Common Health Issues

Dawn Phenomenon and Somogyi Effect

• By Rich Health Editorial Team
• November 01, 2021

DAWN PHENOMENON

What’s going on here? You go to bed at night and wake up the next morning hungry and with an empty stomach. You would expect your blood glucose levels to be low. But instead, you find them to be quite high. This seeming paradox is as a result of the dawn phenomenon. It is the body’s way of giving you a boost of energy to start the day by building up glucose while you sleep.

 

In the early hours of the morning, your body produces certain growth hormones. These hormones repress the action of insulin and allow blood glucose levels to rise between 4 and 8 am. The dawn phenomenon is a natural process and in itself is not a problem. But if your blood glucose levels climb too high during these hours, you may want to make adjustments to keep your blood glucose levels on an even keel.

 

DAWN PHENOMENON SYMPTOMS

If your blood glucose levels rise too high because of the dawn phenomenon, you may wake up feeling some of the symptoms of hyperglycemia: excessive thirst, frequent urination or blurry vision. Or you may feel no symptoms at all. The surest way to find out if the dawn phenomenon is creating problems for you is to test your blood glucose level at 2am and again when you wake up. If it is higher than 200mg/dl, talk to the members of your health care team about how to make adjustments to your nighttime routine to prevent this from occurring.

 

DAWN PHENOMENON RISKS

Any time your blood glucose levels rise too high, you are at risk for all the problems associated with hyperglycemia. Just how great the risk is depends on how high your blood glucose levels rise and how often this happens. High blood glucose levels over time can increase the risk of all the complications of diabetes: eye diseases, kidney disease, nerve disease, heart disease and infections. Extremely high blood glucose levels (over 500mg/dl) can trigger emergency situations such as diabetic ketoacidosis and hyperglycemic hyperosmolar state. 

The dawn phenomenon on its own is unlikely to cause blood glucose levels to rise high enough to trigger such episodes. However, any time your blood glucose goes too high and you don’t make the necessary adjustments to bring it back down, other actions such as eating too much or forgetting to take your insulin or oral medication can greatly increase the risk of severe hyperglycemia.

 

WHAT TO DO

If your blood glucose levels are too high when you wake up, you may need to take a higher dose of insulin than you normally take. Talk to your health care team in advance about the best way to deal with morning episodes of hyperglycemia.

 

 

DAWN PHENOMENON PREVENTION

The best way to deal with hyperglycemia due to the dawn phenomenon is to prevent it from happening in the first place. You might consider decreasing your food intake at night or increasing your physical activity. Adjusting the timing or dose of your insulin may also do the trick. For example, some people find that moving the evening insulin dose from 8pm to 11pm prevents the dawn phenomenon.

However, it is important to distinguish the dawn phenomenon from the Somogyi effect. This condition, which results in high blood glucose, is triggered by low blood glucose levels. Thus, if you think you are affected by the dawn phenomenon, but really have the Somogyi effect, anything that results in lower blood glucose (such as taking more insulin the evening before) could actually worsen your situation. 

 

If your 2am blood glucose level is less than 60mg/dl and then rises above 180mg/dl at 7am, you may have the Somogyi effect. Talk to the members of your health care team about the best way to diagnose and prevent your early morning hyperglycemia.

 

SOMOGYI EFFECT

The Somogyi effect, or rebound hyperglycemia, is another one of your body’s reactions to hypoglycemia. In most people, whenever blood glucose gets too low, certain hormones called counter-regulatory hormones kick in and cause blood glucose levels to rise. In individuals without diabetes, this effect is quickly counteracted by an increase in insulin, which lowers blood glucose. If you have diabetes, your body may not make enough insulin or may not respond to insulin and you may become hyperglycemic due to these hormones

 

SOMOGYI EFFECT SYMPTOMS

If you are experiencing the Somogyi Effect, you may not even notice the episode of hypoglycemia that triggers the hyperglycemia. Or, you may first notice the symptoms of hypoglycemia (shakinesss, nervousness, moodiness, sweating, irritability, chills, clamminess, rapid heartbeat, anxiety, light-headedness, dizziness, hunger, blurred vision, nausea, or tingling or numbness in your lips or tongue) followed by symptoms of hyperglycemia (dry parched mouth, extreme thirst and the need to urinate frequently). 

 

Eating too much food to treat the hypoglycemia can cause an even greater rise in blood glucose levels, which can increase the symptoms of hyperglycemia. Only careful blood glucose monitoring will tell you and your doctor if you are experiencing rebound hyperglycemia. If your blood glucose levels fall below 65mg/dl and then rise above 200mg/dl within a few hours, you may be experiencing the Somogyi effect (the exact blood glucose values may vary). This can occur during waking hours or while you sleep at night.

 

SOMOGYI EFFECT RISK

Swings in blood glucose levels can increase the likelihood and severity of the complications of diabetes over time. The Somogyi effect is a natural mechanism to counteract severe episodes of hypoglycemia. The greatest risk is that blood glucose levels may rise too high, especially if the initial hypoglycemia is treated too aggressively. The trick is to eat just enough carbohydrate to treat the hypoglycemia (probably 15 grams) but not enough to trigger hyperglycemia.

 

WHAT TO DO

The problem in treating rebound hyperglycemia is that you might not know that it was triggered by an episode of hypoglycemia. Aggressive attempts to lower blood glucose could end up causing another episode of hypoglycemia, which in turn causes another bout of hyperglycemia. If you have attempted to treat hyperglycemia with increased doses of insulin and you end up with recurring episodes of hyperglycemia, the Somogyi effect may be responsible.

 

The only sure way to know is to carefully monitor your blood glucose. If you notice that your blood glucose level falls below 65mg/dl and then rises to over 200mg/dl a few hours later, then this may be occurring. Talk to your health care team about the best approach to take in the middle of an episode and what your individual blood glucose values indicating an episode may be. 

 

If your hypoglycemia is mild, you may be advised to take a small amount of carbohydrate (about 15 grams) to bring your glucose levels to within normal range. If your blood glucose levels rise above 200mg/dl, you may be advised to reduce your food intake or increase your physical activity. However, increasing your dose of insulin is not advised if you indeed have rebound hyperglycemia, because it may trigger another round of hypoglycemia and hyperglycemia. If your blood glucose level rises above 250mg/dl, check for ketones and call a member of your health care team. If it rises above 500mg/dl, seek emergency treatment immediately.

 

SOMOGYI EFFECT PREVENTION

The best way to treat rebound hyperglycemia is to determine what is causing the initial episode of hypoglycemia and prevent this from occurring in the future. If your episodes are occurring during the day, measure your blood glucose levels several times throughout the day and take note of your exact mealtimes and physical activity. 

 

You and your health care team should develop a plan based on your pattern of activity. If you are exercising on an empty stomach, for example, you may need to have a snack before you work out, but check your blood glucose to be sure. If you are taking insulin, you may need to make adjustments in the timing of injections and your meals. If you are experiencing rebound hyperglycemia in the early morning, then try measuring your blood glucose levels between 2 and 4 am and then again at 7am. If blood glucose levels fall below 60mg/dl between 2 and 4 am, but then rise above 180mg/dl at 7am, you may want to consider a change in your bedtime snack or postponing your evening dose of insulin. Talk to your health care team about the approach that will work best for you.

 

BRITTLE DIABETES

Brittle diabetes refers to wide, unpredictable swings in blood glucose levels. In the past, many patients felt frustrated because they didn’t always know what was causing these drastic changes in blood glucose levels. The term is used less commonly now, because widespread use of self-monitoring of blood glucose has given people a better handle on controlling their blood glucose levels. 

 

By frequently testing your glucose, you have a clue to what causes your blood glucose to go up and down and you are better able to keep it under control. However, some people still have a hard time controlling blood glucose levels because their bodies have exaggerated responses to food, medication, physical activity and stress. 

 

If you are one of these people, especially if you take insulin, you may eat about the same amount of food every day at the same time, inject the same amount of insulin at the designated times each day and even exercise regularly. But you may find that one day your blood glucose levels are high and the next day they are low for no apparent reason. If this is the case, it may take some detective work to figure out what is causing these wide swings in blood pressure.

 

BRITTLE DIABETES SYMPTOMS

If you have brittle diabetes, you may frequently experience symptoms of both hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose). Symptoms of hypoglycemia include shakiness, nervousness, sweating, irritability, impatience, chills and clamminess, rapid heartbeat, anxiety, light-headedness, hunger, sleepiness, anger, stubbornness, sadness, lack of coordination, blurred vision, nausea, tingling or numbness in the lips or tongue, nightmares, crying out during sleep, headaches, any change in behavior or personality, delirium, confusion and in severe cases, unconsciousness. 

 

Symptoms of hyperglycemia include a dry, parched mouth, excessive thirst and frequent urination. Untreated hyperglycemia could lead to diabetic ketoacidosis or hyperglycemic hyperosmolar state. Your body may not show all of the symptoms of hypoglycemia or hyperglycemia. The only way to know for sure whether your blood glucose levels are swinging one way or another is to measure them.

 

BRITTLE DIABETES RISK

In the short term, both extreme high or low blood sugar levels that go untreated could lead to unconsciousness, seizures, coma and even death. It is important to be aware of the symptoms of both high and low blood glucose levels and know what to do if yours swing too widely. Over time, Diabetes Control and Complications Trials showed that wide swings in blood glucose can greatly increase the likelihood and severity of the complications of diabetes, including eye disease, kidney disease, nerve disease, heart disease and infections

 

WHAT TO DO

If you are prone to wide swings in blood glucose levels, talk to members of your health care team in advance about what to do if your levels fall too low or rise too high. The first thing you should do is to test your blood glucose. If your blood glucose levels are below 60-70 mg/dl or are near 60-70 mg/dl and you are experiencing any of the symptoms of hypoglycemia, you probably need to take a quick fix of carbohydrate. If you are unable to test your blood glucose but feel any of the symptoms, don’t wait to test. Take 10-15 grams of fast-acting carbohydrate, then retest in 15 minutes. If your glucose level is still low, eat another 10-15 grams of carbohydrate.

 

If your blood glucose levels are above 250mg/dl and /or if you are feeling any of the symptoms of diabetic ketoacidosis or hyperglycemic hyperosmolar state, call your health care team immediately. Talk to your health care team in advance about what to do if your blood glucose goes too high. You may need to take an extra dose of insulin, for example. If your blood glucose level is above 500mg/d, get emergency treatment immediately

 

BRITTLE DIABETES TREATMENT

You may be able to adjust your blood glucose levels on your own. Talk to your health care team about specific actions you can take. If your blood glucose levels are too high or too low, you may require emergency treatment.

 

BRITTLE DIABETES PREVENTION

To prevent brittle diabetes from causing further problems, you need to figure out what is causing the wide swings in blood glucose levels. Carefully monitor your blood glucose and keep a log of your daily activities, food intake, medications, insulin and make a note of your general feelings of physical and emotional health. In tracking down the possible culprit, consider the following possibilities:

Timing of Insulin Injection

Are you allowing a full 30 to 45 minutes to give your regular insulin time to kick in before eating meals? You may need to alter the timing of insulin injections and mealtimes

 

Insulin Dose

Check that you are measuring your insulin dose accurately. If you are taking too much insulin at one time, it may take varying amounts of time to work. Consider using an insulin pump to spread out an insulin dose over time

 

Injection Sites

Make sure you are rotating your injection sites regularly. Insulin is absorbed at the most consistent rate from the abdomen

 

Injection Depth

Make sure that you inject your insulin at the same depth each time

 

Blood Flow

Working muscles and warm temperatures speed up insulin absorption. Cool temperatures and tobacco slow it down. Think about whether you are injecting insulin near working muscles or whether your home and office are different temperatures

 

Neuropathy

Damage to nerves can affect the absorption of food

 

Dehydration

If you are dehydrated from high blood glucose levels, it may be harder for insulin to flow into your tissues. 

Talk to your doctor or diabetes educator about other things you can do to better control your blood glucose levels.

 

IMPAIRED GLUCOSE TOLERANCE

If you take a test for diabetes called glucose tolerance test and your test results do not indicate diabetes, but are not normal either, you have impaired glucose tolerance. Most of the time, your blood glucose levels are probably normal. But the test shows that your blood glucose levels remained higher than someone without diabetes. What this diagnosis really means is that you may be at risk for developing type 2 diabetes. People with impaired glucose tolerance are also at greater risk for heart attack

 

SYMPTOMS OF IMPAIRED GLUCOSE TOLERANCE

If you have impaired glucose tolerance, you may show few of the symptoms of diabetes under normal living conditions and you are probably unaware that you even have it. However, it is possible that some symptoms may appear in certain situations, such as when you are under stress, feel ill or consume large amounts of carbohydrates. 

 

Even if you don’t have any of the classic symptoms of diabetes on a daily basis (excessive thirst, frequent urination and blurry vision), if you find that you “feel funny” when you eat a lot of candy or drink a lot of sugar-laden soft drinks, you may want to ask your doctor for a glucose tolerance test. This will tell you whether you have impaired glucose tolerance and whether you may be at risk for developing diabetes in the future.

 

During an oral glucose tolerance test, you will be asked to drink a high-glucose solution. Two hours after the glucose drink, people without diabetes will have a blood glucose level of less than 140mg/dl. People with diabetes will have a blood glucose level above 200mg/dl. If you have a blood level between 140 and 200 mg/dl, you may have impaired glucose tolerance.

 

RISK OF IMPAIRED GLUCOSE TOLERANCE

If you are diagnosed with impaired glucose tolerance, you are up to seven more times likely to develop diabetes within 7 to 8 years than someone with normal glucose tolerance. You are also at a greater risk of developing cardiovascular disease. If you are female, you are more likely to develop gestational diabetes during pregnancy

 

PREVENTION OF IMPAIRED GLUCOSE TOLERANCE

If you have been diagnosed with impaired glucose tolerance, don’t panic. You don’t have diabetes, but you are at risk. Despite this increased risk, many people with impaired glucose tolerance never develop diabetes. Talk to your doctor or a diabetes educator about the best ways to prevent diabetes from occurring.

 

Since type 2 diabetes occurs most frequently in individual who are overweight and inactive, the best approach is to adopt a healthy lifestyle. Keep your weight down, exercise regularly and avoid eating too much fat in your diet. 

You may want to talk to a nutritional counselor about ways to modify your diet to prevent diabetes and eat healthier foods, without entirely giving up all the foods you love. Or talk to an exercise physiologist or personal trainer to find ways to incorporate physical activities that you enjoy into your lifestyle. The trick is to make lifestyle choices that you can live with.

 

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Dawn Phenomenon by Teri O’Neal and Euil Luther

 

• Somogyi Phenomenon by Gizem Reyhanoglu and Anis Rehman