What is the Somogyi effect?
Also known as “rebound hyperglycemia” and named after the physician who first described it, the Somogyi effect is a pattern of undetected hypoglycemia (low blood glucose values of less than 70) followed by hyperglycemia (high blood glucose levels of more than 200). Typically, this happens in the middle of the night, but can also occur when too much insulin is circulating in the system. The cause of the Somogyi effect is said to be “man-made”—that is, a result of insulin or diabetes pills working too strongly at the wrong time.
During periods of hypoglycemia, the body releases hormones which cause a chain reaction to release stored glucose. The end result is that the glucose level can swing too high in the other direction, causing hyperglycemia.
How can you test for the Somogyi effect?
This is the fun part. Set your alarm and wake up between 2 and 3 a.m. and test your blood glucose. Low blood glucose levels could signify the Somogyi effect is in action.
Wouldn’t I know if I’m going too low?
Not always. Sometimes the body has less of a reaction to low blood sugars, especially if you have had wildly fluctuating glucose values for years and can lead to a condition called autonomic neuropathy, which blocks the body’s ability to detect lows. This is more likely to occur during sleep hours—a frightening thought. One option is to ask your doctor or endocrinologist about a 3-day continuous glucose monitoring system (CGMS) exam. About the size of a pager, you would wear the device for 3 days. A little plastic tube taped gently beneath your skin allows the CGMS to read glucose readings several times a minute and can explain exactly when lows occur. Companies are competing to have “real-time” glucose values displayed in this device. Currently, the CGMS devices have to be downloaded at the physician or diabetes educator office for interpretation.
What can I do to correct the Somogyi effect?
The very best way is to prevent the low from happening in the first place. And that takes a little detective work to figure out what made the glucose plummet. You might try any of the following, with your physician or healthcare provider’s blessing:
Have a snack with protein before bedtime, like a piece of toast with peanut butter, or some cottage cheese, or yogurt, or some nuts and small piece of cheese.
Go to bed with a glucose level slightly higher than usual.
Wake up between 2 to 3 a.m. and test your blood glucose. Bring your logbook to your physician and ask if any medication adjustments are needed (like changing the type and/or amount of insulin, oral medication, or switching to an insulin pump). Do not skip or change your medications without your physician’s input!
Ask your doctor about having the CGMS test
· 9 years ago