Somogyi? a thing or not?

#1

Okay so this is my graph last night and I have an almost identical one to it the night previous. I have never seen a dip and rise that looks quite like this one before- right after midnight when I am dead asleep! I googled Symogi effect because I think that’s what it is, but then I discover that it’s never been medically proven and some doctors discredit the phenomenon? I don’t know what my bg has dipped so low in the middle of the night two nights in a row and I wonder what if it has to do with my sleep patterns? I did up my basal rates a few nights ago to combat morning highs, but I brought them back down again today to see if I can avoid such a crazy drop. Anyone else experience this before?

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#2

Sure. But, I think I get less of that endocrine response to lows as I am getting older. I am 37. I dont think I kick the same amount of hormone as I used to, which is good and bad.

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#3

I have also read stuff about the Symogi effect being discredited. At the same time I think hormones definitely come into play after severe lows or lots of lows.

One other possibility, could it be a compression low from lying on the sensor? They often show up as a severe drop and then a rapid recovery.

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#4

Wow, now that’s a term I haven’t heard of in years. My second-worst endo I’ve had, and that was back in the 80’s would say that term so many times I think someone was paying him each time he uttered it. I never got on board with him or his ideas.

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#5

like less glucose from the liver you think?

#6

I did think of that, but it happened two nights in a row at the exact same time! I have gotten compression lows before- generally I notice when my bg is really far off what my cgm says, but since I didn’t actually wake up that’s a good possibility. Generally I can’t sleep when my bg is low. I don’t know? It’s just a weird looking curve on the graph.

#7

Oh gosh. I didn’t realize it was such a dated thing. Now I feel dumb:stuck_out_tongue_closed_eyes: I guess any low in the middle of the night for a diabetic is more likely due to the fact that we take extraneous insulin instead of producing it ourselves and any low at night is more likely due to a wrong basal dose or maybe any outside hormones (the effect of exercise on the body later). I just thought the graph looked funny and the fact that I had the exact same trend TWO nights in a row at that exact same time when I was fast asleep.:woman_shrugging:

#8

Yea, maybe my liver dumps less sugar on demand. Probably less adrenaline production. Your body just does less stuff as you age. Thats why old people dont run as fast as young people. The tendency is for less chaotic readings as people get older - more flatline numbers. In general, old men have more stable numbers than young women. Older women probobly have less chaotic numbers than young women. But, on the bad side, you might not get as much ‘help’ with those lows when your older. I am expecting more stable system behavior in my 40’s, but I expect to need to be less dismissive of lows.

#9

Yes I get that. Usually I am up treating the low. It is hard to tell if it is that or treating the low which is not responding. But since sometimes I don’t get it and use similar treatment, I think it is my body reacting to a very bad low. I can tell by how they feel as well of course. When I don’t wake up it is definitely my liver raising bg. Usually it is less dramatic in the spike.

#10

Is this Medtronic 670 in auto mode? Does the shaded area from 0-1 indicate the pump in suspend mode?

If history is available, can you check insulin delivery though this time, compared to nights where it did not drop?

#11

I started using a continuous glucose monitor or CGM in 2009. Prior to that I had no warning or alert while sleeping. I experienced a lot of hypos while sleeping. Once I got the CGM, I noticed that if I endured a hypo under 60 mg/dL (3.3) for more than about 20 minutes while sleeping, then that produced very high insulin resistance and even treating with just one glucose tab, my glucose would easily go over 200 (11.1) and resist coming down.

I learned that if I woke up low, it was likely that my blood sugar would be elevated for hours and even worse if I ate any breakfast. I thought what I experienced was called the somogyi effect. No matter the name, I definitely became highly insulin resistant following a sustained low while sleeping and it ruined my BGs till noon.

#12

I thought Symogi was just rebound. How is it different? Counter-regulartory hormones – epinephrine, glucagon, growth hormone and cortisol – kick in to raise the blood sugar in response to a low. My understanding is they each kick in at different bG levels and have different durations. At the extreme some can last upto 48 hrs. And, of course, there is variation from person to person. Treating lows quick can mitigate rebound. Hypo unawareness is a reduction in response of these hormones. Especially epi, which is responsible for most of the physical symptoms.

Just before I started on the pump, I saw an new endo. I was two shots per day, a large dose of NPH in the AM and a mixture of NPH and regular in the early evening. I was having problems getting my bG under control.He asked me what I thought was going on and what I should do. That was the first time a doctor asked for my input. He was my endo for the next 30 years. Anyway, I pointed to the highs and said I needed to get those down. I needed to increase the regular, based on the time it seemed the highs were occurring. He said that was reasonable, but the first thing we were going to do was decrease my total insulin by 20%. He explained rebound and pointed out that most of the highs, some lasting half a day, were preceded by a low. Because of the counter-reg hormones, adjusting to the
highs, I was getting to much insulin and would go low as the rebound wore off. Reducing my insulin would stabilize the bGs. It might be consistently high, but once stabilized, we con make adjustments of bring that down. He also put me on 4 shot per day. I don’t remember the details of that regime. Sometime after that, he suggested trying the new thing call an insulin pump. The rest, as they say, is history.

#13

Terry4,

I’m a T2 and after using a CGM and being on Glimepiride I learned I was going low at night. I also learned that like you my morning BG from 6 AM to noon would be my highest of the day. Even if I didn’t eat any carbs in the morning. My night time levels are pretty much in the 80-90s now that I’ve stopped the Glimepiride but the 6 to noon numbers are even higher.

Have you found anything that helps with the morning highs?

#14

Avoiding sustained overnight lows < 60 mg/dL (3.3 mmol/L) for me removes the most significant contributor to morning highs.

Even without the sleeping lows, my insulin resistance is higher in the morning hours and I need to add some extra insulin to counteract that glucose rise. I’ll often lower my Loop glucose target temporarily from 83 to 65 to make my insulin delivery system more aggressive. If my blood glucose still wants to rise in the morning, I will take a 4 unit dose of inhaled insulin, Afrezza.

If you’re not taking any external insulin, your tactics are more limited. I would likely try to get out for a morning walk. I find exercise reduces insulin resistance both in the short and long term. I also find that missing a meal once in a while (fasting) is great at reducing insulin resistance and the effect endures of a day or more after a fast.

Missing the last meal of the day combined with avoiding evening snacking is great at keeping good numbers through the night but also helps reduce insulin resistance the following morning.

Good luck!

#15

Wow, that’s an interesting graph. Without a CGM you would’ve measured at 10PM and gotten 100 and measured at 6AM and gotten 100 and not known that anything had happened in betwee.

I have blamed Symogi only when I wake up at like 300+ and wonder how the heck happened. But really I had no idea how I ended up at 300+.

#16

Or you could blame the phase of the moon, or bad karma. :slight_smile:

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#17

I’ve found that you get more reliable information from sites that call it Somogyi effect or dawn phenomenon.

#18

Google is often effective at interpreting misspellings and returning the info you’re looking for. Our local TuD search engine is not as robust. I will correct the spelling in the topic title so that future TuD searches will uncover this discussion. Thanks for brining this to our attention.

#19

Kinda cool that this was talked about last night at a TCOYD mini series last night. Part of the night was reviewing and troubleshooting CGM reports. And one of the doctors sawed a graph just like this and used the term Somogyi. Also have heard it in a long time but it does happen.
This and dawn phenomenon are the main reason people go on a pump because it is much easier to adjust an overnight basal than an injection.
It was the main reason I went on a pump 29 years ago. Just couldn’t get overnights level enough to get the ok to try and get pregnant. Once the pump started, it was an easy fix.

#20

wow. same here! (you can see I didn’t copy the pregnant part).