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What is Smogyi Phenomenon in diabetes?

Smogyi Phenomenon is elevated or higher blood sugar in early morning then normally found.  It is also called smogyi effect.

It is named after Michael Smogyi, professor at Washington university who devised first insulin treatment for child in 1922.

Why Smogyi Phenomenon happens?

Consider following conditions:

  1. Inability of body to produce insulin leads to type-1 diabetes and
  2. Insulin is not produced in required proportion leads to type-2 diabetes.

Individuals suffering from high blood sugar in above two cases are treated by administering insulin injection. 

Appropriate and timely delivery of insulin in diabetic patients helps to preventing both hyperglycemia (above normal blood sugar) and hypoglycemia (below normal blood sugar).

Any diversion in treatment or does administration then normally prescribed can lead to response from body.  

Insufficient does of insulin can result in hyperglycemia while excess dose can result in hypoglycemia.

Michael Smogyi and others stated that untreated hypoglycemia i.e low blood sugar for longer period of time results in stress in body.

This stress triggers defensive mechanism in body resulting in rebound in blood glucose levels. This is called smogyi phenomenon.

What exactly happens in body during smogyi Phenomenon?

Consider following case:

Peter is suffering from type-1 diabetes since childhood.

Since in type-1 diabetes body is not able to produce insulin, he is completely dependent on externally administered insulin injections on daily basis.

He was continuously found with high blood sugar for few weeks in recent past so his doctor has increased his daily insulin dose.

He was advised to follow this new dosage regime with daily monitoring of glucose level for a week.

Following this regime has led to decrease in blood sugar levels and they consistently appeared below normal.

Peter visited his grandparents in New York for 10 days and continued with same dosage for period.

One day early morning (around 5 to 6 am) during his stay at his grandparents’ house Peter started feeling anxious and exhausted.

He instantly checked his blood sugar levels and found that they were way above normal. He immediately took insulin injection in panic.

Late in day they visited doctor in New York where he was told that it was smogyi effect.

Following point can be deduced form above case:

  1. Peter was suffering from prolonged hyperglycemia initially.
  2. To treat the hyperglycemia he was prescribed higher dose of Insulin injection for a week.
  3. Peter did not visit doctor as per scheduled weekly visit and went to grandparents and continued with higher dose of insulin injection for more than prescribed time of week.
  4. He used higher dose of insulin injections for prolonged period resulting in persistent hypoglycemia for longer duration.
  5. He felt the symptoms and hyperglycemia in early morning after about 15 days.
smogyi phenomenin

Now consider below

Pancreas organ in human being is responsible for production of hormones Insulin and Glucagon.

When the level of glucose falls in blood Pancreas organ causes release of Glucagon hormone to increase the production of glucose in blood.

When the level of glucose increases in blood Pancreas organ causes release of Insulin hormone to decrease the concentration of glucose in blood by promoting absorption of glucose in liver, fat and skeletal muscles for storge in form of glycogen or fat.

Now in above case of since Peter is typ-2 diabetic patient his body does not produce insulin hormone and so is dependent on externally administered insulin injection.

Continuous injection of higher does of insulin before bed by peter for almost 15 days led to hypoglycemia.

This prolonged hypoglycemia led to stress in Peters body triggering defensive response.

As part of defensive mechanism body triggered the release of glucagon hormone and stress hormones like epinephrine, growth and cortisol hormones.

Glucagon hormone triggered release of glucose stored in form of glycogen or fat in liver, fat and skeletal muscles in turn increasing blood glucose levels while stress hormones caused insulin resistance for hours which led to hyperglycemia.

What can be done to avoid Smogyi Phenomenon?

  1. Additional blood testing i.e blood test for 5-6 or more depending on blood sugar levels.
  2. Use contemporary testing methods like Continuous glucose monitoring.
  3. Follow instructions given by doctors. They make plans on basis of their experience.
  4. Testing occasionally in middle of night.

One simple way of discovering if night hypoglycemia is causing morning hyperglycemia is by making patient eat high Protein diet with small amount of carbohydrate before sleep in night.

 This will help to keep blood sugar up while night and prevent Somogyi effect.

In morning blood sugar decreases then this indicates Somogyi effect and daily dose of insulin can be decreased.

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