Tony is a night shift nurse who is assigned to a patient whose glucose levels remain normal at bedtime but experiences hypoglycemia at 3 am and hyperglycemia at 7 am. The patient is likely experiencing what kind of complication of insulin therapy?
A. Insulin resistance
B. Dawn phenomenon
C. Insulin lipohypertrophy
D. Somogyi phenomenon
Correct Answer: D. Somogyi phenomenon
The Somogyi phenomenon ( post-hypoglycemic hyperglycemia) is characterized by a rebound high blood glucose level in the morning in response to low blood glucose that occurs at about 2-3 am in the morning. The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia.
Option A: Insulin resistance happens when a person receiving insulin develops immune antibodies that bind the insulin, hence decreasing the insulin available for use in the body. Insulin resistance impairs glucose disposal, resulting in a compensatory increase in beta-cell insulin production and hyperinsulinemia.
Option B: Dawn phenomenon is characterized by a morning increase of blood sugar which happens as a response to declining levels of insulin and a nocturnal release of hormones (growth hormone, catecholamines, and cortisol).
Option C: Insulin lipohypertrophy is the development of fatty lumps on the surface of the skin and is a common side effect of repeated use of an injection site. Lipodystrophy is associated with increased glycemic variability and unexplained episodes of hypoglycemia further driving up healthcare costs while affecting patient compliance.
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