She was then asked for self monitoring of blood glucose at home 5 times a day for next 4 days at 7 A. So a clinician should have a high degree of suspicion while dealing with cases of persistently high fasting glucose levels in spite of increasing night dose of insulin.
A continuous glucose monitoring (CGM is an FDA-approved system that tracks blood sugar levels of a patient day and night.
On subsequent visits to the fasting glucose levels did not decrease and the primary care physician increased the dose to 30 units before breakfast and 30 units before dinner.
The dawn phenomenon is more common than the Somogyi effect. Insulin-induced posthypoglycemic hyperglycemia is an important cause of poorly controlled diabetes .
To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 2 a.m. This phenomenon, which is known as the Somogyi effect, is characterized by the following: (1) insulin-induced hypoglycemia and a rebound insulin resistant hyperglycemia (prolonged hypoglycemia induced by increased of night dose of insulin can lead to rebound hyperglycemia.
The patient was advised to get Hb A1c done along with lipid profile and renal profile including urine for microalbumin. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released.
Reports revealed Hb A1c level of 6.8 with no other abnormal biochemical parameters. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning.
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You should never attempt to visit any sites listed in without first ensuring that you have the permission of the land and/or mineral rights holders for access and that you are aware of all safety precautions necessary. Physical examination of the patient revealed a BMI of 26, Blood Pressure 132/84 mm of Hg, HR of 102/min and no evidence of any deformity. Based on these findings the patient was diagnosed as a case of Somogyi Effect and her treatment was changed as follows: · Mixtard Insulin (30/70) was omitted. Her night sweats and nightmares decreased and generalized weakness also got better.Systemic examinations including CVS and CNS were normal. · She was advised Insulin Glargine (Lantus) 20 units daily at 8 A. After 4 days of treatment her fasting blood glucose decreased to 164 mg/dl and her 2 A. The population’s prevalence of the Somogyi effect is assessed to be 12.6% according to Mozersky et al. But unfortunately in out-patients clinic settings these cases often go undetected.The dawn phenomenon is a normal rise in blood sugar as a person’s body prepares to wake up.In the early morning hours, hormones (growth hormone, cortisol and catecholamines) cause the liver to release large amounts of sugar into the bloodstream.For most people, the body produces insulin to control the rise in blood sugar.