Many people with diabetes use insulin therapy to help manage their condition. Insulin lowers blood sugar levels, to combat their rise when eating. Occasionally, those with diabetes may notice that their blood sugar levels are irregularly high in the morning. This usually occurs after a person uses insulin before they fall asleep the previous night. The medical community refers to this phenomenon as the Somogyi effect or the chronic Somogyi rebound. Though the theories behind the Somogyi effect are popular, they lack scientific backing and have faced much controversy.
The Somogyi effect originates from the research of a Hungarian-born scientist, Michael Somogyi. He was a prominent professor of biochemistry at Washington University and later worked as the first chemist in the Jewish Hospital of St. Louis. In 1922, he became the first person to prepare insulin treatment for a child with diabetes. Much of Somogyi’s research focused on patients with diabetes and the effects of insulin. In 1938, he presented his research detailing the Somogyi effect.
Somogyi believed insulin therapy itself might play a role in causing unstable diabetes. Normally, a person with diabetes uses insulin in response to high blood sugar levels or hyperglycemia. However, excessive insulin may result in dangerously low blood sugar levels or hypoglycemia. Somogyi believed that hypoglycemia without treatment could cause a rebound in blood sugar levels. Essentially, taking too much insulin at night would cause hypoglycemia while a person sleeps. In response, the body releases hormones such as glucagon, epinephrine, cortisol, and growth hormone. Glucagon causes the liver to release glucose, leading to high blood sugar levels while the other hormones create resistance to insulin.
The symptoms of the Somogyi effect typically mirror those of hyperglycemia, as the Somogyi effect merely attempts to explain why a person’s blood sugar levels might increase upon waking. A person with hyperglycemia may urinate frequently, or experience increased thirst, blurred vision, headaches, or fatigue. The Somogyi effect may also lead to night sweats as hormones such as epinephrine trigger the body’s fight-or-flight response. Typically, individuals with diabetes will not notice the Somogyi effect itself, but a blood sugar monitor will identify the increased blood sugar levels.
It is fairly easy for a person to detect the Somogyi effect. Those with diabetes who wake up with high blood sugar should begin to monitor their blood sugar levels frequently. They can do this by using a continuous glucose monitor, or they can opt to test around ten times a day with a traditional blood glucose meter. People who suspect the Somogyi effect should perform occasional glucose monitoring at night to notice drops in blood sugar levels and help them prevent the Somogyi rebound from occurring.
The Somogyi effect is interesting in that it doesn’t necessarily require any form of treatment. Singular instances of the effect may only require consumption of a light snack when taking insulin before sleep. Typically, treating hypoglycemia requires only 15 to 20 grams of a fast-acting carbohydrate such as fruit juice. However, if the Somogyi effect becomes a chronic condition, it is necessary to consult a physician and provide them with a full account of symptoms, issues, and how frequently the effect is occurring.
When attempting to diagnose the Somogyi effect, doctors will typically ask questions to determine how frequent the blood sugar level fluctuations are and what comprises a typical nightly routine for their patient. Physicians may advise their patients to adjust their insulin treatments and take less insulin at night. Alternatively, they may opt to change what type of insulin their patient is using. If the patient is not already using one, some doctors may advocate for a continuous glucose monitor.
Physicians can also determine if a patient is experiencing the Somogyi effect or a similar condition such as the dawn phenomenon. Like the Somogyi effect, the dawn phenomenon features a rise in blood sugar levels after a person wakes up. However, the latter occurs at different times and includes a dramatic increase in growth hormones. If blood sugar levels are low at 3 a.m., it is likely to be the Somogyi effect. If the levels are normal or high, it is a sign of the dawn phenomenon.
Many people find it simple to avoid the Somogyi effect. A person can follow basic steps to prevent the condition:
Despite its popularity within the medical community, the Somogyi effect has been the subject of a significant amount of controversy because there is little scientific evidence to confirm the research. One study found that morning hyperglycemia is more likely to be the result of not enough insulin rather than an excess. Additionally, a 2007 study found that people with type 1 diabetes often experience hyperglycemia in the morning with no signs of hypoglycemia during the night.
Typically, the Somogyi effect will not interfere with a person’s life as long as they pursue medical attention if the condition becomes chronic. Without treatment, hyperglycemia can lead to serious symptoms such as weakness, confusion, and comas. Frequent hypoglycemia in people with diabetes can also have dangerous effects. Muscle weakness and difficulty speaking are common in people with long-term hypoglycemia, as are seizures and convulsions. In extreme cases, the condition can lead to death.
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