Do high fasting glucose levels suggest nocturnal hypoglycaemia? The Somogyi effect-more fiction than fact?

• Published in: Diabetic medicine Vol. 30; no. 8; pp. 914 - 917
• Main Authors: Choudhary, P., Davies, C., Emery, C. J., Heller, S. R.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.08.2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Biphasic Insulins - administration & dosage; Biphasic Insulins - adverse effects; Biphasic Insulins - therapeutic use; Blood Glucose - analysis; Blood Glucose Self-Monitoring; Circadian Rhythm; Clinical medicine; Cohort Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Drug Monitoring; Endocrinopathies; Fasting; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Glucose; Humans; Hyperglycemia - chemically induced; Hyperglycemia - epidemiology; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemia - physiopathology; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin - administration & dosage; Insulin - adverse effects; Insulin - therapeutic use; Insulin Glargine; Insulin, Isophane - administration & dosage; Insulin, Isophane - adverse effects; Insulin, Isophane - therapeutic use; Insulin, Long-Acting - administration & dosage; Insulin, Long-Acting - adverse effects; Insulin, Long-Acting - therapeutic use; Medical sciences; Middle Aged; Monitoring, Ambulatory; Prevalence; Severity of Illness Index; United Kingdom - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Obesity; Night; Nutrition; Nutrition disorder; Metabolic diseases; Hypoglycemia; Fast; Endocrinology; Nutritional status; Glycemia
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12175

Aims The Somogyi effect postulates that nocturnal hypoglycaemia causes fasting hyperglycaemia attributable to counter‐regulatory hormone release. Although most published evidence has failed to support this hypothesis, this concept remains firmly embedded in clinical practice and often prevents patients and professionals from optimizing overnight insulin. Previous observational data found lower fasting glucose was associated with nocturnal hypoglycaemia, but did not assess the probability of infrequent individual episodes of rebound hypoglycaemia. We analysed continuous glucose monitoring data to explore its prevalence. Methods We analysed data from 89 patients with Type 1 diabetes who participated in the UK Hypoglycaemia study. We compared fasting capillary glucose following nights with and without nocturnal hypoglycaemia (sensor glucose < 3.5 mmol/l). Results Fasting capillary blood glucose was lower after nights with hypoglycaemia than without [5.5 (3.0) vs. 14.5 (4.5) mmol/l, P < 0.0001], and was lower on nights with more severe nocturnal hypoglycaemia [5.5 (3.0) vs. 8.2 (2.3) mmol/l; P = 0.018 on nights with nadir sensor glucose of < 2.2 mmol/l vs. 3.5 mmol/l]. There were only two instances of fasting capillary blood glucose > 10 mmol/l after nocturnal hypoglycaemia, both after likely treatment of the episode. When fasting capillary blood glucose is < 5 mmol/l, there was evidence of nocturnal hypoglycaemia on 94% of nights. Conclusion Our data indicate that, in clinical practice, the Somogyi effect is rare. Fasting capillary blood glucose ≤ 5 mmol/l appears an important indicator of preceding silent nocturnal hypoglycaemia.