Somoji Syndrome is a rare but insidious disease, especially known to people with diabetes. How can it be recognized and can it be cured?
The concept of Somoji syndrome
With diabetes, the correct calculation of the dose of insulin is necessary, but this is often difficult to do, which is fraught with complications. The result of a constant overdose of the drug is Somoji syndrome. In other words, it is chronic insulin overdose syndrome. The American scientist Michael Somoji studied this phenomenon in 1959 and came to the conclusion that the intake of excessive doses of the mentioned substance into the body provokes hypoglycemia - a decrease in blood glucose levels. This leads to stimulation of contra-insulin hormones and a response - rebound hyperglycemia (increased blood glucose levels).
It turns out that at any time the level of insulin in the blood exceeds the required level, which in one case leads to hypoglycemia, in the other - to overeating. And the release of contra-insulin hormones causes constant drops in blood glucose levels, which is the cause of the unstable course of diabetes mellitus, and can also lead toketonuria (acetone in the urine) and ketoacidosis (a complication of diabetes).
Historical facts
For the first time, insulin was successfully used in 1922, after which comprehensive studies of its effect on the body began, experiments were carried out on animals and humans. Scientists have found that large doses of the drug in animals cause hypoglycemic shock, often leading to death. It has been suggested that a large amount of the hormone has a toxic effect on the body. In those distant years, the drug was used to treat patients with anorexia in order to increase their body weight. This led to constant changes in blood glucose levels, ranging from hypoglycemia to hyperglycemia. At the end of the course of treatment, the patient showed signs of diabetes mellitus. The same effect took place in psychiatry, in the treatment of patients with schizophrenia with “insulin shocks”. The pattern between an increase in the dose of insulin and an increase in glycemia was also revealed in the treatment of diabetes mellitus. This phenomenon became known as the Somoji syndrome.
Symptoms
How to independently understand that the body is undergoing a chronic overdose of insulin? Somogyi syndrome is manifested by the following symptoms:
- there is a deterioration in general well-being, weakness appears,
- sudden headaches, dizziness, which can abruptly disappear after eating carbohydrates,
- sleep is disturbed, becomes anxious and superficial, often has nightmares,
- feels constantly tired,sleepiness,
- it's hard to wake up in the morning, one feels overwhelmed,
- visual disturbances may appear in the form of a fog before the eyes, a veil or flickering of bright points,
- sharp mood swings, often in the negative direction,
- increased appetite, weight gain.
Such symptoms are an alarming bell, but cannot be a clear reason for a diagnosis, as they are signs of many diseases. A complete picture of the processes occurring in the body can be tracked using tests.
Diagnosis
The following signs of the disease help to diagnose "Somogyi syndrome":
- appearance of ketone bodies (acetone) in urine,
- sharp and frequent fluctuations in glucose levels from low to high and back throughout the day,
- overt or covert hypoglycemia,
- improving sugar levels in colds,
- Diabetes mellitus worsens with higher insulin doses and improves with lower doses.
Diagnosis of Somogyi syndrome in most cases is difficult even for specialists, not always consulting an endocrinologist can immediately give correct results. This is due to the fact that the symptoms of the patient and the disorders occurring in his body can signal both an excess of insulin and its deficiency. The clinical pictures in these processes are identical, chronic overdose can be detected only whenconstant supervision of a specialist and a thorough study of the analyzes. The diagnosis is made on the basis of such indicators as typical clinical manifestations, frequent hypoglycemic conditions, high glycemic fluctuation rate.
Differential Diagnosis
When diagnosing, Somogyi syndrome is easily confused with manifestations of the “dawn” phenomenon, since the symptoms of these two pathologies are identical. However, there are also significant differences. The phenomenon of "dawn" occurs not only in patients with diabetes mellitus, but also in he althy people, it is manifested by dawn hyperglycemia. This is due to a lack of basal levels of insulin due to its rapid destruction in the liver or with increased secretion of the contrainsular hormone in the morning. Unlike Somogyi syndrome, the manifestation of this phenomenon is not preceded by hypoglycemia. To make a correct diagnosis, you need to know the level of glycemia from two to four in the morning, in a patient with chronic overdose syndrome it is reduced, and in a patient with dawn hyperglycemia it does not change. The treatment of these diseases is exactly the opposite: if in the first case the dose of insulin is reduced, then in the second case it is increased.
Features of diabetes mellitus in Somoji syndrome
The combination of diabetes mellitus with chronic insulin overdose syndrome (CPIS) has a detrimental effect, the disease is especially severe. Against the background of receiving constantly overestimated doses of the drug, hypoglycemia acquires a latent form. Somogyi syndrome in diabetes mellitus affects both the general condition of the patient and his behavior.
Sudden mood swings for no particular reason are common with this ailment. When enthusiastically engaged in some business or game, after a while a person suddenly loses interest in everything that happens, becomes lethargic and apathetic, indifferent to external circumstances. Sometimes unmotivated resentment or aggression can be observed. Very often, the patient has an increased appetite, but despite this, sometimes there is a sharply negative attitude towards food, the person refuses to eat. Such symptoms occur in 35% of patients. More common complaints include bouts of weakness, dizziness, headaches, and sleep disturbance. Some report sudden and short-term visual disturbances (in the form of a veil before the eyes or bright "flies").
Treatment
Treatment of Somogyi syndrome involves the correct calculation of the dose of insulin. For this, the amount of the administered drug must be adjusted, it is reduced by 10-20% with strict monitoring of the patient's condition. How long is Somogyi syndrome treated? Depending on individual indications, different correction methods are used - fast and slow. The first is carried out for two weeks, the second takes 2-3 months.
At first glance, you might think that reducing the dose of insulin will lead to the disappearance of the syndrome, but this is not so. Merely reducing the amount of the administered drug does not improve the course of diabetes mellitus, complex treatment is necessary. It affects the diet (normalizedthe amount of carbohydrates consumed with food), physical activity. Insulin is administered before each meal. Only an integrated approach can give positive results in the fight against Somogyi syndrome.
Forecast
Timely diagnosed chronic insulin overdose syndrome has a positive prognosis. It is important to take care of yourself, the body's signals, any changes in your condition, and if you feel worse, immediately consult a doctor, for example, at the Endocrinology Center on Akademicheskaya (Moscow). In a favorable outcome of treatment, the main role is played by the professionalism and experience of the doctor. With an undiagnosed syndrome, the prognosis is unfavorable: a continued overdose of insulin will only worsen the patient's condition, the course of diabetes mellitus will worsen.
Prevention
The main directions of prevention of CPIS include a set of measures.
- In diabetes, a diet must be strictly observed, well-chosen for the patient and guaranteeing compensation for carbohydrate metabolism. A person must plan his diet, be able to calculate the carbohydrate value of the food consumed, and, if necessary, make an adequate replacement of the product.
- Insulin therapy is carried out in doses required for a particular patient. The doctor's task is to make a correction if necessary, the patient's task is to monitor the manifestations of his body.
- Constant physical activity is necessary for diabetes, especially if the patient leads a sedentary lifestyle or has a sedentary job.
- Constant monitoring of the course of the disease, consultation with an endocrinologist on an individual schedule and as needed.
- Adequate assessment of the state of the body, well-being, rapid identification of suspicious symptoms.
- Creating conditions for self-control in everyday life, teaching patients and family members the principles of self-control.
Somoji syndrome in children
Children with diabetes cannot always track changes in the state of their body, it often seems impossible, so controlling the course of the disease is the concern of parents. You need to carefully monitor the sleeping baby, since the action of insulin occurs mainly at night, and the child's behavior can tell a lot. With the manifestation of the syndrome, his sleep becomes restless and superficial, accompanied by noisy breathing. The child may scream or cry in his sleep due to nightmares. Awakening is difficult, immediately after it there is confusion.
All these manifestations are a sign of a hypoglycemic state. All day the child remains in a lethargic state, he is capricious, irritated, does not show interest in games or studies. Apathy can arise unexpectedly, for no reason, in the course of any occupation. Often unmotivated outbreaks of aggression, mood changes become unpredictable. Often children with the syndrome suffer from depression. Treatment is carried out according to the same principle as in adults. The Endocrinology Center on Akademicheskaya, for example, helps andchildren to cope with Somogyi syndrome.
