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 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.
Somogyi effect occurs in a person who takes insulin doesn’t eat a regular bedtime snack, and the person’s blood sugar level drops during the night.The data can help find ways to better manage the condition) may not be possible in all cases but self monitoring of blood glucose (by a glucometer) 4-5 times in a day including one sample between 2-3 A. in the morning can aid in the diagnosis of such cases. A small snack just before going to bed is also found to be helpful in some cases.Though there is a debate between various methods to manage such cases but replacing NPH insulin with long acting insulin like Glargine can help decrease the nocturnal hypoglycemia. The best option today is continuous insulin delivery by insulin pump but this is costly and cumbersome for many people in rural settings.This locality information is for reference purposes only. 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.