#Somoji_Effect #Down_phenomenon
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Dawn Phenomenon & the Somogyi Effect
In the 1930s, Dr. Michael Somogyi described for the first time that insulin-induced hypoglycemia during the night triggers a counterregulatory hormone response, which can cause early morning hyperglycemia. This effect is called the Somogyi Effect or the Rebound Effect, which is a type of body’s defensive response against long periods of hypoglycemia, which is exerted by stress hormones (GH, cortisol, and catecholamines) and glucagon. The Somoji effect usually starts with hypoglycemia in the middle of the night (around 2 to 3 am) and then is accompanied by a gradual increase in glucose until the early morning. In fact, this effect is to compensate for hypoglycemia and prevent its serious complications. The Somoji effect has been repeatedly reported in diabetic people, especially in diabetes. Type I diabetes (IDDM) has been observed and reported more than type II diabetes (NIDDM).
In general, the Somoji effect occurs when a diabetic patient has high morning glucose despite his evening NPH insulin injection. In other words, this effect or phenomenon is observed when, for any reason, the person’s body is exposed to extra insulin, which in IDDM diabetics, insulin Injection (Exogenous insulin) plays this role. After the Somoji effect, the body faces more resistance to insulin for several hours, and usually the patient is asymptomatic, but sometimes it may be associated with night sweating. The reason for the lack of scientific evidence in the field of Somoji’s work continues to be debated.
Dawn phenomenon is a normal physiological increase in blood glucose before waking up. This phenomenon can be seen in non-diabetic people in addition to diabetics. In the early morning between 4 and 30/6, by means of reverse regulating hormones (such as GH, cortisol, and catecholamines), the body causes the release of large amounts of glucose from the liver into the bloodstream and increases the body’s need for insulin, thus preparing the body for the start of the day’s activities. This phenomenon is associated with a decrease in NPH insulin in the evening in diabetics. After the release of these hormones, blood sugar increases around 6 am. However, the response of healthy and non-diabetic people is different from diabetic people in this situation. In non-diabetic people, insulin secretion increases at the same time as blood glucose increases. However, diabetics face hyperglycemia in the morning due to impaired insulin secretion. Therefore, it is better to inject NPH insulin in the evening, instead of before dinner, before going to bed.
In order to distinguish between the Somoji effect and the Down phenomenon, continuous monitoring of blood glucose is used between 2 and 3 midnight, in which case two results may be obtained:
1. If the blood glucose was low or very low at 2-3 midnight, there is a possibility of Somoji effect.
2 ⃣ If blood glucose is high between 2 and 3 midnight, there is a possibility of Down phenomenon.
This post is written by Amer_7798