What is Somogyi Effect?

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As a diabetic or diabetic caregiver do you understand what is Somogyi Effect?

I hadn’t heard of it either until recently.

During the summer we had taken three of our grandchildren on our sailboat for a 3-day adventure.

We had a lot of fun but it was complicated by the fact that our grandson (5-years-old at the time) is a type 1 diabetic.

We have found that managing diabetes can be tricky enough but for those few days we chose to do it on a moving 26′ sailboat.

Surprisingly, we did well enough that our daughter has told us we can take Alex whenever we want.

It was during this trip that I discovered something I later learned was called the Dawn Effect and that a similar condition called the Somogyi Effect existed.

Because of Alex’s diabetes and my desire to fully understand how to best care for him when he is with us, I follow every rabbit-hole when researching and I end up learning some other fascinating thing I was unaware of.

Such is the case with the Somogyi Effect.

What is the Somogyi Effect

The Somogyi Effect is named after a Hungarian American researcher named Michael Somogyi, who was the first to describe it.What is Somogyi Effect - Michael Somogyi

The Somogyi Effect happens following long periods of low blood sugar. This low blood sugar could be the result of too much exercise, not snacking regularly or taking too much insulin before bed.

Insulin reduces the amount of blood sugar. If blood sugar goes too low the person experiences hypoglycemia (low blood sugar).

Hypoglycemia puts a lot of stress on the body and that stress can cause an increase in our stress hormones:

  • cortisol
  • epinephrine (adrenaline)
  • growth hormone
  • glucagon

Glucagon triggers the liver to convert glycogen into glucose.

This can cause the blood sugar levels to rebound high causing hyperglycemia.

The stress hormones continue to keep blood glucose levels high making the cells less responsive to insulin which is called insulin resistance

The National Institute of Diabetes and Digestive and Kidney Diseases recommends blood sugar levels to be:

  • just before eating – 80 – 130 mg/dl
  • two hours after eating – below 180 mg/dl

While there is no single target for morning glucose readings, your doctor will help determine the targets for you.

Symptoms

If you find you are consistently waking up with unexplained high blood sugar levels in the mornings or night sweats you may be experiencing the Somogyi Effect.

The Dawn Phenomenon

The Dawn Phenomenon occurs when your body can’t release insulin to counter the naturally occurring rise in blood sugars as the body prepares to wake.

It typically occurs between 3 a.m. and 8 a.m.

Nearly everyone who has diabetes has experienced the Dawn Phenomenon.

What is Somogyi Effect - insulin pump

Your diabetes care team will likely have explained how you can take these steps to prevent it:

  • refrain from eating carbs before bed
  • take insulin closer to bedtime rather than earlier in the evening
  • ask your doctor about adjusting your insulin dosage or other medications
  • Use an insulin pump

Causes

Many diabetics, including our grandson, use insulin injections to manage blood sugar levels.

Sometimes you may miscalculate the dosage and inject too much insulin or you take your insulin but fail to eat enough with it then go to bed. That insulin would then lower your blood sugars too much causing hypoglycemia.

Your body then responds by releasing hormones like glucagon and epinephrine which raises your blood sugar levels.

As a result, the Somogyi Effect is sometimes referred to as the “rebound effect”.

There have been times that we have miscalculated Alex’s dosage and we gave him too much insulin. This caused his blood sugars to drop too low so then we had to give him a fast-acting sugar snack. This just emphasizes the necessity of frequent monitoring.

Living with diabetes is a constant balancing act and we don’t always get it right. Accepting that fact is just part of it.

How Can You Tell the Difference

Be sure to tell your doctor if you are waking up with high blood sugar. They will want to find out the cause and determine if it is the Somogyi Effect or the Dawn Phenomenon.

They will want you to test your blood glucose before bed, in the middle of the night (around 2 or 3 a.m.) and upon waking for several nights.

If your levels are consistently low during the middle of the night it is probably the Somogyi Effect.

If not, then it is likely The Dawn Phenomenon.

For your doctor to effectively determine a treatment plan, it is important to determine which it is.

A Controversial Subject

While both doctors and patients refer to the Somogyi Effect, science doesn’t seem to back it up that much.

For example, in this small study, they determined that hyperglycemia upon waking could simply be caused by not taking enough insulin before bed.

The researchers also found that those participants who seemed to have rebound hyperglycemia did not have elevated levels of cortisol, glucagon and epinephrine.

In a 2007 study, researchers found 88 type 1 participants who underwent Continuous Glucose Monitoring (CGM).

They found that the participants who woke with hyperglycemia had not dropped to hypoglycemic levels overnight, clearly dismissing the Somogyi effect.

And yet in another study, researchers analyzed the glucose profiles of 85 type 1 diabetics and collected data for 225 nights.

It was discovered that 61.2% of the participants did in fact experience low blood sugar levels overnight and that 82.4% of participants had high blood sugar levels in the morning.

Based on that evidence they determined:

  • 60% of participants had high morning glucose resulting from the Somogyi Effect
  • 27.1% was a result of poor glucose control
  • 12.9% resulted from the Dawn Phenomenon

Ultimately, they concluded that the Somogyi Effect was the most common cause of morning hyperglycemia in type 1 diabetics who did not effectively manage their blood sugar levels.

How Can I Avoid the Somogyi Effect

The only known way to prevent the Somogyi Effect is to properly manage blood glucose levels by following your diabetes treatment plan as set forth by your diabetes care team.

If you are having difficulty managing the fluctuations in your blood sugar levels you should speak with your doctor, an adjustment in your treatment plan may be required.

What is Somogyi Effect - adjust insulin dose

Treatment options may include:

  • Adjusting what time you take your insulin
  • lowering bedtime insulin dose
  • changing type of insulin
  • having a snack with the evening insulin dose
  • take into account lifestyle factors such as exercise or stress

Your doctors may recommend a continuous glucose monitor (CGM) for long-term diabetes management.

Our grandson wears a continuous glucose monitor (CGM), and we find it fantastic. We only do nighttime finger pokes if he goes low.

It is imperative to work closely with your diabetes care team to find what treatments work best for you.

Final Thoughts

“What is Somogyi Effect” is actually a controversial subject within the research field as I discovered.

Somogyi Effect and the Dawn Phenomenon can be easily confused as in both cases you wake up with high blood sugar levels consistently.

The difference is that the Somogyi Effect is preceded by a hypoglycemic(low blood sugar) event in the early hours of the morning (2 or 3 a.m.).

It is for this reason that the Somogyi Effect is sometimes known as the “rebound effect”.

The Dawn Phenomenon is not preceded by low blood sugars.

The Somogyi Effect is most commonly a result of poorly managed blood sugars.

Often it can be avoided simply by consistently following your diabetes care plan as set forth by your diabetes care team.

If you or a loved one in your care are experiencing morning consistent high blood sugars be sure to discuss this with your doctor.

The doctors will want to determine whether it is the Somogyi Effect or Dawn Phenomenon to determine the best treatment plan for you.

A continuous glucose monitor (CGM) can help determine what your blood sugars are doing at night so you don’t need to wake as frequently to check your sugars.

I strongly recommend you always follow your doctor’s advice.

I am not in any way a medical practitioner, please do not rely on the information on our website as an alternative to medical advice from your doctor or another healthcare provider. We only share our experiences.

Have you experienced the Somogyi Effect?

What treatment worked for you?

Leave your suggestions or experiences in the comment section below, I look forward to learning from other’s experiences. Take care.


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8 thoughts on “What is Somogyi Effect?”

  1. Hi Deborah,

    Very interesting article! I’ve little (close to none) knowledge about Diabetes because none of my family members have it.. You must have had to do plenty of prior research for your grandchild!

    Your site is super useful and thanks for explaining things rather simply too. I’ll make sure to bookmark this for easy reference!

    Cheers.
    SAM

    Reply
    • Thanks for dropping by SAM and taking the time to leave a comment. I am grateful my article has helped educate you about diabetes.

      My mother battled type 2 diabetes for years but because I didn’t see her often due to distance (we lived on opposite sides of the country) I never really understood how much time and effort it takes to properly manage diabetes, although I did learn some things.

      When Alex was diagnosed with type 1 diabetes I started researching to learn as much as I could.

      As a grandparent who was used to spending plenty of time with him with and without his parents, I knew the only way for that to continue was for me to learn how to care for him with our new normal.

      Regardless of whether diabetes affects our family directly, education can help recognize symptoms in someone else and you can direct them to get medical attention. Knowing the symptoms of diabetes could literally help save someone’s life.

      Thanks for bookmarking my article, you never know when you may need more information. Take care.

      Reply
  2. Hi Richard, Hi Deborah,

    thanks for this amazing article. I haven’t heard about the Somogyi effect before. The idea of waking up every morning in sweat sounds terrible, especially when I think about kids.

    My own son is 5 years old now, and it breaks my heart when I think about a kid of his age suffering from diabetes and all the treatment required. You guys are tough! But I have a feeling that you, your daughter’s family, and your grandson are a pretty good team and make the best out of it. That’s heart-warming!

    I wish you guys wonderful holidays. How are you going to celebrate? Especially with the coronavirus situation? Is it something that, taking your grandson’s diabetes into consideration, affects your holiday preparation more than other families this year? Can you see each other? Or do you celebrate Xmas via Zoom?

    All the best,
    Chris

    Reply
    • Thanks for commenting Chris. At first, we were all quite shocked that Alex had this all-consuming disease and learning that there was no cure was devastating. However, once we learned how to properly manage his diabetes we found that with a few adjustments we could still do life pretty much as before.

      Thanks for the compliment about us being a great team. We have always believed that a family should work together towards whatever goal they may have and we instilled those beliefs in our children. Every family member that could potentially be around Alex has learned how to care for his diabetes. When we get together there is always someone watching for signs of trouble. This eases the burden on our daughter and son-in-law.

      The holidays are certainly different this year but that has more to do with COVID than diabetes. We still have restrictions in place but are allowed a one household bubble. Since our daughter is the only one of our 5 children who live close by it made sense that she is within our bubble.

      We will be able to get together with her throughout the holidays this year. In fact last weekend I spent Saturday afternoon baking with her three children. We will also go to their place on Christmas eve and they will come here Christmas day for dinner.

      As for the food, we make the same food we have always made. We just need to count Alex’s carbs and then dose his insulin accordingly. His A1C numbers are great so we are doing something right.

      We will have to Facetime with our sons and their families as they are further away and we are not permitted travel to those areas. Well, actually domestic flights are allowed but we would need to self-isolate for 14 days when we arrive there and again when we returned home. With Alex being diabetic he is at a higher risk of complications if he were to get COVID so we figured it wasn’t worth the risk of travel this year.

      We will make the best of it. In fact, I have a Facetime bake date with a couple of grandsons this weekend that we are all looking forward to.

      I wish you and your family a very Merry Christmas and best wishes for the new year.

      Reply
  3. Wow, Deb, indeed you go out of your way to get all the information. I admire you immensely for that. Moreover, I learn a lot by reading your articles. Since I haven’t anyone in my neighborhood (not anymore that is) who has Diabetes it is at times hard to imagine what it is like. Which is also making it more difficult to remember every detail. But for me that’s OK.

    It’s great to read about your experiences and it is marvelous to have a website to turn to in the unhoped for event that it is necessary.

    Thanks for elaborating on the Somogyi Effect. As probably most people I had never heard of it before!

    Reply
    • Thank you so much for the great compliment, Hannie.

      I enjoy learning new things and because of our grandson, it is important for me to learn about all things diabetes-related especially if we want to be able to have time with him without his parents present.

      Since I started this website to share our experiences as the grandparents of a type 1 diabetic, I believe I should research and make sure the information I share is as accurate as possible.

      My conscience wouldn’t allow me to knowingly state misinformation.

      Before researching a similar article entitled the Dawn Phenomenon, I also had never heard of the Somogyi Effect.

      I do tend to find myself following every little rabbit hole in my research but I find that fun and sometimes spend hours reading information.

      I am grateful I can be of assistance.

      Thanks again and take care.

      Reply
  4. Hi Deborah,
    Thanks for sharing this amazing article had never heard about this before, but your article gave immense knowledge to every individual and it was clearly explained which is commendable.

    You actually made it simple for people suffering from the Somogyi effect to continuously monitor glucose (CGM), essential consideration for proper diagnosis and management of blood glucose level is vital for the body’s metabolic demands.

    A high protein, low-fat snack before bed may help people with diabetes stabilize their blood sugar levels overnight. Loved learning something new from your valuable piece of content.

    Very Nice content
    Have a Nice Day!

    Reply
    • Thank you for dropping by Samantha and taking the time to leave a comment. I am grateful you were able to learn something new from my article. I too enjoy being in a constant learning phase. Knowledge is key in my opinion. With a diabetic grandson, it became very important to me to learn about all things diabetes-related. When he was initially diagnosed I couldn’t find any support for grandparents so began this site to become that support system for others. It is our goal to educate others and share our experiences. Since our grandson has been wearing a CGM (continuous glucose monitor) it has significantly made night time testing of his blood sugar levels easier and faster. Thanks again and take care.

      Reply

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