Somogyi Rebound - Struggling With It And The Endo

[notorious_bob]

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.

 

[EllieM]

How confident are you that your a1C is accurate? Does it match your fingerpricks? It gives erroneous results for some - maybe consider a fructosamine test if it doesn't match your blood tests. (And honestly, if it's just the Sumogyi rebound, and your normal the rest of the time, it sounds too high to me.)

And while 7.7 isn't ideal, as a T1 for 48 years I ran levels like that for decades - and I've still got my eyes, kidney, all extremities etc.... It might be slowly killing you but so slowly that something else will get you first....

Good luck. Try not to get too discouraged.

 

[notorious_bob]

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]

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

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....

 

[EllieM]

Starts climbing at 4am (like clockwork) and there's nothing that stops it.

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?

 

[kokhongw]

Have you tried skipping a couple of dinner or have earlier dinner?

I find that works well for me. Brings my FBG down from 7+ mmol to <5.5 mmol within a couple of days...

 

[Brunneria]

Hi @notorious_bob

Your profile doesn't make clear whether you are T1, T2 or other, and it doesn't say what (if any) meds you are on.
Those things will make quite a difference to the kind of discussion and suggestions you get, so it would help if you filled those in.

Judging by the fact that you are seeing an endocrinologist, I am guessing that you have some kind of history of glucose issues?

 

[Bluetit1802]

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

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.

 

[DCUKMod]

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! :/

May I also ask how you know your rise, towards 12, starts at 4am, and also what it rises from?

In UK an A1c of over 6.5% leads to a diagnosis. Did that happen to you after your 7.7%?

If your Doctor is recommending Victoza, is that for the rise to 12, all your blood glucose numbers or with an aim to trim up a bit?

 

[notorious_bob]

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?

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

 

[notorious_bob]

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....

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

 

[notorious_bob]

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.

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]

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?

 

[DCUKMod]

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.

What time do you get up in the morning and what do you eat and drink in the mornings?

 

[notorious_bob]

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?

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.

 

[NicoleC1971]

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 and so it was back to my high fasting Bg. 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 :/

Well the books/YouTube vids may give you some hope! Finding a naturopath who is also trained in conventional mediciine seems rational as you feel you have had no success with the conventional route and are not even sure of your diagnosis (lada or type 2?).
Sarah Hallberg's company is here btw:
https://www.virtahealth.com/reversediabetes

 

[kokhongw]

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

There isn't any treatment for high fasting glucose. But it is usually a sign of insulin resistant liver.

Here is Dr Jason Fung's take on it...
https://idmprogram.com/dawn-phenomenon-t2d-8/

 

[kitedoc]

Hi @notorious_bob,
My understanding of the Somogyi effect is that is it triggered by a sufficiently low blood sugar to cause release of glucose from one's liver and a corresponding rebound to above normal BSLs. So no hypo = no Somogyi. Where is the hypo that allowed your endo to diagnose the Somogyi effect ? And if you have been on CGM would not the hypo have been obvious?
And also would not an interpretation such as Dawn phenomenon have been feasible in the absence of a hypo cause for high BSLs ?