Diabetes!

Today, I shall post something which I think is an important aspect of diabetes, a malignant disease in the way it is spreading across the globe. Truly debilitating, troublesome and poorly managed due to many reasons.

p/s: I should really summarise these two, but I'm lazy and merely copied and paste. Next time perhaps!

This would be an entry of
Somogyi Effect vs Dawn Phenomenon

The main similarity between these two presentations is that hyperglycaemia occurs upon waking up in the morning
The main difference would be the pathophysiology behind them. One is due to hypoglycaemia at night, and the other does not occur with hypoglycaemia in the night.

Topic: Somogyi Effect

This is quite a controversial topic, and therefore not quite adequately mentioned in general clinical textbooks (i believe) due to its lack of scientific evidence despite being well-known to clinicians ( wikipedia )

A brief description from: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Somogyi_Effect

The tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar. The Somogyi effect, also known as the "rebound" effect, was named after Michael Somogyi, the researcher who first described it.

When blood glucose levels drop too low, the body sometimes reacts by releasing counterregulatory hormones such as glucagon and epinephrine. These hormones spur the liver to convert its stores of glycogen into glucose, raising blood glucose levels. This can cause a period of high blood sugar following an episode of hypoglycemia.

The Somogyi effect is most likely to occur following an episode of untreated nighttime hypoglycemia, resulting in high blood sugar levels in the morning. People who wake up with high blood sugar may need to test their blood glucose levels in the middle of the night (for example, around 3 AM). If their blood sugar level is falling or low at that time, they should speak with their health-care team about increasing their food intake or lowering their insulin dose in the evening. The only way to prevent the Somogyi effect is to avoid developing hypoglycemia in the first place.
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Dawn Phenomenon - also hyperglycaemia presentation in the morning
Difference with Somogyi Effect is that this is NOT due to hypoglycaemia in the night.

Dawn Phenomenon - source: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Dawn_Phenomenon

Very high blood glucose in the early morning due to the release of certain hormones in the middle of the night. The body makes certain hormones called counterregulatory hormones, which work against the action of insulin. These hormones, which include glucagon, epinephrine, growth hormone, and cortisol, raise blood glucose levels, when needed, by signaling the liver to release more glucose and by inhibiting glucose utilization throughout the body.

In the middle of the night, there is a surge in the amount of growth hormone the body releases, followed by a surge in cortisol, which effectively cranks up glucose production in the liver, presumably to prepare the body for daytime activity after a period of fasting. In people who don't have diabetes, these processes are offset by increased insulin secretion by the pancreas, so blood glucose levels remain relatively stable. However, in people with Type 1 diabetes, whose pancreases don't make insulin, and in people with Type 2 diabetes, whose livers may not respond to insulin well enough to stop glucose production, changes in glucose metabolism during sleep can have a profound effect on morning blood glucose levels. Typically, the blood glucose level rises between 4 AM and 8 AM.

It is important to realize that high morning blood sugar may be caused by something else: the body's rebound from low blood glucose levels at night. Rebound hyperglycemia, also caused by the release of counterregulatory hormones, represents the body's defense mechanism against low blood sugar. The only way to tell the two phenomena apart is to check your blood glucose level in the middle of the night (around 3 AM). If your blood sugar is high, you are probably experiencing the dawn phenomenon; if it is low, rebound hyperglycemia is probably at work.