Abstract
The cause of hyperglycemia and acetonuria which may alternate with hypoglycemia in diabetic children are poorly understood. To evaluate the hormaonla basis of the “Somogyi effect” in 3 “brittle” diabetic children, glucose, growth hormone (HGH) and cortisol levels in blood were measured hourly or half-hourly, and urinary catecholamine excretion in 2-hourly collections, for several 24–28 hour periods. Profound hypoglycemi (7–40 mg%) alternating with prolonged hyperglycemia was demonstrated at unpredictabel times, even though fasting glucose was normal or elevated. HGH levels increased sharply, sometimes to as much as 30–75 mμg/ml, with hypoglycemia or following every sharp fall in glucose, even when the latter remained in the hyperglycemic range. These peaks of HGH were usually followed by marked hyperglycemia. Plasma cortisol levels varied errastically without consistent relationship to glucose levels. Rises in catecholamine excretion (to 4–12 μg/hr) occurred following hypoglycemia and also independently of it, but did not always cause elevation of glucose. With gradual reduction of insulin dosage, the control of the diabetes improved, and in one patient who was profoundly stuporous, the mental state improved dramatically. These studies emphasize the importance of determining blood sugar concentration at frequent intervals since hypoglycemia may go unrecognized for years if the standard sampling times are adhered to. The hormonal data support the concept that growth hormone release in response to hypoglycemia in the diabetic is an important factor in producing hyperglycemia and insulin resistance.
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Bruck, E., Mac-Gillivray, M. Hormonal aspects of post-hypoglycemic hyperglcemia (Somogyieffect) in diabetie children. Pediatr Res 5, 397 (1971). https://doi.org/10.1203/00006450-197108000-00110
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DOI: https://doi.org/10.1203/00006450-197108000-00110