Chronic Somogyi rebound

From WikiMD
Jump to navigation Jump to search
File:Somogyi rebound.GIF
The rebounding blood sugar following undetected diabetic hypoglycemia can easily become chronic when the high morning blood sugar data is misjudged to be due to insufficient nighttime insulin delivery.

Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar.[1] When managing the blood glucose level with insulin injections, this effect is counter-intuitive to insulin users who experience high blood sugar in the morning as a result of an overabundance of insulin at night.

This theoretical phenomenon was named after Dr. Michael Somogyi, a Hungarian-born professor of biochemistry at the Washington University and Jewish Hospital of St. Louis, who prepared the first insulin treatment given to a child with diabetes in the USA in October 1922.[2] Somogyi showed that excessive insulin makes diabetes unstable and first published his findings in 1938.[3]

Compare with the dawn phenomenon, which is a morning rise in blood sugar in response to waning insulin and a growth hormone surge (that further antagonizes insulin).

Background

A person with type 1 diabetes should balance insulin delivery to manage their blood glucose level. Occasionally, insufficient insulin can result in hyperglycemia. The appropriate response is to take a correction dose of insulin to reduce the blood sugar level and to consider adjusting the insulin regimen to deliver additional insulin in the future to prevent hyperglycemia. Conversely, excessive insulin delivery may result in hypoglycemia. The appropriate response is to treat the hypoglycemia and to consider adjusting the regimen to reduce insulin in the future.

Somogyi and others[4] have claimed that if prolonged hypoglycemia is untreated, then stress due to low blood sugar can result in a high blood glucose rebound. The physiological mechanisms driving the rebound are defensive. When the blood glucose level falls below normal, the body responds by releasing the endocrine hormone glucagon as well as the stress hormones epinephrine, cortisol and growth hormone. Glucagon facilitates release of glucose from the liver that raises the blood glucose immediately, and the stress hormones cause insulin resistance for several hours, sustaining the elevated blood sugar.

Detection

The first line of defense in preventing chronic Somogyi rebound is additional blood glucose testing. Continuous blood glucose monitoring is the preferred method to detect and prevent the Somogyi rebound, but this technology is not yet widely used. Alternatively, testing blood sugar more often, 8 to 10 times daily with a traditional blood glucose meter, facilitates detecting the low blood sugar level before such a rebound occurs.

Testing occasionally during the middle of the night is also important, particularly when high waking blood sugars are found, to determine if more insulin is needed to prevent hyperglycemia or if less insulin is needed to prevent such a rebound.

Sometimes a person with diabetes will experience the Somogyi rebound when awake and notice symptoms of the initial low blood sugar or symptoms of the rebound. At night, waking with a night sweat (perhaps combined with a rapid heart rate) is a symptom of the adrenaline and rebound. Unfortunately, the evidence shows that patients with type 1 diabetes do not normally wake during nocturnal hypoglycemic episodes [1].

While reviewing log data of blood glucose after the fact, signs of Somogyi rebound should be suspected when blood glucose numbers seem higher after the insulin dosage has been raised, particularly in the morning.

Avoidance

In theory, avoidance is simply a matter of preventing hyperinsulinism. In practice, the difficulty for a diabetic person to aggressively dose insulin to keep blood sugars levels close to normal and at the same time constantly adjust the insulin regimen to the dynamic demands of exercise, stress, and wellness can practically assure occasional hyperinsulinism. The pharmacokinetic imperfections of all insulin replacement regimens is a severe limitation.

Some practical behaviors which are useful in avoiding chronic Somogyi rebound are:

  • frequent blood glucose monitoring (8–10 times daily);
  • continuous blood glucose monitoring;
  • logging and review of blood glucose values, searching for patterns of low blood sugar values;
  • conservative increases in insulin delivery;
  • awareness to the signs of hypoglycemia;
  • awareness to hyperglycemia in response to increased delivery of insulin;
  • use of appropriate types of insulin (long-acting, short-acting, etc.) in appropriate amounts.

Controversy

Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Studies from 2007 onwards using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night don't wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.

See also

References

  1. http://www.ucdenver.edu/academics/colleges/medicalschool/centers/BarbaraDavis/Documents/book-understandingdiabetes/ud06.pdf, Understanding Diabetes a.k.a. The Pink Panther Book by H. Peter Chase, chapter 6 page 47.
  2. Michael Somogyi (www.whonamedit.com)

  3. (As of 2011-05-28, the electronic text is not open access).
  4. Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.2337/diabetes.37.12.1608, please use {{cite journal}} with |doi=10.2337/diabetes.37.12.1608 instead.
  5. Gale, EA, Kurtz, AB, Tattersall, RB. In search of the Somogyi effect. Lancet 2:279-282, 1980, PMID 6105438
  6. Guillod, L., Comte-Perret, S., Monbaron, D., Gaillard, R. C., Ruiz, J. Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring? Diabetes Metab, 2007: 33: 360-365, PMID 17652003
  7. Matyka, KA, Crowne, EC, Havel, PJ, Macdonald, IA, Matthews, D, Dunger, DB. Counterregulation during spontaneous nocturnal hypoglycemia in prepubertal children with type 1 diabetes. Diabetes Care 22:1144-1150, 1999, PMID 10388980

Michael Cooperman, MD; Chief Editor: George T Griffing, MD. Somogyi Phenomenon. Medscape Dec 15, 2011.


WikiMD Resources for Chronic Somogyi rebound

Articles

Most recent articles

Most cited

Review articles

Articles on Chronic Somogyi rebound in N Eng J Med, Lancet, BMJ

Media Chronic Somogyi rebound

Powerpoint slides

Podcasts and MP3's

Videos

Evidence Based Medicine

Cochrane Collaboration

Clinical Trials

Ongoing Trials on Chronic Somogyi rebound

Trial results on Chronic Somogyi rebound

Clinical Trials on Chronic Somogyi rebound at Google

Books and news

Books on Chronic Somogyi rebound

Chronic Somogyi rebound in the news

Commentary Chronic Somogyi rebound

Blogs on Chronic Somogyi rebound

Patient Resources / Community

Patient resources

Discussion groups

Patient Handouts

Other resources

Social Media

Reddit
Quora.png
Pins
Instagram
YouTube videos
Flickr
Bing.png

W8MD Weight Loss, Sleep & MedSpa

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U |V | W | X | Y | Z



W8md2.jpg

World's largest food, health, weight loss, wellnesspedia and encyclopedia

If you are a medical professional or an expert in any field of medicine, please join us in building the world's largest weight loss and wellness encyclopedia created by experts in the field, not by the crowd. WikiMD is sponsored by W8MD weight loss, sleep and medical aesthetic centers


W8MD Weight Loss, Sleep & Medical Aesthetic Centers

Since its inception in 2011, W8MD’s insurance physician weight loss program has successfully helped thousands of patients succeed in not only losing weight but also keep it off with an ongoing maintenance plan.

FANTASTIC PROGRAM. TRULY A LIFE CHANGER. D.M. LOST 100 LBS^^

weight loss success stories

^^Individual results may vary.

Weight-loss.jpg

W8MD weight loss, sleep and medical spa blogs


Support our sponsors

W8MD weight loss, sleep and medspa centers sponsors WikiMD.

W8MD's Locations for losing weight, sleeping better and looking your best

Philadelphia

weight loss Philadelphia | Sleep center Philadelphia

King of Prussia

Lose weight King of Prussia | sleep doctor King of Prussia

New York

Weight loss NYC | Fast weight loss NYC | Lose weight NYC | Sleep apnea NYC

New Jersey

New Jersey Weight Loss, Sleep and Medical Spa Cherry Hill NJ

Other W8MD blogs

Lorcaserin weight loss | Qsymia weight loss | Phentermine weight loss | Weight loss blog | Free weight loss | Saxenda weight loss | Contrave weight loss


This article is a stub. YOU can help Wikimd by expanding it!

WikiMD is a free medical encyclopedia and wellnesspedia moderated by medical professionals.

Diet | Weight loss | Obesity | Metabolic syndrome | Glossary of dietary supplements

Places for Chronic Somogyi rebound

  • W8MD’s insurance weight loss programs one of the best ways to lose weight fast in NYC, King Of Prussia, Philadelphia, New Jersey and other places.

W8mdlogo.png
Tired of being overweight? W8MD can help


W8MD Weight Loss, Sleep & Aesthetic Services

Pennsylvania

Call 215-676-2334

New York

2632 E 21st Street Ste L2 Brooklyn New York 11235.

Call 718-946-5500

New Jersey

  • W8MD Weight Loss, Sleep & MedSpa in Cherry Hill, NJ at 140 E. Evesham Road, Cherry Hill, NJ 08003.

Call 800-W8MD-007

W8MD weight loss | Philadelphia medical weight loss | NYC medical weight loss


W8MD's insurance weight loss program

W8MD can help?

W8md-short.jpg

W8MD’s insurance medical weight loss program is one of the best ways to lose weight fast in NYC, King Of Prussia, Philadelphia, New Jersey and other places.

  • Our weight loss program is based on clinically proven measures to help you lose weight.
  • Our experienced weight loss doctors understand the complex causes of weight gain.
  • We use the best tools to help burn fat fast and effectively unlike many fad diets that make you lose weight by losing muscle.
  • We offer delicious, low cost and affordable weight loss supplements or meal replacements to help reduce caloric intake and burn fat.
  • We offer FDA approved weight loss medications or diet pills to help control hunger, reduce cravings and burn unhealthy fat.

Prab R. Tumpati, MD Founder, WikiMD & W8MD

Dr Tumpati is a board certified physician with significant practice experience in managing sleep disorders, internal medicine, aesthetic and obesity medicine. As one of the few physicians that have the privilege of a fellowship training in Obesity Medicine, Dr Tumpati is very passionate about educating the public and physicians about how some of the nutritional concepts were misunderstood. As the founder of W8MD Weight Loss, Sleep and MedSpa centers, Dr Tumpati is the medical director for the New York, New Jersey and Pennsylvania locations and commutes weekly between the locations.

Popular weight loss searches

Ad. Tired of being overweight? W8MD's insurance weight loss* program can HELP | Advertise on WikiMD

Disclaimer: The entire contents of WIKIMD.ORG are for informational purposes only and do not render medical advice or professional services. If you have a medical emergency, you should CALL 911 immediately! Given the nature of the wiki, the information provided may not be accurate and or incorrect. Use the information on this wiki at your own risk! See full Disclaimer. * Individual results may vary.