Somogyi syndrome (Post-hypoglycemic hyperglycemia, Rebound hyperglycemia, Chronic insulin overdose syndrome). The Somoji Phenomenon The Somoji Effect

Diabetes mellitus is a disease with an absolute or relative lack of insulin in the body.

• high levels of “bad” cholesterol in the blood;

Let's look at the features of type 1 and type 2 diabetes.

First type

This is an insulin-dependent form of the disease. A distinctive feature is the non-production or, alternatively, reduced secretion of the hormone insulin.

This explains a person’s dependence on. A feature of type 1 diabetes is the rapid development of symptoms, up to hyperglycemic coma.

Second type

The main risk group for type 2 diabetes is overweight people over 40 years of age.

Insulin production is normal, but there is no adequate cell response to this. Their sensitivity to the insulin produced is reduced.

Glucose does not penetrate the tissues, but accumulates in the blood. The disease does not appear immediately, but after years. The mild course makes diagnosis difficult.

When talking about signs of a disease, definitions such as symptom and syndrome are often confused. In fact, the syndrome is a specific group of symptoms.

Main syndromes of diabetes mellitus type 1 and 2

Let us consider the main syndromes of diabetes in more detail.

Hyperglycemic

This condition is associated with a prolonged and significant increase in sugar levels in the body (from 0.5-11.5 mmol/l).

combined with impaired body functions:

• . The presence of glucose in the urine leads to an increase in its osmolarity;
• hypohydration. Due to polyuria, the amount of fluid contained in the body decreases;
• thirst, increased water consumption due to dehydration;
• decrease in blood pressure numbers. Hypotension is also a consequence of dehydration;
• hyperglycemic coma is the most formidable, deadly manifestation.

Hypoglycemic

This is a complex group of symptoms, provoked by less than 3.5 mmol/l and manifested by nervous, autonomic and mental disorders. Most often, it appears in the morning.

Excessive utilization of glucose can be caused by an overdose of insulin, as well as the secretion of this hormone by a tumor - insulinoma. Hypoglycemia can be triggered by neoplasms of the pancreas and diseases of the adrenal glands.

The first manifestations of hypoglycemic syndrome:

• tremor;
• strong feeling of hunger;
• weaknesses;
• increased sweating;
• behavioral disorders (it looks like alcohol intoxication).

If the patient is conscious, the symptoms are relieved by eating or eating sweets. If there is no consciousness, hypoglycemic syndrome is stopped by administering glucose intravenously.

Surgery or chemotherapy helps to get rid of hypoglycemic syndrome of tumor origin. For Addison's disease - hormone replacement therapy. Prevention is the timely identification of the causes that provoke symptoms.

Neurological

It is observed in both types of the disease. Sometimes it manifests itself from the very beginning of the disease, sometimes years pass before the first manifestations.

Neurological syndrome is accompanied by the following phenomena:

• disorders of the peripheral nervous system: burning sensation in the extremities (especially in the feet), decreased sensitivity, appearance, urinary incontinence;
• ANS disorders – with a long course of the disease (headaches, abdominal pain, decreased blood pressure);
• optic neuropathy due to diabetes;
• brain damage, risk of stroke.

Metabolic

This is a combination of diabetes with obesity, increased cholesterol levels in the blood and. This “bouquet” sharply increases the risk of developing atherosclerotic vascular lesions and associated pathologies: heart attacks and strokes.

The main signs of metabolic syndrome:

• obesity;
• Blood pressure exceeding 135/85 mm. rt. Art.;
• fasting blood sugar exceeds 6.1 mmol/l;
• tendency to thrombosis;
• high cholesterol.

Somogyi phenomenon

This phenomenon is also known as “chronic insulin overdose.” This is a kind of “response” of the body to frequent events of low sugar in the body (hypoglycemia).

Moreover, this concerns not only pronounced, but also hidden hypoglycemia. It is observed in patients when one insulin injection exceeds 80 units.

Manifestations of the Somogyi phenomenon include:

• significant changes in glucose levels;
• periodic hypoglycemia;
• worsening of the condition with increasing insulin dosage;
• in urine and blood - ketone bodies;
• weight gain for no apparent reason, frequent feeling of hunger.

The syndrome is manifested by significant fluctuations in daily sugar levels.

Diagnosis comes down to measuring blood sugar, including at night. If this syndrome is suspected, the insulin dosage is reduced by 20%. It is also necessary to strictly adhere to the diet, split meals throughout the day (the number of meals is 5-6).

If the condition improves against the background of these measures, then the diagnosis is correct. If outpatient treatment is ineffective, hospitalization is necessary to adjust the insulin dose in a hospital setting.

The phenomenon of “dawn” in diabetics

This term was coined by physician D. Gerich in 1984. Blood sugar levels rise in the morning: from 4 to 9 hours.

The reasons for the phenomenon of “dawn” are eating a lot of food at night, stress and the administration of insufficient amounts of insulin.

The reason for the phenomenon is that in the morning the highest content of cotransular hormones in the blood is observed.

Under the influence, the liver produces more glucose, which contributes to an increase in sugar levels. This syndrome occurs in both types of diabetes, and in the first type of the disease it often manifests itself in children and adolescents. The provoking factor is growth hormone somatotropin.

To identify the phenomenon, it is necessary to measure sugar levels at night, from 2 to 3 am. A uniform increase in glucometer readings indicates the presence of the syndrome.

Syndromes of diabetes mellitus in newborns and children

The most common “childhood” DM syndromes are Mauriac and Nobecourt syndromes.

Mauriac

This is one of the severe complications of childhood and adolescent diabetes due to prolonged decompensation of the disease with frequent and. Nowadays, with adequate and constant monitoring of sugar in the body, this syndrome has become rare.

Signs of Mauriac syndrome:

• retardation in growth, sexual and physical development. The formation of secondary sexual characteristics is delayed, girls have irregular menstruation;
• osteoporosis;
• liver enlargement;
• moderate obesity, characteristic “moon-shaped” face.

An enlarged abdomen in this syndrome occurs not only due to the fat layer, but also due to an enlarged liver.

At the same time, the functioning of the liver remains normal. Treatment consists of maintaining it. With timely treatment, the prognosis for life is favorable.

Nobekura

The clinical signs of this syndrome are similar to Mauriac syndrome.

A complication occurs over a long period of time in children without excess body weight.

The syndrome is manifested by liver dystrophy, as well as delayed sexual and physical development.

Treatment is the same as for Mauriac syndrome: stable compensation of the disease.

Conditions characteristic of Mauriac and Nobecourt syndromes are in most cases reversible. Compensation of metabolic processes leads to normalization of growth development and secondary sexual characteristics.

Video on the topic

Possible acute and chronic complications of diabetes:

As you can see, all diabetes syndromes are dangerous to human health. Timely, thorough diagnosis, proper treatment and compliance with the instructions of an endocrinologist are the key to stabilizing the patient’s condition.

is a state of relative hyperglycemia after hypoglycemia, provoked by periodic administration of large doses of insulin. Fluctuations in sugar levels are manifested by a combination of symptoms of hypo- and hyperglycemia. Patients experience attacks of hunger, excessive sweating, trembling, weakness, dizziness, and daytime sleepiness. Visual disturbances in the form of double vision, blurred vision, and “spots” are common. The key diagnostic method is to monitor daily blood glucose levels, determining the arithmetic difference between the maximum and minimum. Treatment is based on gradual adjustment of insulin doses, adherence to a low-carbohydrate diet and physical activity regimen.

ICD-10

T38.3 Insulin and oral hypoglycemic [antidiabetic] drugs

General information

Somogyi syndrome is named after the American physician-researcher Michael Somogyi, who observed the process of treating patients with diabetes and discovered the existence of the phenomenon of hyperglycemia immediately after acute hypoglycemia, developing on the basis of periodic administration of increased volumes of insulin. Synonymous terms for this condition are chronic insulin overdose syndrome, rebound hyperglycemia, post-hypoglycemic hyperglycemia. Develops in various types of diabetes mellitus, for the treatment of which insulin is used. Children, adolescents and young people aged 18-25 are more susceptible to the syndrome. Epidemiological rates among these groups reach 70%. With a labile course of diabetes, the prevalence of the syndrome is 85-90%.

Causes of Somogyi syndrome

The etiological factor of post-hypoglycemic hyperglycemia is chronic insulin overdose. As a rule, first a single situation of increased blood glucose occurs, the patient decides to increase the dose of the drug, which provokes hypoglycemia. Repeated measurement of sugar gives even higher values ​​than the previous time. An increased dose of insulin is reintroduced. The development of the syndrome is supported by regular injections with inadequate amounts of the hormone. Risk factors for rebound hyperglycemic reactions include:

• Excessive physical activity. The more severe the hypoglycemia, the higher the likelihood of a response increase in glucose. Unusually intense physical activity shortly before or after the injection increases hypoglycemia.
• Malnutrition. A deficiency of carbohydrates in the diet is accompanied by a decrease in glucose in the bloodstream. The next injection of insulin easily leads to hypoglycemia and a subsequent compensatory increase in blood sugar.
• Alcohol consumption. Ethyl alcohol inhibits the processes of gluconeogenesis in the liver. The hypoglycemic effect appears gradually and often coincides with the period of night sleep (hunger).

Pathogenesis

The pathogenetic mechanisms of the syndrome were described by M. Somogyi, and then supplemented by G. Selye’s theory of the formation of stress (general adaptation syndrome). Injecting large amounts of insulin causes a sharp decrease in glucose. Hypoglycemia develops - a condition that is stressful for the body and is regarded as life-threatening. Systems are mobilized that activate spare pathways for energy production - the hypothalamic-pituitary-adrenal and sympathoadrenal. A large amount of adrenaline, norepinephrine, cortisol, adrenocorticotropic hormone, somatotropic hormone, and glucagon are secreted into the bloodstream.

All these hormones have a hyperglycemic and fat-mobilizing effect - they enhance the processes of fat breakdown and the formation of glucose from non-carbohydrate compounds. The basis of hyperglycemia is the active breakdown of glycogen from the liver, a strategic energy reserve. Plasma concentration of sugar reaches 15-20 mmol/l or more. The breakdown of fats accelerates the formation of ketones, removing them through the kidneys and lungs. Thus, the pathogenesis of the Somogyi phenomenon is described by three successive processes: hypoglycemia due to excess insulin, secretion of contrainsular hormones, rebound hyperglycemic reaction.

Symptoms

Diabetes mellitus, occurring against the background of insulin overdose syndrome, is characterized by an unstable and severe course. Hypoglycemia is replaced by hyperglycemia, the classic symptoms of these conditions are smoothed out and modified. The most common signs of low sugar are attacks of drowsiness and fatigue, dizziness, which disappear after eating carbohydrate foods. At night, sleep is disturbed, nightmares occur, and sweating increases. Children cry and scream without waking up. After waking up, headaches are felt, a feeling of fatigue and weakness persists.

During the day, mood instability, irritability, depression, and tearfulness are observed. Children and adolescents become more aggressive, show negativity towards the demands of adults, and refuse to eat. despite the feeling of hunger caused by hypoglycemia. In rare cases, causeless euphoria occurs - joy, high spirits, hyperactivity. The state of decompensated diabetes does not contribute to weight loss; patients eat more than usual, and some gain weight. Another specific symptom is reversible visual disturbances, including blurred vision, double vision, “spots” and dots before the gaze. With a long course of Somogyi syndrome, overt hypoglycemia becomes a rare occurrence; its asymptomatic course is more typical.

Complications

If contrainsular hormones are actively secreted for a long time, diabetic ketoacidosis develops - metabolic acidosis caused by hyperglycemia and excess ketone bodies in the plasma. Nausea, vomiting, abdominal pain, lethargy, drowsiness, dehydration with tachycardia and decreased blood pressure appear. A typical symptom is rapid breathing (Kussmaul breathing) with the smell of acetone in the exhaled air. Without timely medical assistance, a state of darkened consciousness occurs. Ketoacidosis can lead to cerebral edema, ketoacidotic coma, and death.

Diagnostics

The difficulties in identifying the syndrome are due to the fact that the clinical manifestations of excess and deficiency of insulin are difficult to differentiate, and standard laboratory tests for diabetes mellitus (level of glycemia, glucosuria, ketonuria, diuresis) are not informative enough. Often, symptoms of hypoglycemia occur with normal and elevated glucose values ​​and are not caused by its deficiency, but by a sharp decrease in a short time. Therefore, rebound hyperglycemia is suspected in almost all patients with severe labile diabetes. The diagnosis is made on the basis of clinical and laboratory examination data obtained during dynamic observation of the patient. The following signs are characteristic:

• Symptoms of hyperglycemia, hypoglycemia. Patients report malaise, weakness, fatigue, dizziness, sleep disturbances and daytime sleepiness. A specific manifestation is considered to be increased appetite, often with bouts of gluttony, and weight gain. The patient's relatives note changes in the emotional state - irritability, mood swings, tearfulness, aggressiveness.
• Fluctuations in daily glycemia. The glucose concentration monitoring procedure is carried out throughout the day (sometimes it takes 48-72 hours). Sharp changes in indicators from low to high are determined - “diagorkas”. The daily amplitude of glycemic fluctuations is more than 5.5 mmol/l. Most patients have ketone bodies in their urine and blood.
• High dosage of insulin. During the survey, it turns out that patients use high daily doses of insulin, exceeding those prescribed by the endocrinologist. The maximum activity of the drug is determined at night. Attempts to increase the dosage even further are accompanied by deterioration of well-being.

Differential diagnosis involves distinguishing between Somogyi syndrome and the dawn phenomenon, a state of morning hyperglycemia caused by insulin deficiency after a period of overnight fasting. The key differences between the two syndromes are that “dawn” hyperglycemia occurs after normoglycemia, rather than hypoglycemia, and is compensated by a standard dose of insulin.

Treatment of Somogyi syndrome

Based on the pathogenesis and cause of rebound hyperglycemia, it can be assumed that to eliminate it it is enough to reduce the dosage of hormone injections. However, research shows that the isolated use of this technique rarely improves the course of diabetes. Therefore, in clinical endocrinology, an integrated approach is common, combining three key areas:

• Correction of insulin therapy. The main method of treatment is to reduce the daily amount of insulin by 10-20%. There are two correction methods. With the slow method, the dose of the hormone is gradually reduced over 2-3 months. A quick way to reduce dosage takes up to 10-14 days. In both cases, the patient's condition is carefully monitored by a doctor.
• Changes in diet therapy. To prevent hypoglycemia, the amount of carbohydrates is increased to the physiological norm. A larger volume of cereals (porridges, side dishes) and wholemeal products are added to the diet. Insulin is administered repeatedly in small doses before each meal.
• Rationalization of physical activity. Depending on the prevalence of hyper- or hypoglycemia, the physical activity regime is increased or decreased. Based on the results of glycemic monitoring, the optimal time for playing sports, the nature and intensity of the loads are determined.

Prognosis and prevention

With timely detection and proper correction of treatment for diabetes, Somogyi syndrome is prognostically favorable - metabolic disorders become less pronounced, the disease enters the stage of compensation. Prevention should be focused on the use of a minimum dosage of hypoglycemic drugs and insulin, increasing the skills of self-control of the disease. Patients and their family members need to receive as much information as possible about the mechanisms of hyperglycemia and diabetes, introduce the principles of diabetic nutrition, regular exercise and walking, and glycemic control procedures into everyday life.

Diabetics must be able to calculate the required amount of insulin. Its deficiency or excess leads to negative consequences. One of them is Somogyi syndrome. The pathology is also known as “rebound posthypoglycemic hyperglycemia.” This is not a disease, but the consequences of introducing insulin into the body in increased quantities. As this phenomenon develops, the patient's condition worsens significantly. Therefore, it is important to figure out how to get rid of it.

Characteristics of the syndrome

As a result, occurring after the administration of insulin, Somogyi syndrome may develop. A drop in glucose is perceived by a diabetic’s body as severe stress. As a result, the levels of norepinephrine, cortisol, adrenaline, somatotropin and glucagon increase.

The growth of counter-insular hormones provokes the breakdown of glycogen in the liver. This is a strategic supply of glucose that is stored there in case of a sudden sharp drop in sugar. Reacting to the activity of hormones, the liver releases it into the body in huge quantities. As a result, hyperglycemia develops: sugar can rise above 21 mmol/l.

The disease is characterized by the fact that if the hormone is incorrectly calculated and administered in increased quantities, the patient develops hypoglycemia. After some time, the glucose concentration increases, the patient again injects insulin in an increased amount.

As a result, sensitivity decreases. The patient constantly increases the dose, but it is not possible to get rid of hyperglycemia - a constant overdose occurs.

Signs of pathology

The Somogyi phenomenon can cause a rapid drop in sugar concentration. It happens that the patient does not even have time to react to a sharp fall. This is hidden hypoglycemia.

The development of the syndrome can be suspected based on the following signs:

• hypoglycemia;
• constant ;
• deterioration of the condition even with an increase in the amount of insulin administered;
• the appearance of ketone bodies in urine tests;
• weight gain and constant feeling of hunger.

Due to the release of hormones, the process of fat mobilization begins, they break down, resulting in the release of ketone bodies. This leads to the formation of acetone in the urine. Most often its appearance is observed in the morning. With this syndrome, ketone bodies appear not due to hyperglycemia, but as a result of the intense work of counter-insular hormones.

Due to an overdose of insulin, glucose levels drop, the patient suffers from hunger, and as a result, weight gain.

In case of infectious diseases, the condition improves slightly. This occurs because the body is subjected to additional stress. At the same time, the level of counter-insular hormones increases, as a result, an overdose of insulin does not occur.

Patients who develop the Somogyi effect often complain of poor health, which manifests itself in:

• headache;
• sleep disorders;
• dizziness;
• weakness and feeling of exhaustion, especially in the morning;
• the appearance of nightmares;
• constant sleepiness throughout the day.

In addition, visual disturbances occur - “floaters”, fog before the eyes, a veil, and bright spots appear. But visual disturbances quickly disappear. This indicates hidden hypoglycemia.

Diagnosis of the problem

Chronic overdose syndrome is difficult to identify. One of the diagnostic methods is to regularly measure blood sugar and calculate the difference between the maximum and minimum levels throughout the day. If diabetes is stable without complications, then this difference should not be more than 4.5-5.5 mmol/l. If the overdose is chronic, then the surges exceed 5.5.

Many people confuse this phenomenon with dawn syndrome. But it's not the same thing. During the "morning dawn" sugar concentration begins to rise in the predawn hours, usually from 4 to 6 am. At this time, counter-insular hormones begin to work actively - the concentration of sugar increases accordingly.

This phenomenon is typical not only for patients with carbohydrate metabolism disorders. A similar process occurs in healthy people. But in the absence of problems with the absorption of glucose, this does not affect their well-being in any way. Dawn syndrome most often occurs in adolescents, since their bodies produce somatotropin in large quantities at this time.

The main difference between Somogyi syndrome is the fact that between 2 and 4 a.m. the lowest glucose levels are observed, and in the pre-dawn hours its content is normal. They also check acetone and sugar in daily and portioned urine: if the syndrome is present, they will not be detected in all portions.

Determination of the disease in children and detection of hidden hypoglycemia in adults

Although adults with insulin-dependent diabetes can feel signs of hypoglycemia, it is more difficult to understand what is happening to the child.

You can tell that your blood sugar has dropped by the following symptoms:

• the headache that appears goes away after eating easily digestible carbohydrates;
• sudden mood changes;
• the appearance of temporary vision problems;
• sleep disorders.

The following signs may indicate latent hypoglycemia in children:

• the mood changes sharply: calm play is replaced by an overly excited state or, conversely, lethargy;
• when walking outside, the baby may complain of weakness;
• night attacks of low sugar are accompanied by restless sleep, crying at night, and in the morning the child wakes up broken and lethargic.

But only monitoring blood sugar levels throughout the day will help you say for sure.

Ways to normalize the condition

Seeing constantly rising sugar levels, most people begin to increase their insulin dose instead of analyzing the possible causes of hyperglycemia. Before increasing your concentration, you should monitor your condition, trying to adhere to a standard daily routine.

But before dealing with treatment methods, the diagnosis should be confirmed. You can do this yourself by measuring your sugar levels every 3 hours at night. The peak of hypoglycemia in standard cases occurs at 2-3 am. But in situations where the dose of insulin administered is excessively high, the peak fall can occur at any time. Therefore, hourly monitoring will be more indicative.

With Somogyi syndrome, the readings will be normal at the beginning of the night. In the middle, sugar will drop significantly, and in the morning its concentration will increase, because against the background of hypoglycemia, the process of glycogen release from the liver will begin.

Getting rid of pathology is quite difficult. You must adhere to certain therapy. The patient must understand that the syndrome is not a disease, but the consequences of inadequate insulin therapy.

The dosage must be gradually reduced. But you can only reduce it by 10-20%. At the same time, the use of other methods for correcting the condition is required:

• patients should monitor the amount of carbohydrates consumed;
• insulin must be administered before each food consumption;
• Physical exercise becomes mandatory.

Usually the doctor determines the dosage change schedule. Initially, they check how basal insulin works at night, then during the day. They also look at how the patient reacts to short-acting drugs. Depending on the situation and condition, a dose reduction method is chosen:

• fast (2 weeks);
• slow (3 months).

The decision on choosing the appropriate method should be made by an endocrinologist. As soon as it is possible to achieve a decrease in glucose levels, a patient with an insulin-dependent type of disease can begin to feel a decrease in sugar again. The number of hidden hypoglycemia will be minimized. In this case, insulin resistance is normalized.

May lead to Somogyi phenomenon, also known as chronic insulin overdose syndrome.

The pathology increases the amount of glucose in the blood, resulting in the release of hormones. The result is instability in the course of diabetes.

In the 20-30s of the 19th century, many studies were carried out on insulin. Experiments on animals and test inflated doses offered to patients with anorexia showed an unexpected result - rapid transition of the body from a hypoglycemic to a hyperglycemic state.

The pathogenesis formulated by Somogyi in 1941 was clarified first in 1959, then in 1977. The administration of a large dose of insulin leads to a decrease in plasma glucose, causing hypoglycemia. Subsequent stress activates the release of hormones, causing the formation of sugars and hyperglycemia.

The development of Somogyi syndrome is promoted by excessive consumption of insulin-containing substances. The maximum dose identified in 1922 is considered to be 11 units of the substance per day.. According to statistical observations, the syndrome occurs more often in children and adolescents.

Symptoms

The appearance of the syndrome is determined by a combination of factors:

• - low blood sugar. Indicators of 3.5 mmol/l and below are considered dangerous;
• Frequent, sharp changes in plasma sugar levels;
• Deterioration of the patient's well-being with increasing insulin doses;
• Detection of ketone bodies in the patient’s urine;
• Excess weight, constant feeling of hunger.

You should take a urine test in the morning: in a dream, as a result of metabolism, ketone bodies enter the liquid, the presence of which indicates a suspicion of the Somogyi phenomenon. Hunger occurs due to low glucose levels, which indicates hypoglycemia.

Hidden hypoglycemia

The Somogyi phenomenon is accompanied by unrecognized ones. Pathologies are identical to obvious ones. The only difference is the difficulty of detection.
The following symptoms may indicate the presence of hidden hypoglycemia:

• Unexpected migraines, dizziness;
• Short-term weakness, visual impairment;
• Sleep disorders: nightmares, feeling of lack of sleep.

Diagnostics

Somogyi syndrome is not easy to detect. The standard method is to measure sugar levels multiple times daily and calculate the difference between the higher and lower values. With a stable diabetic disease, the maximum jump in sugar is 5 mmol/l. Exceeding this indicator indicates the presence of a complication and requires consultation with a doctor. Sudden changes in sugar levels are also a symptom dawn syndrome.

Important!

The difference is as follows: with the Somogyi phenomenon, jumps are observed throughout the day, and with the “dawn” - only in the morning hours.

Chronic insulin overdose syndrome is marked by an additional unusual phenomenon: at night, between 02:00 and 04:00, the lowest blood sugar levels are observed, then, before the first meal, the level is normal. The detection of such a phenomenon indicates the need for a urine test.

Diagnosis of the disease in children, detection of hidden hypoglycemia

An adult patient can detect problems in the body and consult a doctor on their own, but a child does not always talk about feeling unwell.

Latent hypoglycemia may occur, which is difficult to recognize. In each case, careful observation can help identify the problem.

The presence of hypoglycemia is accompanied by:

• Severe headache, weakness. An important factor: the symptom occurs unexpectedly and goes away quickly after eating light carbohydrates: honey and foods with high levels of sugar;
• Sudden changes in emotional state;
• Short-term disturbances in the functioning of the visual organs;
• Improper sleep - nightmares, insomnia, daytime sleepiness.

In children, symptoms are more pronounced:

• The emotional and physical state changes dramatically in the general direction. A calm child can become active and aggressive. The fidget is the opposite - tired, lethargic. At any moment, the child may suddenly feel weak;
• Sleep becomes restless, awakening becomes sluggish.

A doctor can accurately determine the presence of the disease based on monitoring the level of sugar in the blood plasma.

Diabetes mellitus and Somogyi syndrome

Presence of chronic insulin overdose syndrome worsens the course of diabetic disease. Hypoglycemia becomes more hidden, the patient’s emotional state changes sharply, without reason. An indifferent, apathetic state may appear.

Less commonly, the patient becomes aggressive. In some cases, it is possible to refuse food despite hunger.

Symptoms of hypoglycemia move to a new level: dizziness becomes more frequent, attacks of weakness take more strength, sleep becomes more restless. Violations of the visual organs are aggravated, up to double vision of visible objects.

Methods for relieving symptoms of the phenomenon

An increased sugar level for a diabetic is a signal to increase the dose of insulin. This mistake can have a negative impact on the body.

First you should make sure that the reason is not the Somogyi phenomenon.

To do this, you need to monitor your condition for several days, then consult a doctor and provide information.

During observation, be sure to measure your sugar level at least every 3-4 hours throughout the day. Frequent measurements will help clarify the unclear situation.

Treatment of the syndrome takes time and effort and requires compliance with all doctor’s recommendations. The Somogyi phenomenon is caused by excess insulin, so you need to start by reducing it. The daily intake of the substance should be reduced by a small amount. The result should be a figure of at least 85% of the initial one.

At the same time, you should:

• Count the carbohydrate content of food by eating low-content foods;
• Use insulin only before meals;
• Start physical training to normalize substance consumption.

For accurate advice, you should definitely consult a doctor. The rate of reduction in insulin consumption is also determined by a specialist. Depending on the patient’s body, the process can last from two to thirteen weeks.

An endocrinologist is an expert who can correctly prescribe treatment, which will result in normalization of the diabetic condition.

Useful video:

Learn about insulin in the “Useful Video” section:

Departure from the prescribed insulin intake can lead to the Somogyi phenomenon - a process that harms the weak body of a diabetic. Detection of the syndrome is a complex process, but timely attention to symptoms will help prescribe treatment earlier.

5 / 5 ( 1 voice )

In this article I would like to raise the following question: what is somogyi syndrome and how to get rid of it.

I will say right away that this complication is not as common as dawn syndrome, but no less dangerous. Especially for people of our mentality who like to self-medicate and go to the doctor when they can no longer put it off.

Somogyi syndrome is a chronic insulin overdose that causes frequent (both overt and hidden) symptoms. In scientific circles, this syndrome is more often called post-hypoglycemic hyperglycemia or rebound hyperglycemia.

An example of Somogyi syndrome

To make it clearer for you, I decided to give a clear example.

You measured your sugar, and let’s say it’s 9 mmol/l. To lower this value, you inject insulin and go to work. After some time, signs of hypoglycemia appear, such as weakness. You don’t have the opportunity to eat something to increase your sugar. Over time, the symptoms go away and you return home in a great mood. But after measuring your sugar, you saw a value of 14 mmol/l. Deciding that you took a small dose in the morning, you take insulin and give a larger injection.

The next day the situation repeated itself, but we are not weaklings and we won’t just go to the doctor. You just need to inject more insulin. 🙂

This situation may continue for several weeks. And each time you will prick more and more. Headache and excess weight will appear unnoticed. It is at this moment that women usually run to the doctor. Men are more resilient and can hold out until more serious complications arise.

Signs of Somogyi syndrome

Let's summarize. If you notice any of the following symptoms, do not delay and go to the doctor:

• Frequent hypoglycemia
• Unreasonable sugar spikes
• The need to constantly increase the amount of insulin in injections
• Sudden weight gain (especially on the stomach and face)
• Headaches and weakness
• Sleep becomes restless and shallow
• Frequent and causeless mood swings
• Blurred vision, foggy or grainy eyes

Somogyi syndrome - features

1. Some people confuse this syndrome with dawn syndrome. To make sure you have Somogyi, measure your sugar several times at night at intervals of 2-3 hours. If your glucose doesn't go down, you have dawn syndrome and you need to increase your insulin. If your blood sugar is normal at night, but the symptoms listed above are constant, you need to lower the amount of insulin, since you have Somogyi syndrome.

2. This syndrome is also easy to detect in laboratory conditions. Urine samples are taken at different times. If there is acetone in some samples, but not in others, then sugar is elevated due to constant hypoglycemia, and this is a clear sign of Somogyi.

3. To get rid of the syndrome, you need to gradually reduce the insulin dose by 10-20%. If after a week the situation with blood sugar does not improve, you need to consult a doctor so that he can select the optimal treatment for you.

It is important to remember that very high sugar can cause other, more serious problems. Therefore, it is necessary to cope with this unpleasant syndrome as quickly as possible.