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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam

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Old 04-25-2014
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Default ITT Concepts not on uWORLD

ITT lets post things that you consider that are relevant for the CK but are not on uWORLD.

Well, today i learned about Somagyi and Dawn phenomena.

It occurs in patients that present with hiperglicemia in the mornings.

There are two possible causes for this.

First is DAWN, which happens because of counterinsulin cortisol and GH are released mainly at night (3-5am). These hormones decrease the effectiveness of insulin, resulting in hyperglicemia in the morning. TX is give a higher long acting insulin (NPH) dose, just before bedtime.

Second is Somagyi, which is similar but in this case, you are giving TOO much insulin. At some point in the night, the patient's glucose gets too slow, this kicks in the counter hypoglicemia mechanisms (epineprine, glugacon) resulting in a higher than normal glucose level when the patient wakes up in the morning.

To differentiate between the two you need to do a glucose level at 3 am or surrounding hours.

I learned about these in Kaplan QB.

Please share your thoughts or concepts!
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