Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the likely explanation for a patient with Type 1 diabetes who experiences high morning readings and hypoglycemia before meals?

1. Somogyi phenomenon

2. Dawn phenomenon

3. Inappropriate nutrient balance at night

4. Fluctuations in the honeymoon period

The correct answer is: Somogyi phenomenon

The Somogyi phenomenon refers to a condition where a patient with diabetes experiences high morning blood glucose readings due to nocturnal hypoglycemia. In this scenario, excessive insulin administration during the evening or inadequate nighttime carbohydrate intake can lead to a drop in blood sugar levels while the patient is sleeping. The body responds to this hypoglycemic event by releasing counter-regulatory hormones, such as glucagon, epinephrine, and cortisol. These hormones stimulate gluconeogenesis and glycogenolysis, leading to elevated blood glucose levels in the morning. This phenomenon is particularly relevant in individuals with Type 1 diabetes as they rely on exogenous insulin and may have less ability to counteract hypoglycemia when it occurs. Recognizing the Somogyi phenomenon is crucial for management, as adjusting insulin dosing or modifying nighttime carbohydrate intake can help stabilize blood sugar levels throughout the night and prevent both hypoglycemia and subsequent hyperglycemia. On the other hand, the dawn phenomenon refers to a natural early morning increase in blood glucose levels due to the body's circadian rhythms and hormonal changes. Inappropriate nutrient balance at night typically affects how food intake affects blood glucose but does not account for the specific pattern of fasting hypoglycemia followed by hyperglycemia seen here. Fl