. Their study involved two groups of 29 type 1 diabetic and non-diabetic children. The aim of the study was to determine the response of insulin-antagonistic hormones to hypoglycaemia. The results revealed a small increase of plasma GH and a rise of plasma epinephrine during nightly hypoglycaemia compared to a night without hypoglycaemia. The levels of norepinephrine, cortisol and glucagon were the same after a night with or without hypoglycaemia. Furthermore, the above
mentioned study found a significant increase in plasma insulin concentration between 11 p.m. and 3 a.m. among type 1 diabetic children, but not in non-diabetic children [42]. Perriello et al. [43] showed that fasting and post breakfast plasma glucose levels were significantly higher after nocturnal hypoglycaemia than when hypoglycaemia was prevented. Moreover, fasting levels of plasma glucose in their study correlated directly with overnight plasma levels of epinephrine, GH and cortisol. Bolli et al. [44] drew similar conclusions, and indicated that hypoglycaemia can cause rebound hyperglycaemia in the absence of insulin waning in patients with type 1 diabetes, and that this results primarily from an excessive increase in glucose production due to activation of glucose counterregulatory systems. In another study [45], the authors observed the presence of the relationship between the Somogyi effect and the exuberant counterregulatory release of GH caused by nocturnal hypoglycaemia among patients with type 1 diabetes.

The article then discusses the counterarguments to the Somogyi effect happening but concludes:

the existence of the Somogyi effect has not been definitively proven. However, science supposes it to exist, and it is supposed to be present in clinical practice among large number of patients with morning hyperglycaemia. With regard to the impact of the excessive dose of insulin on the Somogyi effect, it is highly probable that this phenomenon can occur not only among patients with type 1 diabetes, but also among patients with type 2 and secondary types of diabetes, provided patients have been intensively treated with insulin.

Another pretty comprehensive report (also from 2011) can be found at http://emedicine.medscape.com/article/125432-overview#a1

Although no data on frequency are available, Somogyi phenomenon is probably rare. It occurs in diabetes mellitus type 1 and is less common in diabetes mellitus type 2.

And here's where it gets really interesting for the OP.

Patients with Somogyi phenomenon present with morning hyperglycemia out of proportion to their usual glucose control. Nocturnal hypoglycemia is missed or asymptomatic, and posthypoglycemic hyperglycemia is not considered or is confused with the dawn phenomenon.

The most common cause of morning hyperglycemia is hypoinsulinemia. Patients have an increased need for insulin in the early morning primarily due to the release of growth hormone, which antagonizes insulin action. Cortisol may play a supporting role.

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.

So yes, not proof that the Somogyi effect definitely happens. But certainly evidence to suggest it shouldn't be discounted until further testing's been done.

His reply was 'the liver initially will play ball and kick out glucose - but after a while it gets a bit fed up of doing that because it was never geared up to do on an on-going basis so it will one day stop and for some people it never happens and for others it might be months or a couple of years at most but eventually it gets tired and just stops'.

I would politely suggest you've misunderstood his meaning. Think about it - if you go for years without ever having a liver dump to ward off nighttime hypoglycaemia, and then suddenly have a one-off, how could your liver possibly get 'fed up'? What this says to me is that the liver does in fact release glucose but that repeated undetected nighttime hypoglycaemia will eventually dull this response (presumably in much the same way that repeated hypos dull hypo awareness). In other words, this doctor was being absolutely responsible by reiterating to you that there is no substitute for good glucose control and nighttime hypo prevention - which is precisely what I said earlier!

 

[bev]

Well, it's not categorically proven to exist, but at the very least, it's not a closed case that it doesn't.

Endokrynol Pol. 2011;62(3):276-84.
The dawn phenomenon and the Somogyi effect - two phenomena of morning hyperglycaemia.
http://www.endokrynologia.polska.viamedica.pl/en/zamow_art_pdf.phtml?id=43&indeks_art=607



The article then discusses the counterarguments to the Somogyi effect happening but concludes:



Another pretty comprehensive report (also from 2011) can be found at http://emedicine.medscape.com/article/125432-overview#a1



And here's where it gets really interesting for the OP.



So yes, not proof that the Somogyi effect definitely happens. But certainly evidence to suggest it shouldn't be discounted until further testing's been done.



I would politely suggest you've misunderstood his meaning. Think about it - if you go for years without ever having a liver dump to ward off nighttime hypoglycaemia, and then suddenly have a one-off, how could your liver possibly get 'fed up'? What this says to me is that the liver does in fact release glucose but that repeated undetected nighttime hypoglycaemia will eventually dull this response (presumably in much the same way that repeated hypos dull hypo awareness). In other words, this doctor was being absolutely responsible by reiterating to you that there is no substitute for good glucose control and nighttime hypo prevention - which is precisely what I said earlier!

Hi DeusXM,

I would politely reply that I did not misunderstand the meaning!😱 You seem hell-bent on believing what you have been told by the Medical Profession for years so not sure why you want me to 'prove' differently! Fair enough - your the one who knows your diabetes best - as do parents who do all the night-testing - but please dont assume that our experience is not of any value simply because you dont believe it. I would also add that us parents do attend the latest conferences from JDRF and others (FFL) and are up to date with the latest theories - as do our Medical teams who also (in our case) one of the main speakers due to their high standing in the diabetes community. Like I have said before - lets agree to disagree - you wont convince me that somorghyi exists and I wont convince you that it doesnt - check mate - he he!🙂Bev

 

[DeusXM]

You seem hell-bent on believing what you have been told by the Medical Profession for years so not sure why you want me to 'prove' differently! Fair enough - your the one who knows your diabetes best - as do parents who do all the night-testing - but please dont assume that our experience is not of any value simply because you dont believe it.

I'm not hellbent on anything apart from keeping options open. My position has always been the same - the Somogyi effect may exist, and if it does, doesn't necessarily happen in everyone. I'm basing this on the research I've found and my own personal experiences of actually having it happen to me, and indeed, anecdotal evidence from other adults with diabetes.

You are welcome not to believe in the Somogyi effect, but given it is theorised as a cause of morning hyperglycaemia, do you not agree that the OP should at least do the testing to rule it out rather than just assume it couldn't possibly be a factor?

You're arguing that the Somogyi effect NEVER happens - despite the fact it HAS happened to me! It's not ME assuming another person's experience isn't of value. I'm certainly not telling you that your child or anyone else's has had the Somogyi effect happen to them, but you do seem to be telling me that something that happened to me, didn't happen, because it hasn't happened to anyone you know. Is my experience not of value then because you don't believe it?

 

[Northerner]

Difference of opinion and experience noted people, lets not make this a circular argument 😉

 

[Robster65]

Getting back on topic, would be interestign to know from Grainger what her BGs have been before bed, what time she ate and any overnight and mornign BGs since the thread started.🙂

(get well soon Adrienne!)

Rob

 

[Josco]

Original poster

Ah. Thank you. Thinks make much more sense now 😱