Do you usually wake up with high blood sugar, even though your levels were low or normal before going to bed? Do you often feel tired or restless at night, only to notice high sugar levels in the morning? Does your blood sugar seem to be high in the morning despite following your diet and insulin routine? Have you ever noticed unexplained morning highs that don’t match your bedtime sugar readings? This puzzling rise could be due to the Somogyi effect. However, it is essential to note that this is primarily diagnosed only after ruling out other common causes of a morning spike in blood sugar levels. 

Understanding the Somogyi effect is very important if you have diabetes, since it explains how the body regulates insulin and blood sugar levels. 

What is the Somogyi Effect?

When your blood sugar drops too low, your body tries to protect you by releasing certain hormones. One of these is glucagon, which tells your liver to release the stored sugar into the blood. This helps bring your sugar level back up.

But those same hormones don’t just bring the sugar up – they also make your body less sensitive to insulin for a few hours. And because of that, instead of your blood sugar just returning to normal, it can actually shoot too high, especially by the time morning comes. That rebound high after a nighttime low is what’s known as the Somogyi Effect.

Somogyi Effect is more common in people with Type 1 diabetes;  However, it can also occur in those with Type 2 diabetes, especially if they are using insulin.

What are the causes of the Somogyi effect?

• Primary cause: The primary cause of the Somogyi effect is taking too much insulin or sometimes certain diabetes medicines before bed, which lowers blood sugar too much at night. In response, the body releases stress hormones, such as adrenaline and cortisol, to raise blood sugar levels, but this rebound can overshoot, leading to high sugar levels in the morning. 
• Skipping or Eating Less Dinner: If you dont eat enough in the evening, your body may run out of glucose during the night. To make up for it, the liver releases stored sugar, which can result in excessive levels and lead to high morning readings. 
• Wrong Insulin Timing: Even if the dose is correct, the timing may still be off. If insulin peaks at night when your body doesn’t need it, blood sugar can drop too low, triggering a rebound rise. 
• Alcohol Intake: Alcohol affects how the liver releases sugar. At night, this can cause blood sugar to fall, followed by a rebound high in the morning. 
• Stress or Illness: Stress hormones, such as adrenaline and cortisol, can interfere with insulin function. They may cause blood sugar swings and add to the risk of the Somogyi Effect.
• Irregular Eating Habits: Skipping meals or eating at odd times makes it harder for the body and insulin to stay in sync, which may cause overnight glucose imbalances. 
• Medication Side Effects: Certain medications can alter how your body responds to insulin and glucose, sometimes leading to nighttime lows and morning highs. 

What are the Key Risk Factors of the Somogyi Effect?

• Age: Kids and teenagers with diabetes may have more ups and downs in their sugar levels, which can raise the chance of the Somogyi effect. 
• Gender: It usually affects men and women equally, but changes in women’s hormones, like during periods or menopause, can sometimes make sugar control harder. 
• Where You Live: In some areas, accessing the right diabetes care and education can be more challenging, and this can make it harder to manage blood sugar levels properly and increase the risk of complications. 
• Other Health Factors: People whose diabetes isn’t well controlled or who often get low sugar at night are more likely to face this problem.

What are the Symptoms of the Somogyi Effect?

Identifying the symptoms of the Somogyi effect is essential for people with diabetes, especially those using insulin. The symptoms could be:

• Morning Hyperglycemia: One of the common signs is waking up with high blood sugar. A continuous Glucose Monitor(CGM) can help track overnight readings and reveal hidden fluctuations. 
• Nighttime Hypoglycemia: Not always apparent; symptoms such as sweating, restless sleep, and waking up shaky may indicate low blood sugar during the night, which can then lead to morning highs.
• Change in hunger: Sudden hunger or increased hunger may occur as the body rises to stabilise its energy levels after blood sugar swings. 
• Fatigue during daytime: Even after a whole night’s sleep, many people feel unusually tired during the day. This happens because nocturnal hypoglycemia can disturb sleep quality. 
• Mood Swings: Mood swings, such as poor concentration and irritability, can result from the stress of alternating episodes of low and high blood sugar.

What are the Warning Signs of the Somogyi Effect?

It is important to recognise the warning signs which indicate the need for immediate medical attention, such as:

• Severe confusion or feeling very disoriented
• Fainting or losing consciousness
• Seizures(fits or uncontrolled shaking)
• If blood sugar is staying very high (over 250mg/dL) even after treatment. 

What are the Steps To Diagnose the Somogyi Effect:

If you are trying to know whether you have the Somogyi effect, it’s not just about noticing morning high blood sugar levels; it’s about carefully tracking your blood sugar, especially at night. Here is how you can check:

• Check Before Bed: Test your blood sugar before going to sleep. This will give you a starting point. 
• Midnight Test:  Set an alarm around 3 a.m. and check again. If your blood sugar is low at this time, it may mean your body is rebounding with higher blood sugar levels by morning.
• Morning Reading: Take the test as soon as you wake up. If it’s much higher than your 3:00 a.m. reading, it could point to the Somogyi effect. 
• Use a CGM: A Continuous Glucose Monitor (CGM) can track your sugar levels all night and show detailed patterns, without disturbing your sleep. 
• Keep a log: Note down your readings, along with insulin doses, dinner details, and any symptoms or sleep disturbances.
• Talk to your Doctor: Share your log with your healthcare team. Then, you can study the pattern and confirm if it’s the Somogyi effect or something else. 

What are the steps to manage the Somogyi Effect? 

The Somogyi effect occurs when low blood sugar levels at night trigger high blood sugar levels in the morning. Managing it requires a mix of clever insulin use, healthy habits, and regular monitoring. Here is how you can prevent, treat and manage it. 

Prevention Tips:

• Consult your doctor to adjust your insulin dose and timing to prevent nighttime low blood sugar levels.
• Have a light snack at bedtime that includes protein, healthy fats, and complex carbohydrates to help maintain steady blood sugar levels while you sleep.
• Maintain a healthy routine with regular exercise, effective stress management, and sufficient sleep to support balanced blood sugar levels.

Treatment Strategies:

• A Continuous Glucose Monitor(CGM) is used to help track the blood sugar levels overnight and reveal patterns that may point to the Somogyi Effect. 
• Review your insulin plan with your doctor; if nighttime lows are leading to morning highs, they may adjust the type, dose or timing of insulin.

Long-Term Management:

• Stay aware of how food, exercise, stress, and insulin influence your glucose levels. 
• Follow a balanced diet with regular meal times, including high-fibre foods, and avoid highly processed foods.
• Schedule regular check-ups with your healthcare team to review and adjust your management plan. 
• With tools like CGMs and expert guidance, you can see your sugar levels in real time, adjust your lifestyle, and get a diet plan designed for your needs. Small daily habits can have a significant impact on keeping your blood sugar levels and supporting your overall health.

How Can Fitterfly Help You?

The Somogyi effect can be confusing to understand, especially for someone living with diabetes. As a common person, it is not easy to figure out whether your morning highs are due to this or some other cause. But dont worry, that’s exactly where we step in. 

At Fitterfly, we have our highly experienced in-house Diabetologist, Dr. Vidya Walinjkar, who can help you not only understand concepts like the Somogyi effect but also provide a detailed diagnosis of your condition through a one-on-one consultation. Get clarity, take control, and manage your diabetes with confidence.