eMedicine Specialties > Endocrinology > Diabetes Mellitus

Somogyi Phenomenon: Differential Diagnoses & Workup

Author: Michael Cooperman, MD, Clinical Associate Professor of Endocrinology, Temple University; Chair, Department of Internal Medicine, Division of Endocrinology, Jeanes Hospital
Contributor Information and Disclosures

Updated: Mar 30, 2009

Differential Diagnoses

Hypoglycemia

Other Problems to Be Considered

Dawn phenomenon
Uncontrolled diabetes

Workup

Laboratory Studies

  • Fasting blood sugar - The fasting blood sugar is expected to be inappropriately elevated due to hormonally induced rebound.
  • Nocturnal (3-4 AM) blood glucose - A glucose reading in the middle of the night will disclose hypoglycemia as a result of insulin therapy. This will establish the diagnosis.
  • Hemoglobin A1C (Hgb A1C) - Obtaining an Hgb A1C level may be helpful if it is within the reference range or low despite an elevated fasting glucose level. It supports the concept of a rebound fasting hyperglycemia in the face of normal glucose control. An elevated Hgb A1C does not rule out the phenomenon.
  • Frequent glucose sampling - Frequent glucose monitoring may be necessary to confirm the diagnosis and look for other periods of hypoglycemia that may lead to rebound hyperglycemia. Frequent hypoglycemia is responsible for hypoglycemic unawareness, through which the typical symptoms of hypoglycemia may be missed.

More on Somogyi Phenomenon

Overview: Somogyi Phenomenon
Differential Diagnoses & Workup: Somogyi Phenomenon
Treatment & Medication: Somogyi Phenomenon
Follow-up: Somogyi Phenomenon
Multimedia: Somogyi Phenomenon
References
Further Reading
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References

  1. Somogyi M. Insulin as a cause of extreme hyperglycemia and instability. Bull St Louis Med Soc. 1938;32:498-500.

  2. Bolli GB, Gerich JE. The "dawn phenomenon"--a common occurrence in both non-insulin- dependent and insulin-dependent diabetes mellitus. N Engl J Med. Mar 22 1984;310(12):746-50. [Medline].

  3. Campbell PJ, Bolli GB, Cryer PE. Pathogenesis of the dawn phenomenon in patients with insulin-dependent diabetes mellitus. Accelerated glucose production and impaired glucose utilization due to nocturnal surges in growth hormone secretion. N Engl J Med. Jun 6 1985;312(23):1473-9. [Medline].

  4. Shanik MH, Xu Y, Skrha J, et al. Insulin resistance and hyperinsulinemia: is hyperinsulinemia the cart or the horse?. Diabetes Care. Feb 2008;31 Suppl 2:S262-8. [Medline]. [Full Text].

  5. McCrimmon R. The mechanisms that underlie glucose sensing during hypoglycaemia in diabetes. Diabet Med. May 2008;25(5):513-22. [Medline].

  6. [Best Evidence] Singh SR, Ahmad F, Lal A, et al. Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis. CMAJ. Feb 17 2009;180(4):385-97. [Medline]. [Full Text].

  7. Lind M, Fahlen M, Happich M, et al. The effect of insulin lispro on glycemic control in a large patient cohort. Diabetes Technol Ther. Jan 2009;11(1):51-6. [Medline].

  8. Bolli GB, Gottesman IS, Campbell PJ. Glucose counterregulation and waning of insulin in the Somogyi phenomenon (posthypoglycemic hyperglycemia). N Engl J Med. Nov 8 1984;311(19):1214-9. [Medline].

  9. Raskin P. The Somogyi phenomenon. Sacred cow or bull?. Arch Intern Med. Apr 1984;144(4):781-7. [Medline].

  10. Somogyi M. Exacerbation of diabetes by excess insulin action. Am J Med. Feb 1959;26(2):169-91. [Medline].

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Further Reading

Clinical guidelines:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Glycemic management. American Association of Clinical Endocrinologists - Medical Specialty Society
American College of Endocrinology - Medical Specialty Society. 2000 Jan (revised 2007). 19 pages. NGC:005853

Clinical trials:
Insulin Analogues and Severe Hypoglycaemia
Investigation Into Effects Upon Counterregulatory Responses to Hypoglycemia During Intensive Treatment of T1DM

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Keywords

Somogyi phenomenon, diabetes, insulin, diabetes mellitus, type 2 diabetes, hypoglycemia, hyperglycemia, type 1 diabetes, diabetics, glucose levels, blood sugar levels, low blood sugar, high blood sugar, hypoglycemic, complications of diabetes, diabetes complications, diabetes insulin, diabetes hypoglycemia, Somogyi, insulin dependent diabetes, diabetes hyperglycemia, diabetic hypoglycemia, hypoglycemia insulin, Somogyi effect, dawn phenomenon insulin-induced hypoglycemic hyperglycemia, Somogyi’s phenomenon, hypoinsulinemia, diabetes mellitus type 1, diabetes mellitus type 2

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Contributor Information and Disclosures

Author

Michael Cooperman, MD, Clinical Associate Professor of Endocrinology, Temple University; Chair, Department of Internal Medicine, Division of Endocrinology, Jeanes Hospital
Michael Cooperman, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Clinical Endocrinologists, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Gregory William Rutecki, MD, Associate Professor, Program Director, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University
Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kent Wehmeier, MD, Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine
Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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