PEDIATRICS PEARLS: Dawn and Somogyi Phenomenons

Somogyi phenomenon, Dawn phenomenon, and Brittle diabetes:

Somogyi phenomenon: hypoglycemia precedes hyperglycemia. Hypoglycemia is due to insulin, while hyperglycemia is due to secretion of counter regulatory hormones. 

Hypoglycemia occurs in late night or early morning accompanied by sweating,

and terror. Within 4-5 hours, hyperglycemia, ketosis, glycosuria, and ketonuria develop.

Dawn phenomenon: Hyperglycemia in early morning (5-9 A.M.) without previous hypoglycemia. Blood sugar should be done at 3, 4, and 7 A.M .

Findings and management in Dawn phenomenon: 3 A.M. and 4 A.M. (Glucose level= 80 or above), 7 A.M. (Glucose level= 140 or above)= Increase intermediate acting insulin P.M. dose by 10-15%, or give PM injection 2-3 hours later.

Findings and management in Somogyi phenomenon: 3 and 4 A.M. (Glucose level= 60 or below), 7 A.M . (Glucose level= 140 or above)= Decrease intermediate insulin P.M . dose by 10 -15% or delay PM injection until 9 PM.

Brittle diabetes: blood glucose level fluctuates even with increase of insulin doses; often with recurrent DKA. They have normal insulin response in the hospital. Therefore, they have psycho-social or psychiatric problems including dysfunctional family and eating disorders. They need hospital admission, psycho-social or psychiatric evaluation.