Is this the Somogyi effect?

[CBeresford]

If so should I be trying to do something about it? Prediabetic wearing a libre 2 for a month to discover more about my reactions to certain foods, also trying discover why my blood glucose is consistently high in the morning but normal at other times. Healthy weight 8 st 7 lb and physically active.

 

[Inka]

I’d say it was more likely a compression low @CBeresford That is, you lay on the sensor, causing it to give a falsely low reading.

 

[CBeresford]

Ok good point, I will see how subsequent nights pan out. I do wake during the night with night sweats but have always put that down to the menopause.

 

[Amity Island]

Ok good point, I will see how subsequent nights pan out. I do wake during the night with night sweats but have always put that down to the menopause.

When you fit the sensor under arm, if you apply it slightly towards the body rather than outward away from the body, the compressions on the sensor are less likely to occur.

 

[Robin]

I think the term Somogyi effect is usually used with reference to people on insulin who have an episode of low blood glucose caused by too much insulin on board, causing a rebound high in a morning, I think the effect is seen through out the night, not sone quick dip and bounce back, so as @Inka suggests, I think this is more likely to be a compression dip.
Your general overnight trend seems to show a normal pattern of a bit of a fall towards 4am as the body winds down, and a bit of a rise in the morning as it revs up for the day.

 

[Proud to be erratic]

On my DAFNE course last November, the lead DSN observed that the Somogyi effect was felt to be a "flawed" phenomenon, based on poor evidence and not supported by peer review. But, whether it is real or not, it is normally attributed to explaining highs, or rebounds during the night and not lows.

 

[CBeresford]

I think the term Somogyi effect is usually used with reference to people on insulin who have an episode of low blood glucose caused by too much insulin on board, causing a rebound high in a morning, I think the effect is seen through out the night, not sone quick dip and bounce back, so as @Inka suggests, I think this is more likely to be a compression dip.

Thank you, it would be good if the sensor could be located on the inside side of the arm. I can see how compression could occur on the underarm, where mine is located. I think I will scan every time I wake (which is quite often) and if I see a low reading I could follow up with a finger prick. But you are probably right, the level sorts itself out really quickly, without me doing anything at all.

 

[Dragonheart]

You seem concerned about hypos. If so be reassured a non medicated pre diabetic is no more likely to have a hypo than any other person diabetic or not.

Quick 101 on hypos. Hypos are usually caused by certain medications (like insulin and glicliazide for example) overriding the bodies natural mechanism to dump glucose from the liver if levels are dropping a little too low. Eg when fasting or intense exercise. - And that’s why you see a rise in the mornings after sleeping all night along with circadian hormones giving you a shot of energy to get up and going and is labelled dawn phenomenon in that situation.

Real hypos can be caused by a few other fairly rare medical conditions but generally shouldn’t be a concern for many at all outside of those on hypoglycaemic diabetes medications.

False hypos can happen if you are accustomed to very high levels and quickly work to bring them back to normal within a short space of time (days/few weeks). The actual level isn’t hypo but it feels it because the body senses it’s much lower than it’s currently used to be at. They stop happening once your body recognises the new (healthier) normal and don’t really need treating other than a tiny nudge if you feel particularly bad, at risk of a fall, or need to feel safe for driving/machinery use. Just don’t over do it and go back to square one undoing the good work. Again as a prediabetic not full blown also less likely to apply to you as you probably don’t go that high in the first place let alone be consistently there and the libre chart above tends to confirm this.

 

[CBeresford]

You seem concerned about hypos. If so be reassured a non medicated pre diabetic is no more likely to have a hypo than any other person diabetic or not.

Quick 101 on hypos. Hypos are usually caused by certain medications (like insulin and glicliazide for example) overriding the bodies natural mechanism to dump glucose from the liver if levels are dropping a little too low. Eg when fasting or intense exercise. - And that’s why you see a rise in the mornings after sleeping all night along with circadian hormones giving you a shot of energy to get up and going and is labelled dawn phenomenon in that situation.

Real hypos can be caused by a few other fairly rare medical conditions but generally shouldn’t be a concern for many at all outside of those on hypoglycaemic diabetes medications.

False hypos can happen if you are accustomed to very high levels and quickly work to bring them back to normal within a short space of time (days/few weeks). The actual level isn’t hypo but it feels it because the body senses it’s much lower than it’s currently used to be at. They stop happening once your body recognises the new (healthier) normal and don’t really need treating other than a tiny nudge if you feel particularly bad, at risk of a fall, or need to feel safe for driving/machinery use. Just don’t over do it and go back to square one undoing the good work. Again as a prediabetic not full blown also less likely to apply to you as you probably don’t go that high in the first place let alone be consistently there and the libre chart above tends to confirm this.

I am not particularly concerned as my levels rise again very quickly without me eating anything. I have noticed it also happens after exercise my levels will drop below 4 but then go up again really quickly. My levels are all normal accept my fasting levels which are pretty well always in the prediabetic, occasionally diabetic range. Usually higher than my post prandial levels, which I understand is likely to be dawn phenomenon, I was just confused by the low reading at about 0330 this morning. Some people recommend eating something small before bed, and that can help reduce high fasting levels. It may seem a bit OTT to people with full blown diabetes but I would like to get my levels in the normal range at all times. I have a history of pcos and insulin resistance. I wore libre 2 for two weeks about a month ago and averaged 5.2 which is perfectly normal, but my HBA1c was 44 at the end of March on the same diet. I have just had a repeat test done and am awaiting the result.

 

[helli]

it would be good if the sensor could be located on the inside side of the arm.

It can be.
I tend to wear mine high up my arm and as far back as I can reached without putting it in my arm pit. I do not experience compression lows.
And it can't be seen when I wear short sleeves.

 

[CBeresford]

Great idea, I tried one high up on the outer side but hit a capillary so that was no use. Just below armpit sounds good.

 

[harbottle]

I am not particularly concerned as my levels rise again very quickly without me eating anything. I have noticed it also happens after exercise my levels will drop below 4 but then go up again really quickly. My levels are all normal accept my fasting levels which are pretty well always in the prediabetic, occasionally diabetic range. Usually higher than my post prandial levels, which I understand is likely to be dawn phenomenon, I was just confused by the low reading at about 0330 this morning. Some people recommend eating something small before bed, and that can help reduce high fasting levels. It may seem a bit OTT to people with full blown diabetes but I would like to get my levels in the normal range at all times. I have a history of pcos and insulin resistance. I wore libre 2 for two weeks about a month ago and averaged 5.2 which is perfectly normal, but my HBA1c was 44 at the end of March on the same diet. I have just had a repeat test done and am awaiting the result.

Best thing is to try some exercise when you wake - like lifting some weights or something. The hormones make the body less sensitive to insulin and cause a rise in glucose in the early hours, so I'm not sure why eating something before would help. If there's already insulin resistance and/or beta cell dysfunction, the body struggles to deal with it.

Although the graph you posted above doesn't show much of a problem.

 

[Dragonheart]

I am not particularly concerned as my levels rise again very quickly without me eating anything. I have noticed it also happens after exercise my levels will drop below 4 but then go up again really quickly. My levels are all normal accept my fasting levels which are pretty well always in the prediabetic, occasionally diabetic range. Usually higher than my post prandial levels, which I understand is likely to be dawn phenomenon, I was just confused by the low reading at about 0330 this morning. Some people recommend eating something small before bed, and that can help reduce high fasting levels. It may seem a bit OTT to people with full blown diabetes but I would like to get my levels in the normal range at all times. I have a history of pcos and insulin resistance. I wore libre 2 for two weeks about a month ago and averaged 5.2 which is perfectly normal, but my HBA1c was 44 at the end of March on the same diet. I have just had a repeat test done and am awaiting the result.

Not at all over the top to want to resolve a small issue rather than wait for a big one.

I’ve often read about having something small the night before. Presumably this is to make your overnight fast shorter and quite possibly start the night higher so you end up less low and in need of less “extra” from the liver in the morning.

The problem is see with that is that all you are doing is moving the “high” from morning to the night before. And I’d rather use the excess glucose stored in my liver (the nature of type 2 and prediabetes) and have all day to use it up than eat yet more glucose and have it sit there all night.

What I have seen work for a lot of type 2 (and those at risk of getting there) is to eat a small non carb item (egg, cheese, bullet proof coffee etc) first thing. It seems to signal the liver that you are up and don’t need it’s help any more, so it stops dumping thus cutting off the rise and allowing it to fall again.

If the rest of your day is now good (is that as a result of changes made?) then I suspect you will be seeing a better hba1c next time. Many full blown T2 get a normal non prediabetic reading even if their morning is a little high so long as the rest of the day is good. Remember even metabolically totally normal people do see a small and short rise in the mornings often so it might not disappear entirely. Also if you are eating low carb now then physiological insulin resistance aka adaptive glucose sparing is a thing and it’s not pathological like normal IR is. It disappears if you carb up.

 

[Proud to be erratic]

I’ve often read about having something small the night before. Presumably this is to make your overnight fast shorter and quite possibly start the night higher so you end up less low and in need of less “extra” from the liver in the morning.

Almost by accident I stumbled into a simple regime of eating a small "no/very low carb" snack as I go to bed and as soon as I wake up. This started with feeling slightly peckish at bedtime, yet not wanting the faff of taking a tiny bolus. Then after an accidental few days of doing this I noticed my libre graph was very steady.

I'd already been considering having a no carb snack on waking to disrupt the dawn phenomena or foot on the floor effects. I frequently need to make a bathroom trip in the small hours. So as well as the small snack downstairs just before bed I started having something upstairs in readiness, such as a few nuts, a knob of cheese or a little meat. Since this latter, early, snacking the DP or FOTF has not happened for well over a month.

 

[CBeresford]

Not at all over the top to want to resolve a small issue rather than wait for a big one.

I’ve often read about having something small the night before. Presumably this is to make your overnight fast shorter and quite possibly start the night higher so you end up less low and in need of less “extra” from the liver in the morning.

The problem is see with that is that all you are doing is moving the “high” from morning to the night before. And I’d rather use the excess glucose stored in my liver (the nature of type 2 and prediabetes) and have all day to use it up than eat yet more glucose and have it sit there all night.

What I have seen work for a lot of type 2 (and those at risk of getting there) is to eat a small non carb item (egg, cheese, bullet proof coffee etc) first thing. It seems to signal the liver that you are up and don’t need it’s help any more, so it stops dumping thus cutting off the rise and allowing it to fall again.

If the rest of your day is now good (is that as a result of changes made?) then I suspect you will be seeing a better hba1c next time. Many full blown T2 get a normal non prediabetic reading even if their morning is a little high so long as the rest of the day is good. Remember even metabolically totally normal people do see a small and short rise in the mornings often so it might not disappear entirely. Also if you are eating low carb now then physiological insulin resistance aka adaptive glucose sparing is a thing and it’s not pathological like normal IR is. It disappears if you carb up.

Interesting point, I am not naturally someone who snacks so wasn’t so keen on the eating something before bed approach. I have been low carb but I am beginning to increase my carbs, I am at target weight 8 st 7 lb but have been concerned that I still have belly fat whilst muscles seem to be depleted (I am 63 so muscle wastage is a concern), I bought a smart body composition scale and true enough my fat levels are high and skeletal muscle low despite having a healthy BMI. End result I plan to eat more protein and more carbs, I am doing the healthier you online course and it has highlighted by carb intake as too low.

 

[CBeresford]

Almost by accident I stumbled into a simple regime of eating a small "no/very low carb" snack as I go to bed and as soon as I wake up. This started with feeling slightly peckish at bedtime, yet not wanting the faff of taking a tiny bolus. Then after an accidental few days of doing this I noticed my libre graph was very steady.

I'd already been considering having a no carb snack on waking to disrupt the dawn phenomena or foot on the floor effects. I frequently need to make a bathroom trip in the small hours. So as well as the small snack downstairs just before bed I started having something upstairs in readiness, such as a few nuts, a knob of cheese or a little meat. Since this latter, early, snacking the DP or FOTF has not happened for well over a month.

I haven’t generally been someone who snacks but it might be worth trying, maybe just a baby bell or something when I wake.

 

[harbottle]

Not at all over the top to want to resolve a small issue rather than wait for a big one.

I’ve often read about having something small the night before. Presumably this is to make your overnight fast shorter and quite possibly start the night higher so you end up less low and in need of less “extra” from the liver in the morning.

The problem is see with that is that all you are doing is moving the “high” from morning to the night before. And I’d rather use the excess glucose stored in my liver (the nature of type 2 and prediabetes) and have all day to use it up than eat yet more glucose and have it sit there all night.

What I have seen work for a lot of type 2 (and those at risk of getting there) is to eat a small non carb item (egg, cheese, bullet proof coffee etc) first thing. It seems to signal the liver that you are up and don’t need it’s help any more, so it stops dumping thus cutting off the rise and allowing it to fall again.

If the rest of your day is now good (is that as a result of changes made?) then I suspect you will be seeing a better hba1c next time. Many full blown T2 get a normal non prediabetic reading even if their morning is a little high so long as the rest of the day is good. Remember even metabolically totally normal people do see a small and short rise in the mornings often so it might not disappear entirely. Also if you are eating low carb now then physiological insulin resistance aka adaptive glucose sparing is a thing and it’s not pathological like normal IR is. It disappears if you carb up.

T2 don't have 'excess' glucose stores, not that there is such a thing, probably actually smaller stores due to the fact insulin isn't working as well or there may not be much of it being release by a broken pancreas. The glucose created in the liver in T2s has been identified as being mainly from gluconeogenesis. Even when sleeping glucose basal levels are maintained using a mix of both mechanisms, moving towards gluconeogenesis as stores run out during long fasts.

The problem is that the signalling pathway to stop glucose production doesn't work due to liver's insulin resistance and this leads to rising levels that can last for a long period of time. DP occurs when growth hormones are making tissues insulin resistant as well.

The OPs libre graph doesn't look particularly bad - the T2s I know have morning figures way above 8 due to DP and no amount of metformin, glic or flozins stop it for them - exercise is probably the best bet.

 

[CBeresford]

T2 don't have 'excess' glucose stores, not that there is such a thing, probably actually smaller stores due to the fact insulin isn't working as well or there may not be much of it being release by a broken pancreas. The glucose created in the liver in T2s has been identified as being mainly from gluconeogenesis. Even when sleeping glucose basal levels are maintained using a mix of both mechanisms, moving towards gluconeogenesis as stores run out during long fasts.

The problem is that the signalling pathway to stop glucose production doesn't work due to liver's insulin resistance and this leads to rising levels that can last for a long period of time. DP occurs when growth hormones are making tissues insulin resistant as well.

The OPs libre graph doesn't look particularly bad - the T2s I know have morning figures way above 8 due to DP and no amount of metformin, glic or flozins stop it for them - exercise is probably the best bet.

It shows how opposite approaches may have the same effect, sometimes eating something may stop the liver dump, conversely not eating anything and exercising may simply use up the excess blood glucose. I just noticed my post lunch levels were rising quite fast (I had a cheese and pickle sandwich on whole meal warburtons reduced sugar), so I ran up and down the stairs a couple of times and it dropped from 8.2 to 4.4 within about 15 minutes.

 

[Dragonheart]

Interesting point, I am not naturally someone who snacks so wasn’t so keen on the eating something before bed approach. I have been low carb but I am beginning to increase my carbs, I am at target weight 8 st 7 lb but have been concerned that I still have belly fat whilst muscles seem to be depleted (I am 63 so muscle wastage is a concern), I bought a smart body composition scale and true enough my fat levels are high and skeletal muscle low despite having a healthy BMI. End result I plan to eat more protein and more carbs, I am doing the healthier you online course and it has highlighted by carb intake as too low.

Protein and weight bearing exercise is the key to retaining muscle, not carbs. Most low carbers increase proteins and or fats rather than carbs once they reach target weight. BMI has some serious flaws as a sole judge. If you still have belly fat/high body fat how confident are you that you are the right weight now? How does height to waist stack up?

There is no such thing as carbs too low. Whilst almost all of us choose to incorporate some carbs of some type in varying amounts we can survive just fine without them. Any standard nhs eatwell based course, as yours is, will advocate nearly 40% starchy carbs and then there’s any more that come from fruit veg beans and pulses so in all likelihood it’s well over 50% in total. Conversely the nhs in some areas also funds the low carb program which advocates considerably less than eatwell as do various other nhs organisations and practice. Which boils down to; eat what works for you to maintain you blood glucose and weight and sanity rather than an arbitrary number that your body doesn’t recognise

 

[everydayupsanddowns]

On my DAFNE course last November, the lead DSN observed that the Somogyi effect was felt to be a "flawed" phenomenon, based on poor evidence and not supported by peer review. But, whether it is real or not, it is normally attributed to explaining highs, or rebounds during the night and not lows.

This is interesting - and I’ve heard clinicians saying that they don’t really see much evidence of Somogyi in their practice now that CGM is more widely available.

But liver dumps do seem to still be a thing?

A worldwide hypo-specialist professor I saw giving a talk at a conference mentioned that some years after a T1 diagnosis the hormonal response to overnight hypoglycaemia becomes measurably diminished - presumably, I suppose, meaning that something akin to Somogyi might occur early on… but perhaps not for long?