Mnemonic for Dawn & Somogyi phenomenon

Hello everyone....

A diabetic patient who is taking NPH insulin regularly at early evening time presents with early morning headache. He also feels very stressed & tiredness. 

I have checked that he is hyperglycemic.

Suddenly I think about Dawn & Somogyi phenomenon. But I have a confusion between that 2 terms.

So I make a mnemonic…

Here it is ..

Dawn & Somogyi phenomenon

In both Early Morning High Glucose 

= Due to ⬆️ GH & Cortisol Surge 

What is the difference ??

Normal is DAWN = Normal Glucose at 3 AM = You have to treat Patient with Night Long acting insulin.

but if you give high dose = Risk of SomOGYi ..!!

Secondary to Excessive Night Insulin Dose in SomOGYi= HypOGLYcemia at 3 AM 

Normally NPH action is maximal in late evening & middle of night & minimal in early morning.

So patient is taking NPH insulin too early because of that he has normoglycemia at bedtime & Nocturnal hypoglycemia & Early morning Hyperglycemia even before breakfast.

So what is the solution for this patient ? 

Shift the time from early evening to before bedtime.

Or Shift the type from NPH to Insulin Glargine / Detemir ( Longer acting & flatter profile ).

Read detailed explanation by awesome IkaN here...

https://www.medicowesome.com/2015/02/somogyi-effect-and-dawn-phenomenon-in.html