dwan and somayagi - drman7

[ArchivalUser]

how to handle these.whether we have to alter morning or night dose.

[ArchivalUser]

somogyi is too high dose,, give dose at dinertime rather then bed time decrease dose next step
dawn is too low dose , increase dose

[ArchivalUser]

you mean,we have to increase night dose for dawn.

[ArchivalUser]

Dawn phenomena....insulin given is of low dose than required to control glucose level, therefore in morning pts have high glucose...Rx: increase insulin dose

Somogi...insulin given in very high doses, as a result very low level of glucose in midnight...so counter-regulatory hormones are secreted in large amounts to compensate which increases the glucose levels in morning....Rx: decrease insulin

if in morning the patient is with high glucose levels...n u r not sure that if the patient is having dawn phenomena or somogi effect...as in both cases patient has high glucose in morning: then first decrease insulin because if u decrease insulin and the next morning the patients glucose is normal than it is somogi, and if it is more higher than its dawn...n then adjust accordingly

Note: u cannot increase insulin as first step because if u inc insulin in the patient and if its somogi then the pt may die of hypoglycemia in midnight...on the contrary incresing insulin will not cause an immediate death...

i hope it helps

[ArchivalUser]

last line must be, the contrary decreasing insulin will not cause an immediate death.

[ArchivalUser]

I dont think one should decrease insulin with out attempting to daignose DAWN vs. Somogyi effect.

Archer lectures say:

The differentiation between DAWN vs. Somogyi effect can easily be done.
1. Look for clinical features like nightmares in case history. NIGHTMARES in a question like this suggest a hypoglycemic effect.
2. If there is no clue like this in the history, do a 3 AM RANDOM BLOOD SUGAR. If a 3AM random sugar is low, it suggests somogyi as the cause of early morning hyperglycemia. If 3 AM sugar is high, that suggests DAWN phenomenon.

After confirming this :
Next step, reduce night time insulin dose if SOMOGYI EFFECT.
Increase night time insulin if DAWN phenomenon.

never adjust insulin doses with out confirming first.

[ArchivalUser]

I meant to say NIGHTMARES in history suggests somogyi effect.