Diabetes: Somogyi effect: practice question

A General Medicine 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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General Medicine · Diabetes: Somogyi effect

Sample item

A person with type 1 diabetes on evening NPH insulin has high fasting glucose, but a 3 a.m. glucose of 48 mg/dL. What is the appropriate adjustment?

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

The answer and the reasoning

B. Reduce the bedtime insulin dose

Nocturnal hypoglycaemia triggers counter-regulatory hormones, causing rebound morning hyperglycaemia (Somogyi effect). Reducing the evening insulin or changing its timing prevents the low. The dawn phenomenon instead shows steadily rising glucose without a nocturnal low.

Option by option

  • A. Add metformin

    Metformin does not address the rebound mechanism in type 1 diabetes.

  • B. Reduce the bedtime insulin dose (correct)

    Correct. Preventing the nocturnal low removes the rebound hyperglycaemia.

  • C. Stop all insulin

    Stopping insulin in type 1 diabetes causes ketoacidosis.

  • D. Increase the bedtime insulin dose

    Increasing insulin would deepen the nocturnal 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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Reduce the bedtime insulin dose. Nocturnal hypoglycaemia triggers counter-regulatory hormones, causing rebound morning hyperglycaemia (Somogyi effect).

Why is "Add metformin" not the answer?

Metformin does not address the rebound mechanism in type 1 diabetes.

Why is "Stop all insulin" not the answer?

Stopping insulin in type 1 diabetes causes ketoacidosis.

Why is "Increase the bedtime insulin dose" not the answer?

Increasing insulin would deepen the nocturnal hypoglycaemia.

What concept does this question test?

It tests Diabetes: Somogyi effect in General Medicine. Reducing the evening insulin or changing its timing prevents the low. The dawn phenomenon instead shows steadily rising glucose without a nocturnal low.

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 Diabetes: Somogyi effect?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.