Somogyi hypothesis

Q: Somogyi hypothesis is a dangerous phenomenon in patients with brittle blood sugar issues, and should particularly be watched in ICU? 

A) True

B) False

Answer: B

Somogyi hypothesis once very popular in diabetic literature has now been discredited. Somogyi hypothesis states that nocturnal hypoglycemia causes hyperglycemia the following morning. It has now almost proven that patients with morning hyperglycemia usually have high blood glucose at night. Other reasons to have morning hyperglycemia are nocturnal growth hormone secretion and hypoinsulinemia.

Also, the myth should be busted that nocturnal hypoglycemia awakens patients from the sleep. This is not true even in patients who have insulin pumps i.e., continuous subcutaneous insulin infusion (CSII). This is due to the fact that sympathoadrenal responses to hypoglycemia are diminished during sleep, which means defense against hypoglycemia is reduced, and people with diabetes are less likely to be awakened by autonomic symptoms.

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References:

1. Tordjman KM, Havlin CE, Levandoski LA, et al. Failure of nocturnal hypoglycemia to cause fasting hyperglycemia in patients with insulin-dependent diabetes mellitus. N Engl J Med 1987; 317:1552.

2. Jones TW, Porter P, Sherwin RS, et al. Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 1998; 338:1657.

3. Banarer S, Cryer PE. Sleep-related hypoglycemia-associated autonomic failure in type 1 diabetes: reduced awakening from sleep during hypoglycemia. Diabetes 2003; 52:1195.