Somogyi Rebound - Struggling With It And The Endo

So got my latest set of results in as I go around the buoy again with another different endo.

She agreed about the Somogyi Rebound Effect being the most likely cause of my Bg spiking between 4am and 8am.

But then this happens... all my tests, except the fasting finger-stick, come back normal. No indicators of anything. My A1c was 7.7.

So having a real battle with the endo's office to get them to treat the cause and not the symptom. The current prescription is Vitoza but I'm not particularly convinced that will do anything positive.

Really struggling with "what to eat" and getting really depressed about it.

With this being my 4th attempt to get a diagnosis and treatment I'm getting resigned to this slowly killing me.

Well, the clinic did the A1c so I guess I could ask them if it's accurate :/

My rebound is pretty epic... my fasting Bg is around 12 (200). Starts climbing at 4am (like clockwork) and there's nothing that stops it.

Hard not to get discouraged - here (in the States) they obsess over the fasting finger-prick test. I even did a full glucose test in the past and that was normal too! :/

EllieM said:

Well, insulin probably would, but that seems pointless given that your endocrine system is working perfectly well for the rest of the time. Does it start going down again the minute you get up, or do you get a post breakfast high that's more than 12?

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Insulin actually caused the rebound to be worse - like 50 points worse!

EllieM said:

It may be accurate, but there are lots of blood conditions which affect the result and give you an erroneous impression of your average blood sugars. (eg anaemia, having blood cells which live longer or less than 3 months, some genetic factors). Personally, I wouldn't stress about fasting blood sugars too much if my blood sugar was normal for the rest of the time....

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That would be OK if the doctors here wouldn't make their diagnosis on the basis of the fasting Bg - it seems to be the be all and end all. I just can't seem to get them to treat the cause - maybe there isn't a treatment

Bluetit1802 said:

What were you expecting your A1c to be? I'm not sure I understand why you think 7.7 is normal? Converting this to mmol/l as per our meters it is an average of 9.7mmol/l (174.6mg/dl). As @Brunneria said, we really need to know a bit more about your diabetes status and diabetes medication in order for all this to make sense to us.

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I don't think it's normal, but it's forced high because of the Somogyi - it's being artificially bumped. Converting to "your" numbers, my average Bg between 12 noon and 6am is 7.0-8.0high, yep. But my average between 6am and 12 noon is 11.0!

I'm on a CGM so I can see my rise start at 4am - like clockwork. It rises from between 100-140.

the attached pic is a pretty typical day - sometimes I can bring my Bg back down quicker than I did on this day.

No, in the US a diagnosis is made on the basis of a fasting fingerprick test.

My Endo is recommending Vitoza because I think they're running out of ideas. It might help lower the high by making me create more insulin, but it won't address the problem, adding insulin will probably make things worse as it did when they had me injecting.

NicoleC1971 said:

I would agree that taking more insulin will make your condition worse by increasing your insulin resistance.
I am not surprised that your specialists aren't interested in root causes but you could try finding some answers for yourself. Doctors such as Jason Fung and Sarah Hallberg advocate ignoring the advice of ADA for example! The former has written a book called The Diabetes Code and the latter is part of Virta Health who offer online diabetes management based on low carb diets.
Rebound hyperglycaemia implies that you are going low at some stage but you have not mentioned other meds that might be causing this? e.g. insulin or sulphonyurea type of drug
Alternatively there is the good old dawn phenomenom in which blood sugars rise due to a normal physiological effect of getting ready to be up and active. Have you ruled that out?

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I'm not taking any drugs at all at the moment... waiting on starting Vitoza because I'm not sure.

This endo agreed about the Somogyi Rebound Effect (the 1st time in 13 years that's happened) but my labs came back in the normal ranges (C-Pep etc.) and so it was back to my high fasting Bg and the boosted A1c. I guess it could be good ole DP, I just don't know any more. I've tried Metformin, Insulin last thing at night and 1st thing in the morning and Januvia all with either no, or negative effects.

Because my fasting Bg is the worse I'm always going to be diagnosed as Type 2 - irrespective of anything else.

Reading into things there are no clinical treatments for Somogyi - has anyone had any success with Naturpaths?

I started taking Aswaghanda (sic) to maybe lower my cortisol level - not sure if I'm seeing any difference though - maybe I'm a little more mellow!

Thanks for the book tips - something else to read between salads :/

P.S. I get up at between 6:30 and 7:00 am, usually eat around 8:00. I make a fritatta for my breakfast and I have a cup of tea, no sugar and I switched to lactose free milk recently to see if that would make any difference. I've asked my Endo for dietary advice as low-carb doesn't seem to be helping.