Mukherjee Brijesh
Morning hyperglycemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycemic control. The dawn phenomenon is a normal rise in blood sugar as a person’s body prepares to wake up. In the early morning hours, hormones (growth hormone, cortisol and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar. If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. If the body doesn’t produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). Somogyi effect occurs in a person who takes insulin doesn’t eat a regular bedtime snack, and the person’s blood sugar level drops during the night. The person’s body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning. The dawn phenomenon is more common than the Somogyi effect. To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 2 a.m. and 5 a.m. or use a continuous glucose monitoring system.