Systemic paediatrics: Somogyi effect in type 1 diabetes: practice question

A Pediatrics 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.

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Pediatrics · Systemic paediatrics: Somogyi effect in type 1 diabetes

Sample item

A 10-year-old with type 1 diabetes on twice-daily regular and NPH insulin has fasting blood glucose of 280 mg/dL with morning ketonuria. A 3 a.m. glucose check is 48 mg/dL. What is the right adjustment?

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

The answer and the reasoning

A. Reduce the evening NPH insulin dose

Nocturnal hypoglycaemia triggers counter-regulatory hormones, producing rebound morning hyperglycaemia (Somogyi effect). The remedy is to lower the evening intermediate-acting insulin, not to raise it, and to check overnight glucose.

Option by option

  • A. Reduce the evening NPH insulin dose (correct)

    Correct. Lowering the evening NPH dose prevents the nocturnal hypoglycaemia and its rebound.

  • B. Increase the morning regular insulin dose

    More morning regular insulin does not address the night-time low.

  • C. Add rapid-acting insulin at bedtime

    Bedtime rapid-acting insulin would add to the risk of hypoglycaemia overnight.

  • D. Increase the evening NPH insulin dose

    Raising the evening dose would deepen the night-time hypoglycaemia.

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.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Reduce the evening NPH insulin dose. Nocturnal hypoglycaemia triggers counter-regulatory hormones, producing rebound morning hyperglycaemia (Somogyi effect).

Why is "Increase the morning regular insulin dose" not the answer?

More morning regular insulin does not address the night-time low.

Why is "Add rapid-acting insulin at bedtime" not the answer?

Bedtime rapid-acting insulin would add to the risk of hypoglycaemia overnight.

Why is "Increase the evening NPH insulin dose" not the answer?

Raising the evening dose would deepen the night-time hypoglycaemia.

What concept does this question test?

It tests Systemic paediatrics: Somogyi effect in type 1 diabetes in Pediatrics. The remedy is to lower the evening intermediate-acting insulin, not to raise it, and to check overnight glucose.

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 Systemic paediatrics: Somogyi effect in type 1 diabetes?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.