Insulin: Somogyi effect and dawn phenomenon: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Pharmacology · Insulin: Somogyi effect and dawn phenomenon

Sample item

A type 1 diabetic on bedtime NPH insulin has fasting glucose of 220 mg/dL, and a 3 a.m. glucose of 48 mg/dL. What is the likely explanation and adjustment?

ADawn phenomenon, so increase the evening insulin doseBInsulin resistance, so double the doseCSomogyi effect, rebound hyperglycaemia after nocturnal hypoglycaemia, so reduce the evening insulin doseDSteroid effect, so add prednisolone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Somogyi effect, rebound hyperglycaemia after nocturnal hypoglycaemia, so reduce the evening insulin dose

In the Somogyi effect nocturnal hypoglycaemia triggers counter-regulatory hormones and morning hyperglycaemia, and the remedy is to lower the evening dose. In the dawn phenomenon the 3 a.m. glucose is normal or high, with a rise at dawn due to growth hormone and cortisol.

Option by option

A. Dawn phenomenon, so increase the evening insulin dose
Dawn phenomenon shows no nocturnal hypoglycaemia.
B. Insulin resistance, so double the dose
Doubling the dose would worsen hypoglycaemia.
C. Somogyi effect, rebound hyperglycaemia after nocturnal hypoglycaemia, so reduce the evening insulin dose (correct)
Correct. Low 3 a.m. glucose points to the Somogyi effect.
D. Steroid effect, so add prednisolone
Steroids are not involved.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Somogyi effect, rebound hyperglycaemia after nocturnal hypoglycaemia, so reduce the evening insulin dose. In the Somogyi effect nocturnal hypoglycaemia triggers counter-regulatory hormones and morning hyperglycaemia, and the remedy is to lower the evening dose.

Why is "Dawn phenomenon, so increase the evening insulin dose" not the answer?

Dawn phenomenon shows no nocturnal hypoglycaemia.

Why is "Insulin resistance, so double the dose" not the answer?

Doubling the dose would worsen hypoglycaemia.

Why is "Steroid effect, so add prednisolone" not the answer?

Steroids are not involved.

What concept does this question test?

It tests Insulin: Somogyi effect and dawn phenomenon in Pharmacology. In the dawn phenomenon the 3 a.m. glucose is normal or high, with a rise at dawn due to growth hormone and cortisol.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Insulin: Somogyi effect and dawn phenomenon?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.