Pattern Analysis

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The Myth of the Somogyi Effect

The Somogyi Effect refers to high fasting glucose readings caused by counter-regulatory hormone release from untreated overnight hypoglycaemia. Despite most evidence failing to support this effect, the concept of the Somogyi effect persists in many health care providers and patients, preventing them from increasing overnight insulin.

Choudhary et al analyzed patient data and concluded the Somogyi effect is indeed, very rare. Their research confirmed previous findings in patients with Type 1 diabetes that overnight hypoglycaemia is associated with low fasting glucose readings.

Taylor outlines some history of how Michael Somogyi (a biochemist) became associated with morning hyperglycaemia secondary overnight hypoglycaemia (even though morning hyperglycemia was not part of his hypothesis and not mentioned in his summary.) Observations that Somogyi made in 1938 and published in 1959 were that five young people had markedly unstable blood glucose control with frequent hypos and periods of excess glycosuria; control was re-established by decreasing insulin doses. Excess secretion of the counter- regulatory hormones was postulated as a cause. Taylor notes a more likely cause of hypoglcyemia in the subjects was the transitioning from the insulin resistance of adolescence, which required dose reductions.

References:

Choudhary, P et al. Do high fasting glucose levels suggest nocturnal hypoglycaemia? The Somogyi effect-more fiction than fact? Diabet Med 2013; 30: 914–917. DOI: 10.1111/dme.12175

Taylor, R. Things that go bump in the night Diabet Med. 2013 Aug;30(8):889-90. DOI: 10.1111/dme.12183.