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Question

58yo male, with DMI controlled with insulin, has blood glucose measurements in the morning of 205-272 mg/dL for the past week.  He reports that his evening blood glucose measurements before bed range from 103-127 mg/dL.  What are two potential causes of these findings?

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Answer

There are two potential causes of early morning hyperglycemia in a diabetic patient on insulin.

1. Dawn Phenomenon
   1. Due to the early morning rise of cortisol, patients can experience an early morning hyperglycemia as a result
2. Somogyi Phenomenon
   1. (as covered by last week’s Ep-PAINE-nym) This was theorized to occur as undetectable hypoglycemia while the patient was asleep and the resultant hyperglycemia from instrinsic protective mechanisms.