Somogyi Phenomenon

Another weirdly titled post with “phenomenon” in it’s name. So, why should it concern you? As doctors often like to do, the Somogyi phenomenon is named after the doctor who discovered it, a Hungarian-born professor called Michael Somogyi.

Somogyi can often punish T1DM patients for having a hypo. It is postulated to be caused by the stress put on the body by having a hypo. Have you ever noticed yourself, a friend or a patient having a hypo and then their blood sugars seeming to swing in the opposite direction a few hours later? When having a hypo, the body releases hormones to defend against it and raise the blood sugar. These include glucagon, epinephrine and cortisol. Again, another helpful reaction of the body that is a nuisance for diabetics. As well as raising blood glucose, these hormones also cause insulin resistance for several hours following a hypo. Waking up in the morning with a high blood sugar can prompt you to increase your insulin the night before, but can result in blood sugars being even higher the morning after by increasing the Somogyi effect.

This infuriating effect can often result in curing a hypoglycaemia only to find you’ve given yourself a hyperglycaemia. It can present itself in the form of high morning blood sugar (hypos can often go unnoticed in the night), or during the day after a hypo.

I’ll never discuss a challenging aspect of management without going through the ways to solve it. But, Somogyi is a particularly difficult one. The first point of call should be to increase blood glucose monitoring frequency. This includes waking up during the night to check for night hypos. When it comes to diabetes management, I’m a realist. People aren’t going to regularly test their blood sugars 10 times a day and wake up during the night. The best way to combat this would be to purchase a continuous glucose monitor, although they are very expensive.

Increasing insulin after having a hypo might combat the Somogyi effect. However this should always be done with extreme caution to avoid the risk of precipitating another hypo. Always follow the advice of your responsible healthcare professional.