What is Pre Breakfast Hyperglycemia and Honeymoon period?

Somogyi Effect :

In some diabetics there will be increase in blood glucose levels in the early morning due to Somogyi effect. Somogyi effect is due to a surge of counter regulatory hormones to produce high glucose levels. Another reason is waning of circulatory insulin in the early morning.

Pattern of blood glucose levels -
(Ref. to CMDT)

At 10 PM – 90 mg/dl
At 3 AM – 40 mg/dl
At 7 AM – 200 mg/dl

Dawn phenomenon :

Another reason for pre breakfast hyperglycemia is due to reduced tissue sensitivity.

Pattern of blood glucose levels -
(Ref. to CMDT)

At 10 PM – 110 mg/dl
At 3 AM – 110 mg/dl
At 7 AM – 150 mg/dl

Both are diagnosed by glucose monitoring at 3 AM for few days along with regular 7 PM glucose. The dose of insulin is adjusted to prevent this. For example in Dawn phenomenon, dosage of intermediate insulin is divided at dinner time and bed time.

Honeymoon period :

This is generally seen in Type 1 diabetes. There is an initial period of ketoacidosis followed by symptom free interval (honeymoon period). Due to stress induced epinephrine blocks insulin secretion. No treatment as such is required for it.

[tags]hyperglycemia, somogyi, diabetes, diabetic[/tags]

High Blood Glucose Levels – Specific to Diabetes?

Diabetes is a disorder of carbohydrate metabolism caused by relative or complete deficiency of insulin leading to hyperglycemia and in long term may result in organ complications such as retinipathy, nephropathy, neuropathy and cardiovascular complications.

Type 1 diabetics are more prone to ketoacidosis with high blood glucose levels. They generally depend on insulin treatment as opposed to type 2 diabetics. Under stressful conditions insulin may not be adequately adjusted, causing susceptibility to diabetic ketoacidosis.

Type 2 diabetics on other hand are more prone to yyperosmolar nonketotic hyperglycemic coma (HHNKC) than ketoacidosis or hyperosmotic non-ketoic acidosis (HONK). This is severe hyperglycemia in the absense of significant ketosis. Precipitating factors are noncompliance with treatment and inability to drink sufficient water to keep up with urinary loss.

Gestational diabetes is glucose intolerance developed during pregnancy. Fortunately this condition usually resolves once the baby is born.

The most prevalent cause of high blood glucose levels (hyperglycemia) is Diabetes. But there are some other clinical conditions that cause hyperglycemia though they are not nearly as common.

All of these need special investigation, medical attention, and timely treatment. It is always advised to approach your physician anytime you have concern regarding your health.

1. Cushing’s Syndrome: Caused by persistent and inappropriate increase in glucocorticoid hormones. Patients are obese and symptoms include plethoric face, thin skin that bruises easily, and pathological fractures due to osteoporosis.
2. Pheochromocytoma: Excess production of catecholamines by tumors of sympathetic nervous system. Symptoms include headache, anxiety, palpitations, sweating, hypertention, hyperglycemia.
3. Glucagonoma: They are tumors of pancrease and produces lots of glucagon a hormore that counteracts the actions of insulin. Patients have hyperglemia with skin rash.
4. Pancreatic Conditions like pancreatitis, hemosiderosis etc also cause hyperglycemia due to damage of insulin producing cells in pancreas.
5. Liver Diseases like cirrhosis, hemochromatosis.
6. Medications such as diuretics, niacin, and phenytoin (taken in epilepsy) are also known to induce hyperglycemia. Discontinuing these drugs result in a return of normal glucose status.
7. Acute stress: In people with mild carbohydrate intolerance, stressful conditions like infections, myocardial infarction, and surgery may cause marked hyperglycemia. Some of these patients will not need therapy once the stressful condition has passed.

A physician can differentiate these conditions by running some tests beyond those identifying blood glucose levels. For example, there are tests that detect high levels of glucagon, cortisol in blood.

Investigations like abdominal CT scans and ultrasound can be used to screen for any tumors, pancreatic pathology, and liver pathology.