#379 Defining Diabetes: Somogyi Effect
Scott and Jenny Smith define diabetes terms
Defining Diabetes: Somogyi Effect
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Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.
I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about the smokey effect. But there are two others that go with it. The other one's called defining diabetes, feet on the floor. And the third one defining diabetes dawn phenomenon.
Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm gonna have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.
If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One, you go to Contour Next one.com forward slash juice box. And of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that type one diabetes for over 30 years, Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She is my favorite person. I want to do three defining diabetes ideas. Okay, and then see if we can do a Mini Pro tip about glycemic load index. Sure that makes sense. I pick that one. I pick all the sexy diabetes topics.
Jennifer Smith, CDE 3:18
Absolutely.
Scott Benner 3:19
You know what I realized that for the last number of years now, as the new year rolls over, I have this horrible pit in my stomach. And I think I'm never going to come up with stuff for Jenny to do. And I'm gonna run out of it. And now it's September already. And unlike we don't have enough time to record all the stuff that I'd like to record. I just I think back to the person who told me like, no, you're starting a diabetes podcast that won't last long, you'll run out of things to say and I think more now that that person just didn't realize all the things their work to say, you know,
Jennifer Smith, CDE 3:55
right. Well, and I think so many things engine with being with having your, like online kind of groups and whatnot, I think there are a lot of topics and things that end up coming up that you're like, Oh, good one to talk about for certain
Scott Benner 4:12
for certain of all the trepidation I had about starting a private Facebook group. watching all of those people speak to each other. Like sometimes like really lights me up. I'm like, Ooh, that's such a good thought right there or, or somebody has a half a thought, and they can't get to the rest of it. And you can see the rest of it. And you're like, Oh, I wouldn't have thought of the first part. But I understand how to finish this idea. Right. So anyway, it has been it's been incredibly valuable. At this point. I don't see why this podcast would have to end. And in the beginning, I thought like oh, it could probably only go for a certain amount of time. But I think that might have just been bad advice from somebody. All right. So three defining diabetes episodes today that I think of, I'm going to put them up separately, but I think they could probably all go together. I want to do Dawn phenomenon feet on floor and the one I can't pronounce somehow G. A fellow he's Mogi. Is that what it is? Yeah. All right. Let's start with the one I don't know anything about so you can get warmed up. What is the smoky effect?
Jennifer Smith, CDE 5:18
Do you want to actually spell it for people? Sure.
Scott Benner 5:22
I have it here is so mo gyi and then effect in the classic way, with an E, for all of you who always use an A when you mean a.
Jennifer Smith, CDE 5:35
What the interesting thing
is that this topic is kind of one that's sort of like it's like this 5050. I don't know that that's the exact like percentile breakdown of people who believe versus don't really believe that it's kind of the issue, but it's essentially relative to why you might have elevated blood sugars in the morning. Okay, what ends up happening after you have a low blood sugar is it's a rebound, high blood sugar that you end up with in response to having had the lower blood sugar value, some from what we call kind of counter regulatory hormones that are released in terms of a low blood sugar. Yeah, why sometimes it happens, versus not all the time, I think is probably the reason that people question whether it's a real thing. I guess that's the easiest way to because it
Scott Benner 6:38
doesn't consistently happen every time.
Jennifer Smith, CDE 6:41
Correct. Okay. Exactly. I mean, there is in relevance, it seems to be low blood sugars that are usually less than about 55. And that are more sustained in length that seemed to have this counter regulatory hormone output, and can then result in the higher blood sugar later. Now some of it also is we have a low blood sugar, especially with today's technology, you get an alert right from your CGM. And so then you may treat that low blood sugar. And because those counter regulatory hormones are not like, hey, right now, she or he needs this right now. Yeah, they could have lingering impacts, you end up treating this low blood sugar with what would normally work for you, right? 10 grams, it always works, it brings you up, you never go too high from it. But now with the counter regulatory hormones in the picture along with your normal 10 gram treatment, you end up at like 290. When you wake up in the morning, you're like,
Scott Benner 7:45
yeah, so Okay, so I have, I feel like I have some experience with this, not knowing that it was a thing or had a name, or at least a name that is hard to pronounce. And oddly spelled, but it is, but you know
Jennifer Smith, CDE 7:59
that it's actually named after a person gets up. It is it's named after it's the last name of things, the professor or the doctor who saw it happen, and thus named after him. All right, if I remember correctly,
Scott Benner 8:14
I'll try to figure out who he is. While I'm telling you that before Arden had a CGM. I've said this a ton of times on the podcast, right? I would get her blood sugar up to like 190 put her to bed. She'd wake up at 100. And I was like, look how good I am at this. Right. And then one day, we put a dexcom honor and I realized I was pushing her up to 190. In the early part of overnight, she was dropping to like 55 sitting there for an hour or two. And then she'd rise back up and level off at 90.
Jennifer Smith, CDE 8:50
And you never treated the low because you didn't really without a CGM. You didn't really know that it was happening.
Scott Benner 8:56
Never knew it. I took all that anecdotal data about her waking up at 90 and starting at 190. And I never considered she could have gone below 90 and come back up again. I always just thought she was drifting 100 points down overnight. Yeah, right.
Jennifer Smith, CDE 9:09
And that's she had to be hired to go to bed at night. Because otherwise, if she went to bed at 100, she'd be in the toilet by the time she woke up, even though it was happening sooner. Yeah. And then just naturally rising back up from the counter regulatory release.
Scott Benner 9:24
And I want to keep everyone focused on the idea that the reason Arden drifted down overnight was because I did not have any meaningful idea about how to use insulin like so. She She was just like, you know, because I've been helping this person recently. Who hears me, but can accept it. You know what I mean? They just think oh, no, the low happens at night. I'm like, No, you are messing up your meal bolus, then your overcorrecting afterwards and then she is experiencing a low blood sugar later and no matter how many times I say You know, what's happening now is not about now it's about before, you know, it's it's like this a fee for this person specifically. And I would imagine for a lot of people, it's this fear that's been built into them day after day, week after week, month after month, year after year of thinking like this is just random, and there's no reason for anything that's happening here. Because they can't see the causation. Right? They, they just they see the pencil go in the pocket and they think, Oh, it's the pencil. It's not the pencil. You're you're looking here. What's going on over here is what's happening. And when you talk about a hormonal release, is that from the liver? Mm hmm. Okay. And it's just glucagon, right? Or no, it is. Yes. Yeah. But you can't count on it.
Jennifer Smith, CDE 10:50
You can't count on. You can't count it always happening. From my base understanding of it. Yes. And secondly, you can't count on how much is don't.
Scott Benner 11:03
Plus, I would assume you can't count on an overpowering a certain amount of insulin active insulin, like maybe it could catch a drift where the insulin is almost gone. But if you were to put in a large bolus, it would take you right past that it would power right through any glucagon dump and just tank you. Right. Alright. Okay. Apparently it's Stephen. smudgy. And he's a jersey guy. Sup, Steven? Oh, is somebody who's gonna tell you that they heard this on here and come back and let you know about it. This is the guy it's I don't know. He's an internist. Apparently. All right. Well, no, no, wait. Now there's another smokey. There's a guy and he's an orthopedic. How many Smokies Could you be in the world? Yeah, what I
Jennifer Smith, CDE 11:47
found is it says it's a theater at theoretical phenomenon was named after Michael smudgy, a Hungarian born professor of biochemistry at Washington University and Jewish Hospital of St. Louis. I have it here. Who prepared the first insulin treatment given to a child with diabetes in the US in October of 1922. Smokey showed that excessive insulin makes diabetes unstable, and first published his findings in 1938. That's what I found. And
Scott Benner 12:15
he will not take offense to what I just said. Because he died the year I was born. So he has I don't care for quite a long time. Although you got to give this guy props. Born in 1883 he lived till 1971. Wow, that's amazing. 101 a math? What's math? Yeah, that's almost 100. What? 1883 17 years? 1771? Hold on seven, carry the one. It's eight. He was like, 88.
Jennifer Smith, CDE 12:50
Yeah, he was, wow.
Scott Benner 12:52
Go to public school. So
Jennifer Smith, CDE 12:54
I did not know cap Catholic school from first grade through 12th grade.
Scott Benner 12:59
We've just let down the Catholic and public school systems in one fell swoop. Really good. All right. So is there anything else to say about the smokey effect? It causes? It causes high blood sugar high blood sugar in the morning due to low blood sugars overnight because of a glucagon dump. That happens from a low if in fact, any of this is happening. Wow. All right, then. That's a rock solid. It's a rock solid description. It's a rock solid description of something that may or may not exist.
Jennifer Smith, CDE 13:33
Well, and I think the interesting thing about it too, in terms of like pushing it a little further is that it's really something that's considered or named after just that morning, high blood sugar and the potential reason for that morning, high blood sugar beyond another thing that we're going to define which we'll talk about high blood sugars in the morning, too. Yeah. But during the daytime, it's not like you don't have this counterregulatory potential impact either. So you could, again, have a low blood sugar during the day. And you could also have counterregulatory hormone impact in the aftermath. Again, treating it as you normally treat it, let's say 10 grams of carb is your staple treatment, it always works. And now all of a sudden, today for some reason, you're at, you know, a high 200. And you're thinking well, why, you know, so again, it could be the relative nature of the number or the low that you were at, and possibly how long the low was sustained, in terms of those counter regulatory hormones.
Scott Benner 14:45
If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com Thanks so much to the Omni pod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my office. The pod.com forward slash juice box, learn more about the dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply, in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org. forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show. The pentameter of that reminds me of save the cheerleader save the world. From heroes, you remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them. Go into your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app all episodes, scroll down, you'll see them you can go to Juicebox Podcast comm and scroll down a little bit. Right, and you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books you look up. Oh, hold on. Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right, it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginie I explained that to you. ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes. But you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes. Two new ones that are out right now around this, like I mentioned the beginning, I think go together with this one. The other two are feet on the floor. And this Moji effect, there's some Mogi effect. I don't know how to say that word, but you'll see it it'll be the only word that sounds like some Oh gee, when you read it, looking for a great doctor or other type of diabetes practitioner, check out check out Whoo, there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add. Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.
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