Failure of Nocturnal Hypoglycemia to Cause Daytime Hyperglycemia in Patients With IDDM

Abstract

To test the hypothesis that nocturnal hypoglycemia causes postprandial hyperglycemia the next day (the Somogyi phenomenon) in patients with insulin-dependent diabetes mellitus (IDDM), we studied 10 moderately well controlled patients, who were on their usual therapeutic regimens, from 2000 to 2000 on three occasions. On a control day, samples were obtained without intervention. On another day, nocturnal hypoglycemia was prevented (by intravenous infusion of glucose, if necessary, from 2200 to 0400 to keep plasma glucose levels at greater than 5.6 mM). On another day, nocturnal hypoglycemia was induced (by stepped intravenous insulin infusions between 2200 and 0200 to reduce plasma glucose levels to less than 2.8 mM). After nocturnal hypoglycemia (1.9 +/- 0.2 mM), fasting (0800), morning (0800-1100), afternoon (1200-1500), evening (1600-2000), and entire-day (0800-2000) plasma glucose concentrations were no higher than those after prevention of nocturnal hypoglycemia or sampling only. On the control day, fasting and daytime plasma glucose levels were directly related to the preceding 2200 (r = 0.723, P less than 0.02, and r = 0.762, P = 0.01, respectively) and nocturnal nadir (r = 0.714, P less than 0.02, and r = 0.728, P less than 0.02) plasma glucose concentrations. Daytime plasma glucose levels were unrelated to peak nocturnal plasma glucagon, epinephrine, norepinephrine, growth hormone, or cortisol concentrations. We conclude that nocturnal hypoglycemia does not appear to cause clinically important daytime hyperglycemia in patients representative of most patients with IDDM.

Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: Prevalence and contributors

“…Our results, together with those of Porter et al 6 . suggest that, as in adults, 24,31 , 32 rebound fasting hyperglycaemia following nocturnal hypoglycaemia (the so‐called ‘Somogyi phenomenon’) is very rare in children, if it occurs at all. On the rare occasions both bedtime and fasting glucometer glucose was below 6 mmol/L, hypoglycaemia was universal and prolonged during the intervening night.…”

Frequency of the Dawn Phenomenon in Type 2 Diabetes: Implications for Diabetes Therapy

“…12 In contrast, nocturnal hypoglycemia has been shown to result in lower early morning and post-breakfast blood glucose levels. 13,14 Furthermore, the impaired ability of many diabetic patients to mount a significant counterregulatory response to hypoglycemia has cast doubt on the importance of the Somogyi effect in clinical practice. 15 Nor is endogenous hypoinsulinemia responsible for the dawn phenomenon, as evidenced by the dawn rise in insulin secretion consistently observed in studies of type 2 diabetic volunteers.…”

Hipoglicemia como fator complicador no tratamento do diabetes melito tipo 1

“…Com os anos, prevaleceu o conceito de que a liberação de hormônios contra-reguladores após hipoglicemia era de magnitude suficiente para provocar hiperglicemia reacional. Embora estudos mensurando glicemia plasmática tenham já negado a existência desse fenômeno, a medida contínua de glicemia intersticial (continuous glucose monitoring system -CGMS) trouxe a confirmação da inexistência de hiperglicemia após hipoglicemia (37). Høi-Hansen e cols.…”