Do you also have high blood sugar in the morning? Could this be due to the Somogyi Effect?

Have you ever had this happen to you, a diabetic? Even though you've been taking your medication at night and your blood sugar levels are well controlled, when you wake up in the morning and check your glucometer, your blood sugar is very high. You might be thinking, "Oh, I don't know if I took enough insulin at night." But the reason for this could be something completely different than you think. Today we're talking about a condition that can be suspected at times like these, but is not very well known. That's the 'Somogyi effect.'

What is the Somogyi Effect?

Simply put, the Somogyi Effect is when your blood sugar levels drop too low (hypoglycemia) in the middle of the night while you're sleeping, and your body releases hormones in response, causing your blood sugar levels to rise too high (hyperglycemia) when you wake up in the morning. It's like a rubber band that snaps back in one direction when you let go. This is sometimes called "rebound hyperglycemia."

This was first discovered in the 1930s by a doctor named Michael Somogyi, which is why the condition is named after him.

But here's something important to understand. Scientists still don't consider the Somogyi Effect to be 100% proven, it's a 'theory'. That means that even though there is scientific evidence that it can happen, not everyone accepts it. In the past, doctors thought that this was the main reason for high blood sugar in the morning, but new technology, especially the advent of continuous glucose monitoring (CGM), has raised questions about this idea.

However, it is very important to be aware of this as one of the many reasons for high blood sugar in the morning.

What are other reasons for high blood sugar in the morning?

Before pointing the finger solely at the Somogyi effect, there are several other common causes of high blood sugar in the morning.

• Insufficient medication dosage: If you take too little of your diabetes medication or insulin at night, it may lose its effectiveness by morning and cause high blood sugar.
• Dawn Phenomenon: This is the most common reason for high blood sugar in the morning. Let's look at this in a little more detail.
• Mismatch between dinner and medication dosage: If the insulin dose is not calculated to match the amount of carbohydrates eaten at dinner, blood sugar levels may increase in the morning.
• Insulin Resistance: A condition in which the body's cells do not respond properly to insulin.

What is the difference between the Somogyi Effect and the Dawn Phenomenon?

Although both of these cause a spike in blood sugar in the morning, there is a big difference between the two. As a person with diabetes, understanding this difference will be very helpful for you.

The Dawn Phenomenon is when our bodies naturally release certain hormones (such as cortisol and growth hormone) in the early morning (around 3-4 am). These hormones cause blood sugar levels to rise. This is also true for people without diabetes, but their bodies produce and control insulin. People with diabetes can't do this, so they have high blood sugar levels in the morning.

But the Somogyi Effect is different. It occurs in response to a drop in blood sugar (hypoglycemia) in the middle of the night. In the Dawn Phenomenon, there is no drop in blood sugar at night.

Let's look at the main differences between the two.

What are the symptoms of the Somogyi effect?

The main sign of this is high blood sugar levels when you wake up in the morning. However, you may also experience symptoms of low blood sugar at night.

Symptoms of high blood sugar in the morning (Hyperglycemia)

• Increased thirst: Feeling like you're not getting enough water no matter how much you drink.
• Frequent urination: Needing to urinate more often than usual.
• Increased hunger: Feeling hungrier than usual in the morning.
• Headache: Headache upon waking up in the morning.
• Anger: Getting angry over small things.

Symptoms of low blood sugar at night (Nocturnal Hypoglycemia)

You may not notice these symptoms because you are asleep.

• Sweating in sleep: Sweating so much that the sheets and pajamas are wet.
• Bad dreams: Waking up from sleep after having a frightening dream.
• Restless sleep: Tossing and turning, sleeping restlessly.
• Feeling tired when you wake up in the morning: Feeling tired and groggy in the morning, even after sleeping well.

If you have symptoms like these at night and your blood sugar is high in the morning, you may suspect the Somogyi effect.

Why is this happening? What is the reason?

Imagine, you took an insulin injection at night, or you exercised before dinner. For this reason, in the middle of the night while you were sleeping, without you even realizing it, your blood sugar level drops dangerously low (`hypoglycemia`).

At this point, your body thinks, "Oh, something bad is going to happen!" So the body takes emergency action to "save" you. That is, it suddenly releases several hormones into the bloodstream that are activated in emergencies.

• Adrenaline
• Corticosteroids
• Growth hormone
• Glucagon

These hormones combine to send a signal to your liver to "Quickly release sugar into your bloodstream!" The liver then suddenly releases a large amount of glucose that has been stored there into your bloodstream.

If this happens to someone without diabetes, their body produces insulin to control the increased sugar levels. But because your body with diabetes can't do that, the increased sugar levels just keep going up, and when you wake up in the morning, you see high sugar levels (hyperglycemia) . That's what happens, quite simply.

How exactly do you find this situation?

Since there are many reasons for high blood sugar in the morning, it can be a little difficult to determine if this is the Somogyi effect. Also, as we mentioned earlier, since this is not considered a very common cause anymore, it can be a challenge even for a doctor to "diagnose" it.

The best thing to do, if you continue to have high blood sugar in the morning, is to talk to your diabetes doctor about it. He or she will try to find out the cause by looking at how your blood sugar levels are changing.

The best way to do this is to use a Continuous Glucose Monitoring (CGM) device. This allows you to see a clear graph of how your blood sugar levels have changed throughout the night.

If you are not using a CGM, your doctor may tell you to do something like this:

By doing this for a few days and showing the readings to your doctor, he can get a good idea of ​​what's going on at night. If your blood sugar is low in the middle of the night and high in the morning, it could be the Somogyi effect.

What solutions can be done for this?

Once you've identified the cause, you and your doctor should work together to find a solution. Everyone is different, so there's no one-size-fits-all solution. It may take some time to find what works best for you.

Your doctor may suggest solutions like these:

• Changing your insulin or medication dose: You may be asked to slightly reduce your insulin dose at night.
• Changing your dinner: You may be advised to change the amount of carbohydrates, protein, or fat you eat for dinner. You may also be advised to have a small snack before going to bed.
• Switching to an Insulin Pump: If possible, an insulin pump can help control insulin doses more accurately.
• Changing the time of your workout: If you exercise in the evening or at night, you may want to change the time or intensity of your workout.

What are the complications that can occur if this is ignored?

Regardless of whether the Somogyi effect really happens or not, this situation raises two main points that we with diabetes should be aware of:

1. Continuously high blood sugar levels.

2. Risk of low blood sugar levels at night.

1. Continuously high blood sugar levels

Having high blood sugar levels for a few hours every morning is not good for your overall diabetes management. It can increase your `A1C` value. `A1C` is a test that gives an idea of ​​your average blood sugar levels over the past three months. A high `A1C` value over a long period of time increases your risk of complications from diabetes.

• Eye damage (Retinopathy)
• Kidney damage (Nephropathy)
• Neuropathy (affecting the nerves)
• Heart disease

2. Risk of low blood sugar levels at night

Many people experience symptoms of hypoglycemia when their blood sugar drops below 70 mg/dL. They may experience shakiness, hunger, and sweating. But if this happens while you're sleeping, it may be too late to notice the symptoms and wake you up. Severe hypoglycemia can be life-threatening.

If you often experience low blood sugar at night, be sure to talk to your doctor about it. Your treatment plan may need to be changed to prevent it.

When should you definitely see a doctor?

If you consistently have high blood sugar when you wake up in the morning, don't ignore it. It's important to tell your diabetes doctor. He or she can look at your readings, determine if the cause is the Somogyi effect, the Dawn phenomenon, or something else, and give you the best treatment for you.

Having high blood sugar in the morning can be really frustrating. But since there is no one-size-fits-all solution, it may take some time to find the right solution for you. Be patient and work with your doctor. Taking action now can go a long way in helping you avoid short-term and long-term complications.

Diabetes, sugar, Somogyi effect, morning high blood glucose, hyperglycemia, hypoglycemia, dawn phenomenon, insulin