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Somogyi Effect – Causes, Symptoms, Diagnosis & Treatment

The Somogyi effect, also known as the rebound effect, occurs in people who have diabetes. Although widely reported, this phenomenon continues to remain controversial as there is still very less scientific evidence for the theoretical reasoning of the Somogyi effect [1] .

When a diabetic is on insulin therapy, he or she continues to measure the blood sugar levels repeatedly several times a day. Depending on the results, one needs to take insulin to lower the raised blood sugar levels.

When you take insulin before going to bed and still wake up with high blood sugar levels, then this phenomenon is referred to as the Somogyi effect [2] .

Read on to know more about this effect, its causes, how it differs from the dawn phenomenon, how it can be diagnosed, treated and prevented.

What Is The Somogyi Effect?

This phenomenon is more often reported by people with type 1 diabetes than by people with type 2 diabetes [3] . In this, people who have low blood sugars during late evenings tend to show a rebound effect in the body that causes high glucose levels in the early morning.

This phenomenon is named after the researcher, Michael Somogyi, who described it first. He explained this effect to be the body's defensive mechanism to prolong periods of low blood sugar [4] . He reported that one of the causes for this could be a very high dose of insulin just before bedtime.

Hypoglycemia occurs when insulin causes a reduction in the amount of glucose in the blood [5] . This makes the body stressed, eventually triggering the release of the stress hormones epinephrine, cortisol and growth hormone. The endocrine hormone 'glucagon' is also released.

The released glucagon triggers the liver to convert the stores of glycogen into glucose. This causes a rebound high of the blood glucose levels. Moreover, the stress hormones maintain blood glucose at raised levels. This happens when the cells become less responsive to insulin. This condition is referred to as insulin resistance [6] .

Symptoms Of The Somogyi Effect

The first symptom of this phenomenon is high levels of blood glucose as soon as you wake up in the morning (which are not responsive to increased insulin doses). The other symptoms are [7] as follows:

  • Night sweats
  • Rapid heart rate
  • Waking with a headache
  • Low glucose levels at about 2 am/3 am
  • Blurred vision
  • Confusion
  • Fatigue
  • Dry mouth
  • Dizziness
  • Thirst
  • Increased appetite

Causes Of The Somogyi Effect

Most of the people who have diabetes, use insulin injections to keep their blood glucose levels under control. However, problems could occur if the dosage of insulin injected is not correct or suitable for one's health conditions. Ideally, the causes of the Somogyi effect are [8]

  • taking too much insulin or
  • not eating enough before bed.

The above two factors can cause blood glucose levels to fall too low. This makes the body respond in such a way that it begins to release hormones to raise blood sugar levels. At times, this results in the sugar levels going too high, leading to hyperglycemia.

Diagnosis Of The Somogyi Effect

If there is no other cause for raised blood glucose levels in the morning, then it is most likely due to the Somogyi effect. Another indicator is the resistance of treatment with increased insulin that happens for morning-time hyperglycemia [9] .

Recording your blood glucose readings over several nights can help you diagnose the Somogyi effect quite easily.

People should make it a habit to check their blood sugar levels [10]

  • before bed
  • anytime between 2 am and 3 am
  • upon waking

If you observe that you have a low glucose level at about 3 am but a very high blood glucose reading upon waking up, then you are most likely facing the Somogyi effect.

It would be best to use a continuous glucose monitoring (CGM) system [11] . You should discuss this possibility with your doctor. This method involves insertion of a tiny glucose sensor under your skin. This is usually done by the doctor. The recorded information is sent to a monitoring device. This tracks the glucose levels and helps you know if the levels are too high or too low.

Treatment And Prevention Of The Somogyi Effect

Avoiding the development of hypoglycemia is the best (and the only) way to prevent the Somogyi effect.

The treatment options include [12]

  • lowering the dose of insulin taken before bed,
  • timing the insulin administration well,
  • changing the type (brand) of insulin being used,
  • altering lifestyle factors (exercise, stress) and
  • eating a snack while you administer the evening insulin dosage.

CGM systems are highly effective and might also be prescribed by your doctor for the long-term management of diabetes alongside the Somogyi effect. The CGM system works by alerting the patient of hypoglycemia or hyperglycemia with the use of alarms [13] .

For further and constant monitoring, your doctor might ask you to keep your weight under check. Not just that, the levels of a red blood cell protein called haemoglobin A1C [14] (this binds to glucose) might also need to be monitored over time.

The risks of Somogyi might increase if one has to take an increased dosage of insulin just before bedtime. In such cases, recording the blood glucose levels at about 3 am daily, for at least the first few days, might become necessary. In case of issues, consult the doctor immediately, who might recommend increasing the insulin dosage gradually so that the body gets time to adjust.

How The Somogyi Effect Differs From The Dawn Phenomenon [15]

Many people get confused between the Somogyi effect and the dawn phenomenon (dawn effect). This is basically so because, like the Somogyi effect, the dawn effect also makes a person experience hyperglycemia (raised blood sugar levels) in the morning. However, the reason behind hyperglycemia differs in the case of the dawn effect.

The cause behind the occurrence of the dawn effect is a trigger that occurs due to the decline in the insulin levels and an increase in the growth hormones (causing a rise in the blood glucose levels in the early morning hours).

To distinguish between the Somogyi effect and the dawn effect, one needs to test the blood sugar levels at 3 am followed by a test in the morning again. If the blood sugar reading is low at 3 am, then it indicates the Somogyi effect. On the other hand, if the blood sugar reading is high or normal at 3 am, it indicates the dawn phenomenon.

To Conclude...

Always ensure that you speak to your doctor before you make any adjustments to your insulin dose. This is all the more important if you are experiencing sharp blood sugar fluctuations.

The outlook for diabetic patients is excellent if the Somogyi effect is identified on time and managed well. Alongside insulin management, it is also essential that such patients manage their lifestyle well, taking into consideration factors such as diet and exercise.

View Article References
  1. [1] Yang, X., Mei, S., Gu, H., Guo, H., Zha, L., Cai, J., Li, X., Liu, Z., … Cao, W. (2014). Exposure to excess insulin (glargine) induces type 2 diabetes mellitus in mice fed on a chow diet. The Journal of endocrinology, 221(3), 469-480.
  2. [2] Choudhary P, Davies C, Emery CJ. Do high fasting glucose levels suggest nocturnal hypoglycemia? The Somogyi effect‐more fiction than fact? Diabet Med. 2013;30:914–917
  3. [3] Somogyi M. Exacerbation of diabetes by excess insulin action. Am J Med. 1959;26:169–191.
  4. [4] Pandit K. (2012). Continuous glucose monitoring. Indian journal of endocrinology and metabolism, 16(Suppl 2), S263-266.
  5. [5] Kalra, S., Mukherjee, J. J., Venkataraman, S., Bantwal, G., Shaikh, S., Saboo, B., Das, A. K., … Ramachandran, A. (2013). Hypoglycemia: The neglected complication. Indian journal of endocrinology and metabolism, 17(5), 819-834.
  6. [6] Freeman AM, Pennings N. Insulin Resistance. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  7. [7] Minicucci, W. J., Maia, F. F., Neto, A. M., & Zantut-Wittmann, D. E. (2015). Somogyi effect as the most common cause of fasting hyperglycemia in T1D patients. Diabetology & Metabolic Syndrome, 7(Suppl 1), A62.
  8. [8] McMillan FD, Feldman EC. Rebound hyperglycemia following overdosing of insulin in cats with diabetes mellitus. J Am Vet Med Assoc. 1986;188:1426–1431.
  9. [9] Li, W., Du, S. N., Shi, M. J., & Sun, Z. Z. (2016). Spontaneous and transient predinner hyperglycemia in some patients with diabetes: Dusk phenomenon. Medicine, 95(47), e5440.
  10. [10] Pandit K. (2012). Continuous glucose monitoring. Indian journal of endocrinology and metabolism, 16(Suppl 2), S263-266.
  11. [11] Moretti S, Tschuor F, Osto M, et al. Evaluation of a novel real‐time continuous glucose‐monitoring system for use in cats. J Vet Intern Med. 2010;24:120–126.
  12. [12] Hoi‐Hansen T, Pedersen‐Bjergaard U, Thorsteinsson B. The Somogyi phenomenon revisited using continuous glucose monitoring in daily life. Diabetologia. 2005;48:2437–2438.
  13. [13] Pandit K. (2012). Continuous glucose monitoring. Indian journal of endocrinology and metabolism, 16(Suppl 2), S263-266.
  14. [14] Sherwani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomarker insights, 11, 95-104.
  15. [15] O'Neal TB, Luther EE. Dawn Phenomenon. [Updated 2019 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Read more about: diabetes glucose sugar insulin
Story first published: Monday, March 18, 2019, 10:31 [IST]
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