Type 1 DM on insulin with high morning glucose, possible cause?
1. Dawn effect: not enough insulin
Increase dose or add a bedtime NPH
2. Somogyi phenomenon: Too much insulin leading to hypoglycemia leading to counterregulatory hormones secretion leading to hyperglycemia
Decrease the amount of night insulin
So, mgt approach:
Assume Somogyi effect until proven otherwise
DO NOT INCREASE INSULIN UNTIL SOMOGYI HAS BEEN RULED OUT. SEVERE NOCTURNAL HYPOGLYCEMIA MAY OCCUR
Best initial step is to Check sugar at 3am for some nights to differentiate.
Somogyi phenomenon: There's 3am hypoglycemia
Dawn effect: No 3am hypoglycemia