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What is the Somogyi effect?

waking up groggy

The Somogyi effect may be similar to the dawn phenomenon.

Named after Michael Somogyi, a Hungarian-born researcher who first described it, the Somogyi effect is the body’s defensive response to prolonged periods of low blood sugar. A dose of insulin before bed that is too high can be a cause.

When insulin reduces the amount of glucose in the blood by too much, it causes hypoglycemia. In turn, hypoglycemia makes the body stressed, triggering the release of the stress hormones epinephrine (adrenaline), cortisol, and growth hormone. The endocrine hormone glucagon is also released.

Glucagon triggers the liver to convert stores of glycogen into glucose, which can send blood glucose levels into a rebound high. The stress hormones keep the blood glucose levels raised by making the cells less responsive to insulin. This is known as insulin resistance.

 

Controversy

The Somogyi effect is widely cited among doctors and people with diabetes, but there is little scientific evidence for the theory.

For example, one small study found that hyperglycemia upon waking is likely to be caused by not enough insulin before bed. Researchers also found that participants who appeared to have rebound hyperglycemia did not have higher levels of growth hormone, cortisol, or glucagon than others.

A 2007 study of 88 people with type 1 diabetes using continuous glucose monitoring, found that individuals who experienced hyperglycemia upon waking had not experienced hypoglycemia at nighttime. In other words, the Somogyi effect was not observed.

However, other studies cite the Somogyi effect as a common cause of morning time hyperglycemia in people with type 1 diabetes.

 

Somogyi effect versus dawn phenomenon

The dawn phenomenon, or “dawn effect,” is similar to the Somogyi effect in that people experience hyperglycemia in the morning. But the reasons for the hyperglycemia differ.

The dawn effect results from a rise in early-morning blood sugar levels, which are triggered by declining levels of insulin, and an increase in growth hormones.

Testing blood sugar levels at 3.00 a.m. and again in the morning can help distinguish between the Somogyi effect and the dawn phenomenon. Blood sugar that is low at 3.00 a.m. indicates the Somogyi effect, while high or normal blood sugar at that time suggests the dawn phenomenon.

The Somogyi effect is considered less common than the dawn phenomenon. But some researchindicates it is the most common cause of fasting hyperglycemia in people with type 1 diabetes.

Symptoms

lady waking up looking concerned

Symptoms of the Somogyi effect may include blurred vision, confusion, and dizziness upon waking.

Symptoms of the Somogyi effect start with high blood glucose levels upon waking, which are unresponsive to increased insulin doses. Symptoms include:

  • low blood glucose levels at 2.00 a.m. or 3.00 a.m.
  • night sweats
  • rapid heart rate
  • waking with a headache
  • blurred vision
  • confusion
  • dizziness
  • dry mouth
  • fatigue
  • increased appetite
  • thirst

Causes

The Somogyi effect is seen in people with diabetes who use insulin therapy to manage their condition. It is caused by:

  • taking too much insulin
  • not eating enough before bed

Both of these factors cause blood glucose levels to fall too low. The body then responds to this by releasing hormones to raise blood sugar levels. However, sometimes the sugar levels get too high, causing hyperglycemia.

Diagnosis

People who have hyperglycemia in the morning without any other known cause may be experiencing the Somogyi effect. Also, morning-time hyperglycemia that resists treatment with increased insulin is also an indicator.

Diagnosing the Somogyi effect is relatively straightforward. It can be done by taking blood glucose readings over several nights.

People should check their blood sugar levels:

  • before bed
  • at 3.00 a.m.
  • upon waking

Low blood glucose at 3.00 a.m., with a high blood glucose reading upon waking, indicates the Somogyi effect.

Diabetes UK advise that, due to the nature of nocturnal hypoglycemia, many people who experience it do not wake up during the night. Therefore, monitoring blood glucose during the night is especially important in diagnosing the Somogyi effect.

Frequent glucose monitoring

Frequent glucose monitoring using a continuous glucose monitoring (CGM) system may be especially helpful.

It can help confirm the diagnosis over time and check for other periods of hypoglycemia that can cause rebound hyperglycemia.

This continuous testing also helps in the management of hypoglycemic unawareness, a complication of diabetes linked to frequent episodes of hypoglycemia. It occurs when a decrease in blood sugar no longer causes the characteristic symptoms of low blood sugar levels, leaving the person unaware that their levels are low.

Treatment and prevention

insulin injection

The only way to prevent the Somogyi effect is to avoid the development of hypoglycemia. Treatment of it should always be in consultation with a doctor.

Treatment options include:

  • adjusting the timing of insulin administration
  • lowering the dose of insulin taken before bed
  • changing the type of insulin used
  • eating a snack with evening insulin dosage
  • taking into account lifestyle factors, such as stress and exercise

Doctors may recommend CGM for the long-term management of diabetes and the Somogyi effect. A CGM system can alert people to hypoglycemia or hyperglycemia through the use of alarms.

To ensure proper management of the Somogyi effect, a person’s weight and levels of the red blood cell protein called hemoglobin A1C, which binds to glucose, may also be monitored over time.

If people need to increase their nightly insulin dose, the risk of the Somogyi effect increases. So, to check for the Somogyi effect, testing blood sugar levels at 3.00 a.m. may be necessary for the first few nights following the insulin increase. If the new dose is causing issues, a doctor may recommend increasing the dosage gradually so that the body can adjust.

Outlook

If the Somogyi effect is properly identified and managed, the outlook is excellent.

It is vital that people who are experiencing the Somogyi effect discuss the issue with their doctor before making any changes to their insulin regimen. In addition to insulin management, diet, exercise, and other lifestyle factors can also affect the outlook for people with diabetes and the Somogyi effect.

 

 

Honeymoon phase in diabetes: What you need to know

Last reviewed
When someone is first diagnosed with type 1 diabetes and insulin treatment starts, their blood sugar can stay at near-normal levels, and their diabetes symptoms vanish.

This near-normal blood sugar condition is achieved with decreasing amounts of insulin, and some people manage to come off insulin temporarily. This status quo is known as the honeymoon phase.

In this article, we take a look at the honeymoon phase in diabetes, and how long it might last. We also examine how it affects blood sugar levels and diabetes management.

 

What is the honeymoon phase in type 1 diabetes?

Woman with diabetes injecting herself with insulin during honeymoon phase.

After an initial diagnosis of diabetes type 1, a honeymoon phase may occur.

The honeymoon period occurs in some people with type 1 diabetes right after their initial diagnosis and once insulin treatment is started. During this time, a person’s diabetes may seem to go into remission or disappear.

Type 1 diabetes is the result of an immune attack against the pancreas, which is the organ that produces insulin.

When a person is first diagnosed with type 1 diabetes, some of their insulin-producing cells still function. With these cells continuing to do their job, the body retains some ability to produce insulin.

The need for synthetic insulin may decrease initially once treatment with insulin has begun. Some people may come off shots altogether.

This period, known as the honeymoon phase of diabetes, may last from a few weeks to several months but will eventually end.

Unfortunately, when a person with diabetes experiences the honeymoon phase, it does not mean that their diabetes has been cured. After a while, their remaining insulin-producing cells will stop working, as indicated by blood sugars rising again and an increasing need for synthetic insulin.

Once the insulin-producing cells die, the pancreas can no longer produce insulin and the honeymoon period ends.

After this happens, a person with type 1 diabetes will not have another honeymoon period and will depend on external insulin.

 

Is there a honeymoon phase in type 2 diabetes?

Healthy tofu quinoa bowl.

Eating a healthful diet and exercising regularly is usually recommended for those with type 2 diabetes.

While some people may experience a reduction in their type 2 diabetes symptoms after they are diagnosed, this is not the same as a type 1 honeymoon phase.

Doctors may advise someone with prediabetes, or a person who is first diagnosed with type 2 diabetes, to modify their diet and lifestyle. This may include getting regular exercise and eating a healthful diet.

These changes can lower a person’s blood glucose levels. However, if they stop these healthful habits, blood glucose levels can rise again.

 

Honeymoon period duration

There is no standard time for a type 1 diabetes honeymoon phase to last, and no guarantee that each person with type 1 diabetes will experience this phenomenon.

Each person who goes through the honeymoon phase after a type 1 diabetes diagnosis will experience it differently, and for differing amounts of time.

The honeymoon phase usually occurs in the first 3 months after diagnosis.

Over a period of weeks to as much as a year or more, the immune system will continue to attack the pancreas and kill off the remaining cells that are producing insulin. As more insulin-producing cells die, the honeymoon period comes to an end.

 

Blood sugar levels during the honeymoon period

Person with diabetes measuring their blood sugar levels.

As the honeymoon period ends, blood sugar levels will no longer remain normal.

During the honeymoon period, a person with diabetes may experience normal or nearly normal blood sugar readings while taking no or minimal insulin.

Normal blood sugar levels, or plasma blood glucose readings, for people with diabetes, are:

  • After fasting: 70–130
  • After meals: Less than 180
  • At bedtime: 90–150

During the honeymoon period, a person with diabetes may see these blood sugar readings regularly while taking little or no prescribed insulin.

However, over time, they will notice fewer readings within the normal level, signaling that the remaining insulin-producing cells no longer function and the honeymoon period may be ending.

 

Diabetes management during the honeymoon period

It is vital for a person to work with their doctor to find the right amount of insulin during this time.

During the honeymoon period, people should take some insulin, as doing so may preserve the remaining insulin-producing cells for longer.

Some doctors try to extend a person’s honeymoon period as long as possible, as blood sugar levels can be healthy during this time.

A doctor may suggest a person in the honeymoon period of diabetes take a certain amount of insulin in addition to making dietary changes.

Some research suggests that people with diabetes can extend their honeymoon period by following a gluten-free diet.

One study looked at newly-diagnosed children with type 1 diabetes. Half of the children were instructed to follow a gluten-free diet. Those that adhered to a gluten-free diet had better blood sugar levels after 6 months than those who did not.

Another study found that taking vitamin D and omega-3 fatty acids supplements may help extend the honeymoon phase and better manage diabetes. Researchers gave vitamin D supplements to 19 people out of 38 with type 1 diabetes.

The 19 people that were taking the vitamin D supplements had a longer honeymoon period than those who were given placebos.

Ongoing studies are actively looking at ways to delay the progression of type 1 diabetes.

As blood sugar levels may be within a normal range with little or no insulin treatment, a person in the honeymoon phase of diabetes must avoid taking too much insulin. Too much insulin can cause blood sugar levels to drop too low, leading to hypoglycemia.

A doctor will work directly with a person to determine the right amount of insulin for them.

 

Outlook

Unfortunately, the honeymoon period during diabetes is only temporary. As the disease progresses, the remaining insulin-producing cells will die, and a person will become dependent on insulin treatments.

There is currently no cure for type 1 diabetes. After the honeymoon period ends, a person with type 1 diabetes will need to take insulin every day for the rest of their life.

There are several different ways to take insulin, including pumps, injections, and pens. A doctor will recommend the best treatment option for a person.

Treating type 1 diabetes and managing blood sugar levels can help a person avoid some of the serious complications that can occur with diabetes, including:

  • heart disease
  • vascular disease
  • kidney failure
  • blindness
  • loss of limbs

The better a person with diabetes controls their blood sugar, the less chance they have of experiencing these complications.

If a person with diabetes manages their blood sugar well, they can live a healthy and active life.

What are the early signs of type 2 diabetes?

Last reviewed
Type 2 diabetes causes a person’s blood sugar levels to become too high. Recognizing the early signs and symptoms of this chronic condition can result in a person getting treatment sooner, which reduces the risk of severe complications.

Type 2 diabetes is a common condition. A 2017 report from the Centers for Disease Control and Prevention (CDC) found that 30.3 million adults in the United States have diabetes. The report also estimated that another 84.1 million U.S. adults have prediabetes.

People with prediabetes have higher-than-normal blood sugar levels, but doctors do not consider them to have diabetes yet. According to the CDC, people with prediabetes often develop type 2 diabetes within 5 years if they do not get treatment.

The onset of type 2 diabetes can be gradual, and symptoms can be mild during the early stages. As a result, many people may not realize that they have this condition.

In this article, we look at the early signs and symptoms of type 2 diabetes and the importance of early diagnosis. We also discuss the risk factors for developing this condition.

 

Early signs and symptoms

The early signs and symptoms of type 2 diabetes can include:

1. Frequent urination

When blood sugar levels are high, the kidneys try to remove the excess sugar by filtering it out of the blood. This can lead to a person needing to urinate more frequently, particularly at night.

2. Increased thirst

The frequent urination that is necessary to remove excess sugar from the blood can result in the body losing additional water. Over time, this can cause dehydration and lead to a person feeling more thirsty than usual.

3. Always feeling hungry

Woman eating breakfast in kitchen.

Constant hunger or thirst can be early signs of type 2 diabetes.

People with diabetes often do not get enough energy from the food they eat.

The digestive system breaks food down into a simple sugar called glucose, which the body uses as fuel. In people with diabetes, not enough of this glucose moves from the bloodstream into the body’s cells.

As a result, people with type 2 diabetes often feel constantly hungry, regardless of how recently they have eaten.

4. Feeling very tired

Type 2 diabetes can impact on a person’s energy levels and cause them to feel very tired or fatigued. This tiredness occurs as a result of insufficient sugar moving from the bloodstream into the body’s cells.

5. Blurry vision

An excess of sugar in the blood can damage the tiny blood vessels in the eyes, which can cause blurry vision. This blurry vision can occur in one or both of the eyes and may come and go.

If a person with diabetes goes without treatment, the damage to these blood vessels can become more severe, and permanent vision loss may eventually occur.

6. Slow healing of cuts and wounds

High levels of sugar in the blood can damage the body’s nerves and blood vessels, which can impair blood circulation. As a result, even small cuts and wounds may take weeks or months to heal. Slow wound healing also increases the risk of infection.

7. Tingling, numbness, or pain in the hands or feet

High blood sugar levels can affect blood circulation and damage the body’s nerves. In people with type 2 diabetes, this can lead to pain or a sensation of tingling or numbness in the hands and feet.

This condition is known as neuropathy, and it can worsen over time and lead to more serious complications if a person does not get treatment for their diabetes.

8. Patches of dark skin

Patches of dark skin forming on the creases of the neck, armpit, or groin can also signify a higher risk of diabetes. These patches may feel very soft and velvety.

This skin condition is known as acanthosis nigricans.

9. Itching and yeast infections

Excess sugar in the blood and urine provides food for yeast, which can lead to infection. Yeast infections tend to occur on warm, moist areas of the skin, such as the mouth, genital areas, and armpits.

The affected areas are usually itchy, but a person may also experience burning, redness, and soreness.

 

Importance of early diagnosis

Doctor showing patient something on tablet.

An early diagnosis may help prevent complications.

Recognizing the early signs of type 2 diabetes can allow a person to get a diagnosis and treatment sooner. Getting appropriate treatment, making lifestyle changes, and controlling blood sugar levels can greatly improve a person’s health and quality of life and reduce the risk of complications.

Without treatment, persistently high blood sugar levels can lead to severe and sometimes life-threatening complications, including:

  • heart disease
  • stroke
  • nerve damage, or neuropathy
  • foot problems
  • kidney disease, which can result in a person needing dialysis
  • eye disease or loss of vision
  • sexual problems in both men and women

Untreated diabetes can also lead to hyperosmolar hyperglycemic nonketotic syndrome (HHNS), which causes a severe and persistent increase in blood sugar levels. An illness or infection will usually trigger HHNS, which can require hospitalization. This sudden complication tends to affect older people.

Keeping blood sugar levels under control is crucial for preventing some of these complications. The longer that blood sugar levels remain uncontrolled, the higher the risk of other health problems.

 

Risk factors for type 2 diabetes

Anyone can develop type 2 diabetes, but certain factors can increase a person’s risk. These risk factors include:

  • being 45 years of age or older
  • living a sedentary lifestyle
  • being overweight or obese
  • eating an unhealthful diet
  • having a family history of diabetes
  • having polycystic ovary syndrome (PCOS)
  • having a medical history of gestational diabetes, heart disease, or stroke
  • having prediabetes
  • being of African American, Alaska Native, Hispanic or Latino, American Indian, Asian American, Native Hawaiian, or Pacific Islander descent

 

Takeaway

Type 2 diabetes is a common condition that causes high blood sugar levels. Early signs and symptoms can include frequent urination, increased thirst, feeling tired and hungry, vision problems, slow wound healing, and yeast infections.

Anyone who experiences possible signs and symptoms of diabetes should see a doctor for an evaluation, especially if they have other risk factors for developing this condition. The early detection and treatment of type 2 diabetes can improve a person’s quality of life and reduce the risk of severe complications.

Can people with type 2 diabetes stop taking metformin?

Last reviewed
Metformin is generally a safe and effective treatment for type 2 diabetes. However, it can cause side effects, and some people may prefer to manage the condition through lifestyle and dietary changes.

Type 2 diabetes occurs when the body’s cells stop responding to insulin appropriately. As a result, levels of glucose, or sugar, in the blood rise too high.

Certain lifestyle factors can increase the risk of type 2 diabetes, including:

  • being overweight or obese
  • engaging in low levels of physical activity
  • eating a poor diet

Metformin is an oral medication that helps control the effects of type 2 diabetes. In people with prediabetes, the drug can also help prevent or delay the onset of the condition. Doctors prescribe metformin to nearly 120 million people worldwide.

In this article, we look at the side effects of metformin and explore the reasons that a person with type 2 diabetes might want to stop taking it. We also describe the risks of stopping the medication and how to do it safely.

 

Side effects of taking metformin

Metformin tablet box

Metformin may cause digestive problems.

Metformin is an effective treatment for type 2 diabetes. It helps lower blood glucose levels by:

  • making the body’s cells more sensitive to insulin
  • slowing the release of glucose stored in the liver
  • slowing the absorption of glucose from food in the gut

However, metformin has a number of potential side effects. Some are common, while others are rare.

Common side effects of metformin include:

A person should talk to a doctor before stopping metformin treatment. Taking the medication with food reduces the risk of digestive problems.

Around 30 percent of people taking metformin in the long term experience vitamin B-12 deficiency. Symptoms can include:

  • weakness
  • shortness of breath
  • nerve damage

Less common side effects

In some people, metformin causes blood glucose levels to drop too low, and the medical term for this is hypoglycemia.

Hypoglycemia is more likely to occur if a person is taking insulin as well as metformin.

There is also a very low risk of developing a condition called lactic acidosis, which results from a buildup of lactic acid. This condition can be life-threatening.

Certain people taking metformin may also have a risk of kidney damage. A 2018 study suggests that metformin may reduce kidney function in people with both chronic kidney disease and type 2 diabetes.

Other considerations

Exercise can reduce insulin resistance and improve type 2 diabetes symptoms. However, some research suggests that taking metformin in the short term may reduce the positive effects of exercise on insulin sensitivity.

 

Reasons for stopping metformin

Class at gym with weighs

Regular exercise and losing excess weight can help reduce the need for metformin.

Due to the side effects of metformin and other antidiabetic medications, a person may prefer to manage type 2 diabetes through lifestyle changes. Even people who experience no side effects may wish to avoid the long-term use of medication.

Many people with type 2 diabetes find that they can manage their condition through lifestyle changes alone. These can include:

  • Making dietary changes: A 2017 reviewfound that changing the diet may significantly reduce type 2 diabetes symptoms and prevent complications.
  • Losing weight: In a 2018 study, almost half of the participants reversed their type 2 diabetes and came off antidiabetic medications following a 12-month weight loss program.
  • Exercising regularly: A 2014 study suggests that a single exercise session can help to temporarily improve symptoms of type 2 diabetes.

Stopping smoking and reducing or avoiding alcohol can also help control symptoms.

 

Risks of stopping metformin

When a person chooses to stop taking metformin, or any other antidiabetic medication, there is a risk of symptoms becoming worse.

It is, therefore, essential that people manage their symptoms through sustainable lifestyle changes involving the diet, weight management, and regular exercise.

If left untreated, high blood glucose levels can lead to complications, such as:

 

Stopping metformin safely

Doctor in senior patients home pointing out thing on tablet.

A doctor can offer advice for stopping metformin safely.

Speak to a doctor before stopping metformin or any other antidiabetic medication.

A person can go off the drug safely if they are able to effectively manage their type 2 diabetes with sustainable lifestyle changes. These should involve:

  • the diet
  • weight management
  • regular exercise

A doctor will often use certain criteria to determine whether it is safe for an individual to stop taking metformin. These criteria include:

  • having a fasting or pre-meal blood glucose level of under 130 milligrams per deciliter (mg/dL)
  • having a random or after-meal blood glucose level of under 180 mg/dL
  • having a hemoglobin A1c result of under 7 percent

A doctor can give advice about choosing the right diet and exercise plans. They can also help set realistic goals and provide monitoring and support.

If necessary, they can refer a person to a dietician or another specialist.


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