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Question:

From CompuServe:

I am 28 years old and have had diabetes for 13.5 years (Type 1). I cannot seem to find a doctor who will work with me. I have a hard time getting regulated even though I follow my diet religiously and exercise when normal. I am now very motivated to get tight control. I am approaching my 30's without complications and would like to stay that way. My A1C is elevated at 8.2, but all other tests (as in cholesterol, kidneys, etc.) are normal. I am on an intensive program of Toronto [Regular insulin] 3 times a day and NPH at bedtime.

My question is: Can you suggest how to test properly in the night so I can discover if I am experiencing the Somogyi Effect? So far the doctors I have seen either dictate what I should do without explanation or they get frustrated with me because I don't improve under their care. Then I end up being told that I must be cheating, etc. My most recent doctor was adjusting my NPH in great quantities and I felt that for my body to respond we needed to take smaller adjustments. I find that it takes about a week before I really know if something is working or not. I just really need a suggestion on how to monitor my sugars at night properly so that I can find the correct dosage. I also find that fatigue affects my sugars so I want to avoid this while getting an accurate picture of my blood sugars. Help! I really feel that if I can get my morning right I can manage the rest of the day with accuracy.

Answer:

I'm sure that you will appreciate that any answer to your question can only be in general terms without knowing an awful lot more about your insulin regimen, diet and blood sugar results. However, the issue of the Somogyi effect has been debated for years. Quite often "silent" hypos during the night are followed by headaches and lethargy on waking in the morning. If you live alone, you have little choice but to set an alarm for around 3am to check a sugar. If you have all the kit laid out the night before then the disruption to your sleep should be minimal. On the other hand, if you don't live alone, then enlist the help of someone else to measure your sugar for you - if you are concerned that the act of wakening up will alter the result. I don't think that this makes much difference since you will have done the test by the time any effect of adrenaline occurs.

The real issues of control can only be discussed with your own diabetes team.

KJR

Original posting 10 Mar 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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