Monday, November 19, 2012

What is Somogyi effect and Dawn phenomenon ?


SOMOGYI EFFECT AND THE DAWN PHENOMENON

A special form of rebound from hypoglycaemia is the somogyi phenomenon, in which nocturnal hypoglycaemia occurs. There is awakening with malaise, headache and bedclothes damp from sweating are suggestive. Again due to falling blood glucose counter regulatory hormone are released and again hyperglycemia occurs. The rebound from the nocturnal hypoglycaemia results in patient waking with blood glucose concentration higher then desirable, causing the temptation to take at least as much (or even more) insulin the next night.

Non-diabetic subjects show circadian changes in blood glucose. The most marked such circadian effect is the dawn phenomenon which typically occurs between 4 and 7h and is an increase in plasma glucose and decrease in insulin sensitivity due to increased secretion of counter-regulatory hormones at that time. During this period people with diabetes usually experience modest rise (20-40 mg/dl) in blood glucose without ingestion of food.

Brittle diabetes

This is a condition of episodes of hypo or hyperglycaemia whatever their cause. Causes include psychological abnormalities such as eating disorders, personality disorders, etc. Other causes are inappropriate education, unsuitable insulin regimen, intercurrent illness such as thyroid disease, Addison’s disease, SLE (antibodies to insulin or its receptor), etc.
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