Did you know that research indicates that elevated postprandial (after-meal) glucose levels
often emerge before fasting glucose levels become abnormally high in the natural history of
diabetes? This is one of the many reasons that research is very important and we must fight
as clinicians to assist with the efforts of researchers.
On a side note, my 45 year old diabetic is on maximum doses of oral antidiabetic agents,
yet the Hemoglobin A1C remains 9. I know that I can start lantus insulin 10 units at night.
I’m sure her blood glucose will improve. I also educated her to count carbohydrates and
exercise daily.
Here is a pearl for you: On the board certification exam, you may have a patient scenario
which is rather long. The patient might have a high blood glucose and the question might
ask “what would you do next”. All of the answers look correct. When a question asks
“which one would you do first”, go through the answers for elimination. If the answer is
“recheck the glucose test” this would be the answer. It would be the first thing you would
do.
Have you heard of Somogyi effect?
The Somogyi (so-MOH-gyee) effect happens when a low blood sugar
(hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning
due to a surge of hormones. It can affect people with diabetes who take insulin.
The effect was named after the doctor who first wrote about it in the 1930s — Dr. Michael
Somogyi. Healthcare providers sometimes call it “rebound hyperglycemia.”
Researchers consider the Somogyi effect a theory, meaning it’s not considered to be a fact,
but there’s scientific evidence that supports it. While healthcare providers once thought of
the effect as a likely cause of morning high blood sugar, more recent studies
involving continuous glucose monitoring (CGM) have disputed the Somogyi effect.
The Somogyi effect is one of multiple possible causes of high blood sugar in the morning,
including:
• Too little medication, which wears off overnight.
• Dawn phenomenon.
• Miscalculating your medication dose with your evening meal/food consumption.
• Insulin resistance.
What is the difference between the Somogyi effect and dawn phenomenon?
, The Somogyi effect and dawn phenomenon are both phenomena that can cause people
with diabetes to have high blood sugar in the morning.
Dawn phenomenon happens when hormones your body naturally makes in the early
morning (including cortisol and growth hormone) increase your blood sugar.
The Somogyi effect also involves a surge of hormones, but it’s due to a low blood sugar
episode overnight. Dawn phenomenon doesn’t happen because of low blood sugar.
Dawn phenomenon is also a much more common cause of high blood sugar in the morning
than the Somogyi effect.
During summertime (now), there is a greater incidence of otitis externa. Do you know why?
Do you know what pathogen is the most common in causing otitis externa? Look it up!!
More summertime fun. Have you ever treated someone with heatstroke? I believe it is very
important for you to know, especially in the summer. The first line of treatment is cooling
and rehydration. In fact, the most commonly utilized intervention for patients with
heatstroke is known to be rehydration. Rehydration regulates body temperature, maintains
organ function & prevents further complications
Let’s talk Atherosclerotic Cardiovascular Disease (ASCVD)
This is a tool that might come in handy: ASCVD Risk Estimator +
Here is a breakdown with regard to statin use:
• Patients with diabetes aged 40-75 years should be started on a moderate-intensity
statin therapy, regardless of their 10 year ASCVD risk
• Patients with diabetes aged 40-75 years and higher cardiovascular risk should be
started on high-intensity statin therapy aiming to reduce LDL cholesterol by 50% or
more
Important notes: Moderate-intensity statins typically lower LDL cholesterol by 30-49%.
High intensity statins lower LDL cholesterol by 50% or more. Low-intensity statings are
generally not recommended for people with diabetes but may be used if higher doses are
not tolerated. Statins are effective in reducing the risk of cardiovascular events in people
with diabetes, even those at moderate or low ASCVD risk. While statins can increase blood
often emerge before fasting glucose levels become abnormally high in the natural history of
diabetes? This is one of the many reasons that research is very important and we must fight
as clinicians to assist with the efforts of researchers.
On a side note, my 45 year old diabetic is on maximum doses of oral antidiabetic agents,
yet the Hemoglobin A1C remains 9. I know that I can start lantus insulin 10 units at night.
I’m sure her blood glucose will improve. I also educated her to count carbohydrates and
exercise daily.
Here is a pearl for you: On the board certification exam, you may have a patient scenario
which is rather long. The patient might have a high blood glucose and the question might
ask “what would you do next”. All of the answers look correct. When a question asks
“which one would you do first”, go through the answers for elimination. If the answer is
“recheck the glucose test” this would be the answer. It would be the first thing you would
do.
Have you heard of Somogyi effect?
The Somogyi (so-MOH-gyee) effect happens when a low blood sugar
(hypoglycemia) episode overnight leads to high blood sugar (hyperglycemia) in the morning
due to a surge of hormones. It can affect people with diabetes who take insulin.
The effect was named after the doctor who first wrote about it in the 1930s — Dr. Michael
Somogyi. Healthcare providers sometimes call it “rebound hyperglycemia.”
Researchers consider the Somogyi effect a theory, meaning it’s not considered to be a fact,
but there’s scientific evidence that supports it. While healthcare providers once thought of
the effect as a likely cause of morning high blood sugar, more recent studies
involving continuous glucose monitoring (CGM) have disputed the Somogyi effect.
The Somogyi effect is one of multiple possible causes of high blood sugar in the morning,
including:
• Too little medication, which wears off overnight.
• Dawn phenomenon.
• Miscalculating your medication dose with your evening meal/food consumption.
• Insulin resistance.
What is the difference between the Somogyi effect and dawn phenomenon?
, The Somogyi effect and dawn phenomenon are both phenomena that can cause people
with diabetes to have high blood sugar in the morning.
Dawn phenomenon happens when hormones your body naturally makes in the early
morning (including cortisol and growth hormone) increase your blood sugar.
The Somogyi effect also involves a surge of hormones, but it’s due to a low blood sugar
episode overnight. Dawn phenomenon doesn’t happen because of low blood sugar.
Dawn phenomenon is also a much more common cause of high blood sugar in the morning
than the Somogyi effect.
During summertime (now), there is a greater incidence of otitis externa. Do you know why?
Do you know what pathogen is the most common in causing otitis externa? Look it up!!
More summertime fun. Have you ever treated someone with heatstroke? I believe it is very
important for you to know, especially in the summer. The first line of treatment is cooling
and rehydration. In fact, the most commonly utilized intervention for patients with
heatstroke is known to be rehydration. Rehydration regulates body temperature, maintains
organ function & prevents further complications
Let’s talk Atherosclerotic Cardiovascular Disease (ASCVD)
This is a tool that might come in handy: ASCVD Risk Estimator +
Here is a breakdown with regard to statin use:
• Patients with diabetes aged 40-75 years should be started on a moderate-intensity
statin therapy, regardless of their 10 year ASCVD risk
• Patients with diabetes aged 40-75 years and higher cardiovascular risk should be
started on high-intensity statin therapy aiming to reduce LDL cholesterol by 50% or
more
Important notes: Moderate-intensity statins typically lower LDL cholesterol by 30-49%.
High intensity statins lower LDL cholesterol by 50% or more. Low-intensity statings are
generally not recommended for people with diabetes but may be used if higher doses are
not tolerated. Statins are effective in reducing the risk of cardiovascular events in people
with diabetes, even those at moderate or low ASCVD risk. While statins can increase blood
