What are 2 causes of AM hyperglycemia in diabetes mellitus?
Dawn phenomenon and Somogyi Effect
What's the difference?
-The dawn phenomenon is likely due to an increase in nocturnal secretion of GH.
-The Somogyi effect is a rebound response to nocturnal hypOglycemia.
How do you figure out the difference clinically?
If AM hyperglycemia is present, check the glucose at 3AM...
If the glucose is ELEVATED, the pt has the dawn phenomenon, you should ELEVATE his/her evening insulin (this will provide extra coverage in the overnight hrs)
If the glucose is LOW, the pt has Somogyi effect, you should LOWER his/her evening insulin (this will avoid nocturnal hypOglycemia)
Resource: Step Up to Medicine 2nd Ed. Agabegi & Agabegi
Bianca,
ReplyDeleteExcellent post, and great review. I like very much how you highlight the buzz parts, shuch as "hypOglycemia."
You are an effective teacher. Peace.
John Bielinski