Given in my epistemology
1 100% non-scholar non-mm-doctor and 90% of mm doctors are idiots
2 only normal people are cochrane collaboration, SENS, MIT biology and scholars
view my research with care or move on.
Clinical Question
Does metformin increase the
risk of fatal or nonfatal lactic acidosis?
Evidence-Based Answer
In
patients without standard contraindications to metformin therapy, metformin
does not increase the risk of lactic acidosis.1 (Strength
of Recommendation = B, based on inconsistent or limited-quality
patient-oriented evidence)
Blood Sugar Chart
Updated
March 27, 2018
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BLOOD SUGAR CHART
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A Bedtime Snack and Blood Sugar: Diabetes
Questions & Answers
Published April 12, 2018 by Gary
Scheiner, MS, CDE
Q: Does a bedtime snack help or hurt the wake-up blood sugar reading?
A: Like most things having to do with diabetes, it depends. If you
are not taking insulin, bedtime snacks can either cause your wake-up reading to
be elevated or force your pancreas to produce extra insulin during the night to
offset the effects of the snack — neither of which is a good thing.
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If you take
insulin, a bedtime snack may be needed if your blood sugar tends to drop
overnight. This is often a sign that your basal insulin dose (via injection or a pump) is a
bit too high. Basal insulin’s job is to keep your blood sugar steady
overnight. So if you’re dropping, you may be getting too much basal
insulin. In this case, without a snack, you might wind up with low blood
sugar in the middle of the night. And if you overeat or “rebound” from the low,
your wake-up reading could wind up too high. So with basal insulin doses
that are a bit too high, a snack at night may be necessary. However, it would
be better to get the basal insulin dose set properly.
If your basal insulin dose is correct
and your blood sugar holds steady through the night without a snack, a bedtime
snack will make your blood sugar rise. A dose of rapid-acting insulin
would likely be needed to offset the effects of the carbohydrates in the snack.
While we
sleep, the body produces a hormone called leptin that curbs appetite. So if
you’re trying to shed some body fat, a bedtime snack may be counterproductive.
And since excess body fat leads to insulin resistance, all those extra bedtime snacks can
lead to higher-than-desired blood sugars in the morning that persist around the
clock.
Want to learn more
about maintaining target blood sugar levels during sleep? Read “Exorcising the Specter of Overnight Hypoglycemia” and “The Dawn Phenomenon and Somogyi Effect: What You Can
Do.”
Gary
Scheiner, MS, CDE, is owner and clinical director of Integrated Diabetes
Services (www.integrateddiabetes.com, 610-642-6055), a private
practice specializing in intensive insulin therapy for children and adults. He
and his team of certified diabetes educators work with clients throughout the
world via phone and online. Gary has lived with Type 1 diabetes for 30 years
and was named Diabetes Educator of the Year in 2014 by the American Association
of Diabetes Educators. He has written six books, including Think Like a
Pancreas, and is a regular contributor to Diabetes Self-Management.
Disclaimer Statements: Statements and
opinions expressed on this Web site are those of the authors and not
necessarily those of the publishers or advertisers. The information provided on
this Web site should not be construed as medical instruction. Consult
appropriate health-care professionals before taking action based on this
information.
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The Dawn Phenomenon and Somogyi Effect: What
You Can Do
https://www.diabetesselfmanagement.com/blog/dawn-phenomenon-somogyi-effect-can/Published
October 23, 2017 by Amy Campbell, MS, RD, LDN, CDE
Waking up with a high blood sugar
reading is not exactly the way you want to start off your day. Besides rushing
to get ready for work or getting the kids off to school (or both), you now have
to decide if and how you’ll deal with that reading on your meter. Maybe you
decide to skip breakfast. If you take mealtime insulin, perhaps you inject a
few extra units. Or you put in some additional time during your workout.
Another option is to shrug it off and hope that your blood sugar comes down in
a few hours. You might also ponder the reason your blood sugar is high. Could
it be that you ate dinner later than usual last night? Or you ate too much carb
at dinner? Or maybe it was your snack?
While it’s
normal to have high blood sugars when you have diabetes, it’s time to pay
attention when the highs become the norm. Morning hyperglycemia (high blood sugar) is frustrating
for many people; figuring out the cause is the first step in dealing with (and
preventing) it.
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Dawn
phenomenon: hormones that wreak havoc
It’s easy to
blame your morning high on the plate of pasta last night. But while that could
certainly be a factor, chances are, your “highs” are a result of hormones. An
imbalance of insulin, amylin (a hormone released by the pancreas), and
incretins (hormones released by the gut) is the likely culprit. Other hormones
get in on the act, too, including glucagon, growth hormone, cortisol, and adrenaline.
Why? Overnight, the body gets this idea that it needs fuel (glucose). The
witching hour seems to be around 3 AM or so. At this time, the liver and
muscles obligingly respond to the signal for fuel and release glucose into the
bloodstream. In someone without diabetes, insulin and its other hormone pals
kick in to keep blood sugar levels on an even keel. In the case of diabetes,
though, those hormones are pretty much missing in action. End result? Blood
sugar levels climb. You wake up, check your blood sugar, and it’s above and
beyond the “80–130” range. In case you’re wondering, this cascade
of events is called the “dawn phenomenon” or “dawn effect.” It’s estimated that
between 10–50% of people with either Type 1 or Type 2 diabetes will experience this at one time
or another.
What you
can do about the dawn phenomenon
• First, figure out what’s happening
overnight. This means, for a few days in a row, setting your alarm for around 3
AM and checking your blood sugar, and then checking again when you wake up at
your usual time in the morning. If your blood sugar is within your target range
when you check at around 3 AM but is high when you wake up, there’s a high
likelihood of the dawn phenomenon going on.
• Rethink your bedtime snack. Some
experts recommend avoiding carbohydrate close to bedtime. If you can’t squelch
those hunger pangs, try eating a low- or no-carb snack, such as a small handful
of nuts, a hard-boiled egg, or raw veggies dipped into nut butter that doesn’t
contain sugar. On the other hand, other experts recommend eating about 15–20
grams of carb — doing so may prevent the liver from pumping out too much
glucose. Examples include a small piece of fruit, 6 ounces of light-style
yogurt, or 3 cups of popcorn. Try out both options and see if either one helps
to lower your fasting blood sugar.
• Rethink your diabetes medicine. This
can mean changing the time when you take your medicine, whether it’s a diabetes
pill or bedtime insulin (meaning, take it at bedtime rather than at
dinnertime). You might also benefit from changing the type of medication that
you take, or even adding a medication, such as a long-acting insulin. Talk with
your health-care provider before you make changes to your medication schedule,
and discuss any other options that may be available.
• Consider an insulin pump. If you have
Type 1 diabetes or Type 2 diabetes and take both fast and long-acting insulin,
using an insulin pump can help you better manage your blood sugars overnight
and into the wee hours of the morning.
Somogyi
effect: rebounding from a low
The Somogyi
effect, also called the rebound effect, is named after Michael Somogyi, a
Hungarian researcher who first identified it. The claim behind this effect is
that the blood sugar goes low overnight. This drop triggers the release of
counterregulatory hormones, such as adrenaline, cortisol, growth hormone, and
glucagon, which, in turn, signal the liver to release glucose. The result?
Blood sugars rebound and are higher than desired in the morning. The theory,
too, is that those hormones create insulin resistance, so that it’s sometimes harder to
lower those morning readings.
Interestingly, scientists question the
Somogyi effect; some studies have failed to prove its existence. Other studies,
however, have shown that this occurrence happens in those with Type 1 diabetes.
What you
can do about the Somogyi effect
• If you’re curious about the Somogyi
effect and think it could be happening to you, once again, you’ll need to wake
up during the night to test it out. A low blood sugar at around 3 AM followed
by a high blood sugar when you rise and shine could prove this theory to be
correct. You might also have the following symptoms: a rapid heart rate, night
sweats, a headache, blurred vision, thirst, and/or dizziness.
• Using
a continuous glucose monitor (CGM) is another
helpful way to get a picture of what your blood sugars are doing overnight. A
CGM checks glucose levels about every five minutes, and also will alert you to
either high or low glucose levels, using an alarm.
• The best
way to stop the Somogyi effect in its tracks is to prevent it in the first
place. This means adjusting nighttime diabetes medication (either your sulfonylurea or your long-acting insulin), making
sure you eat enough in the evening (no skipping meals), limiting alcohol
intake, and planning for exercise more carefully. Talk with your diabetes educator or health-care provider about
options that are best for you.
Morning
high blood sugar: more food for thought
• Sure, it’s a pain to have to wake up
in the middle of the night to check your blood sugar. Remember, though, that
this isn’t forever. If you can do this for at least three nights, you should
get a clearer picture of what’s happening. Pick nights when you feel well
(meaning, you don’t have a cold or the flu), you aren’t planning to exercise
between dinner and bedtime, and your bedtime blood sugar is around 150 or so
(not too high, but not too low, either).
• Experiment a little with bedtime
snacks, as mentioned above. You may find that not eating a snack helps with
your morning blood sugar; on the other hand, eating a reasonable
carb-containing snack may help, too.
• Pay attention to high-fat dinners and
how they may affect your morning readings. Fat doesn’t directly affect blood
sugars, but it can increase insulin resistance and also slow the digestion of
carbohydrate. This means that four, six, or eight hours later, you’ll see the
effect of that fatty meal on your blood sugars. There’s also some evidence that
saturated fat can increase or worsen insulin resistance, as well.
• Don’t overlook the role of stress on
your diabetes control, too; recent or extreme stress, whether it be issues at
work or at home, an illness, or a recent medical procedure, for example — can
affect your blood sugars.
• If you
have Type 2 diabetes and you continue to wake up with high readings, don’t be
afraid to consider starting, switching, or adding medication, including
long-acting insulin, especially if lifestyle changes, such as weight loss, physical activity, and meal planning, aren’t enough to get and keep your blood
sugars in a healthy range.
Want to
learn more about the dawn phenomenon and Somogyi effect? Read “Controlling the Dawn Phenomenon” and “Somogyi Effect.”
Disclaimer of Medical Advice: You
understand that the blog posts and comments to such blog posts (whether posted
by us, our agents or bloggers, or by users) do not constitute medical advice or
recommendation of any kind, and you should not rely on any information
contained in such posts or comments to replace consultations with your
qualified health care professionals to meet your individual needs. The opinions
and other information contained in the blog posts and comments do not reflect
the opinions or positions of the Site Proprietor.
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