Management of Early Morning Hyperglycemia in Patients with Type 1 Disease

在馬偕小兒念到 Dawn phenomenon，恰巧之前也在學長板上看到：

今天才知道早上AC sugar高→調高HS的insulin劑量完全是錯誤的
不該是一個內科醫師該有的行為@@

(雖然我應該沒做過這種事 可是聽起來超級無敵合理的!!!!)
據說AC sugar高的正確動作是半夜三點再測一次

一時興起，查了一下

Somogyi effect: 半夜低血糖會引發回饋，分泌激素使得晨血增高。
Dawn phenomenon: 較常見，因為 insulin 已耗盡。75% Type 1 DM 跟大多數 T2DM 及正常人，因為在入睡時 Growth hormone 被釋放，使得在5~8點時 insulin 的 tissue sensitivity會降低。
Dx: 半夜三點多抽一次血糖
Tx: 可分作幾種情形─A. Waning of circulating insulin levels, B. dawn phenomenon, C. Somogyi effect

1. Somogyi effect: ↓睡前insulin。
2. A. or B. or A.+B.：↑basal insulin。用NPH的則建議改成 insulin glargine 上pump的，在4~5點調高 basal infusion rate。可看半夜三點的 sugar 作調整。
3. A.+B.+C.：書上沒寫，我想應該是 (1) + (2) 吧
   
   

Table 18–17. Typical Patterns of Overnight Blood Glucose Levels and Serum Free Immunoreactive Insulin Levels in Prebreakfast Hyperglycemia Due to Various Causes in Patients with Type 1 Diabetes.	Blood Glucose Levels (mg/dL)			Serum Free Immunoreactive Insulin Levels (μU/mL)
	10 PM	3 AM	7 AM	10 PM	3 AM	7 AM
Somogyi effect	90	40	200	High	Slightly high	Normal
"Dawn phenomenon"	110	110	150	Normal	Normal	Normal
Waning of circulating insulin levels plus "dawn phenomenon"	110	190	220	Normal	Low	Low
Waning of circulating insulin levels plus "dawn phenomenon" plus Somogyi effect	110	40	380	High	Normal	Low

Reference: Greenspan's Basic & Clinical Endocrinology > Chapter 18. Pancreatic Hormones & Diabetes Mellitus