The health care provider suspects the Somogyi effect in a client whose 7:00 A.M. blood glucose is 12.2 mmol/L. Which action should the nurse plan to take? a. Check the client’s blood glucose at 3:00 A.M. b. Administer a larger dose of long-acting insulin. c. Educate about the need to increase the rapid-acting insulin dose. d. Remind the client about the need to avoid snacking at bedtime.
The correct answer and explanation is:
The correct answer is: a. Check the client’s blood glucose at 3:00 A.M.
Explanation:
The Somogyi effect, also known as rebound hyperglycemia, occurs when a person experiences low blood glucose (hypoglycemia) during the night, typically around 2:00 to 3:00 A.M. This hypoglycemia triggers a counter-regulatory hormone response, including the release of glucagon, epinephrine, cortisol, and growth hormone. These hormones cause the liver to release glucose into the bloodstream, leading to elevated blood glucose levels by early morning. This results in a high blood glucose reading at 7:00 A.M., such as the 12.2 mmol/L observed in this client.
To confirm if the Somogyi effect is the cause of the morning hyperglycemia, the nurse should check the client’s blood glucose level around 3:00 A.M. If hypoglycemia is detected at this time, it supports the diagnosis of the Somogyi effect. This is important because the treatment depends on the cause of the morning hyperglycemia.
Administering a larger dose of long-acting insulin (option b) or increasing the rapid-acting insulin dose (option c) could worsen the problem if the Somogyi effect is present, as this would increase the risk of overnight hypoglycemia. The rebound hyperglycemia is a response to the earlier low blood sugar, so increasing insulin doses without confirming the cause might worsen nighttime hypoglycemia and potentially dangerous symptoms.
Reminding the client to avoid snacking at bedtime (option d) is not a standard intervention for the Somogyi effect. In fact, sometimes a bedtime snack is recommended to prevent nocturnal hypoglycemia.
Therefore, checking the blood glucose at 3:00 A.M. allows for proper assessment and guides the appropriate management. If hypoglycemia is confirmed at night, treatment might include reducing the insulin dose or providing a bedtime snack to prevent the drop in blood sugar and subsequent rebound hyperglycemia.