Both will result in AM (morning) hyperglycemia.
DAWN: “Think Dawn is Down” => Early morning hypergylcemia without preceding hypogylcemia. Secondary to Growth hormone surge at dawn (normal physiology), increasing insulin requirements and serum glucose levels. Treat: May need to increase dose of night time long acting insulin.
SOMOGYI: “SoMo is So Much insulin” => Nocturnal hypoglycemia (from fasting or excess bedtime insulin) causing rebound hypergylcemia. Surge of counter-regulatory hormones (i.e epinephrine and glucagon) that results in hyperglycemia. Treat: Decreasing rather than increasing night time insulin.
NOTE: Evidence (1,2) exists that discredits the Somogyi hypothesis. In fact if a patient has high AM blood sugars, they likely had high blood sugars overnight.
REFERENCES
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