IDDM Honeymoon Period and Somogyi effect - USMLE Forums
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Old 09-11-2013
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Pancreas IDDM Honeymoon Period and Somogyi effect

KLN says it's a symptom free period and treatment (insulin) is not needed. and that it's caused my 'stress induced epinephrine release blocks insulin secretion, causing the syndrome'

how would this diabetic patient in the honeymoon period not need insulin while it's blocked from being released (so no exogenous nor endogenous insulin?!!)

i looked online and what i understood is that its a period when the patient is still having some functioning b cells and are making some insulin. this made more sense to me than KLN.. unless i didn't understand KLN correctly?

both somogyi effect and the down phenomenon are cases of hyperglycemia. both caused by the counter regulatory hormones. the difference in presentation (in diabetics) is that the down phenomenon is in the early morning but the somogyi effect can happen at any times? did i get it right? ^^'

thank you and good luck
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Old 09-12-2013
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honeymoon phase in diabetics usually occur just after dx of iddm...
patients still have a few functioning b cells in their pancreas which produces insulin...so if insulin is supplemented during this period the patient may experience some episode of hypoglycemia...
i never clearly understood what kaplan meant to convey with that particular line
with somogyi and dawns...
simple way to dx them is measure glucose levels at 3am...somogyi will show hypoglycemia...while dawns will have normal glucose levels..
and never choose increase insulin dose as the answer coz if the pt is experiencing somogyi phenomenon increasing his insulin will further cause hypoglycemia...n can lead to coma!!!
rx somogyi with decreased insulin n dawns with increased!!
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Old 09-12-2013
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read this somewhere...about the stress thing in iddm..
IDDM 1 is an autoimmune disease in which the pt's pancreas face the brunt of immune system.
there is slow but progressive loss of pancreatic tissue but untill the pt loses a critical level of the tissue ,he does not have clinically detectable DM.During this period (when the pt is completely asymptomatic) if the pt has an infection or any other stress which requires increased amounts of insulin,unlike normal people this pt will not be able to accordingly increase his insulin("stress induced epinephrine release blocks insulin secretion,causing the syndrome.In normal individuals insulin reserve is such that hormone release is adequate even in the face of stress"..) and so the stress condition ppts DM in this patient. The pt gets treated for the infection (+ insulin) He again returns to his previous status i.e. no more hyperglycemia after the ppt cause is removed . this is his honeymoon period since he is euglycemic again till the remaining pancreatic mass gets destroyed too.
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Old 09-12-2013
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Somogyi phenomenon; hypoglycemia during the late evening induced by insulin could cause a counterregulatory hormone response that produces hyperglycemia in the early morning. Dawn effect due to little insulin, both gives morning hyperglycemia. Cut the insulin at night by 4-5 units, until to know the cause, by checking of glucose in the mid of the night. In Honey moon period, type 1 DM, due to residual mass of beta cells still functioning, just reduce the amount of insulin.
Simple way to dx them is measure glucose levels at 3am, Somogyi will show hypoglycemia, while Dawns will have normal glucose levels.
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Endocrinology-, Internal-Medicine-, Pediatrics-

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