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Chapter 2 Index
A. Evaluation by system B. Other categories of illnesses:
1. Metabolic and Endocrine:
--Treatment of Diabetes: The Rule of “1’s”
--Outpatient Management of Diabetes |
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Hyperglycemia in Diabetics in the AM:
What to Do
Somogyi Phenomenon: hypoglycemia episodes alternating
with hyperglycemia hypoglycemia begets hyperglycemia: outpouring of
counterregulatory hormones in response to an outpouring of counterregulatory
hormones in response to insulin induced hypoglycemia. Often associated
with >2u/kg of insulin
Dawn Phenomenon: elevations of blood glucose between 5 and
9 AM without preceding hypoglycemia. This is a physiologic event and often
follows patients treated with continuous insulin. Nocturnal surges of growth
hormone antagonize insulin’s metabolic effects leading to hyperglycemia.
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3AM |
7AM |
Treatment |
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Somogyi |
Hypoglycemia |
Hyperglycemia |
reduce PM NPH or delay until 9PM |
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Dawn |
normal or hyper |
Hyperglycemia |
increase PM dose NPH |
Both of these phenomena can lead to the child termed the “brittle
diabetic.” Other manipulations that can try if the above fails are:
- switch to two daily injections of insulin if not already on two shots
- change from beef-pork mixtures to pure pork or human insulin
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