While providing care for a patient with type 2 diabetes, the nurse recognizes which of the following symptoms may indicate the patient could be experiencing a Somogyi effect? (Select all that apply.)

Question

a. Fasting morning glucose is 80 mg/dL.
b. Fasting morning glucose is 264 mg/dL.
c. Patient reports night sweats.
d. Bedtime glucose is 110 mg/dL.
e. Patient complains of headaches in the morning.
f. Blood glucose is rising despite increased doses of insulin.

Answer 1

ANS: B, C, E, F
The Somogyi effect may be at fault when the patient's blood glucose seems to be rising in spite of increasing insulin doses. If insulin levels are too high, the blood glucose may drop too low, stimulating release of counterregulatory hormones (epinephrine, glucagon, corticosteroids, growth hormone) that then elevate the blood glucose. The low glucose levels often occur during the night, and the patient may report night sweats or morning headaches. The high morning glucose is then interpreted as hyperglycemia, and the insulin dose may be further increased, compounding the problem.