Somogy's Syndrome, or Chronic Insulin Overdose Syndrome (SXPI): Symptoms, Diagnosis, Treatment

Somogy's syndrome is a rare but insidious disease, especially known to people with diabetes. How can one recognize it and can it be cured?

The concept of Somogy's syndrome

When diabetes is necessary to properly calculate the dose of insulin, but often it can be difficult to do, which is fraught with complications. The result of a constant overdose of the drug becomes Somogy syndrome. In other words, it is a syndrome of chronic overdose of insulin. American scientist Michael Somogy studied this phenomenon in 1959 and came to the conclusion that the ingestion of high doses of the substance mentioned provokes hypoglycemia - a decrease in the level of glucose in the blood. This leads to stimulation of counterinsulin hormones and a response - ricochet hyperglycemia (increased blood glucose level).

It turns out that at any time the level of insulin in the blood exceeds what is required, which in one case leads to hypoglycemia, in another - to overeating. And the release of counterinsulin hormones causes constant fluctuations in blood glucose levels, which is the cause of the unstable course of diabetes mellitus, and can also lead to ketonuria (acetone in the urine) and ketoacidosis (a complication of diabetes mellitus).

Historical facts

For the first time insulin was successfully applied in 1922, after which comprehensive studies of its influence on the body began, experiments on animals and humans were conducted. Scientists have found that large doses of the drug in animals cause hypoglycemic shock, often leading to death. It was suggested that the toxic effect of a large amount of the hormone on the body. In those early years, the drug was used to treat patients with anorexia in order to increase their body weight. This led to constant changes in the level of glucose in the blood, fluctuations 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, when treating patients with schizophrenia with "insulin shocks". The pattern between increasing the dose of insulin and increasing glycemia was also found in the treatment of diabetes mellitus. This phenomenon became known in the future as Somoji syndrome.

Symptoms

How do you independently understand that the body is exposed to a chronic overdose of insulin? Somoji's syndrome is manifested by such symptoms:

• There is a deterioration in overall health, there is a weakness,
• Sudden headaches, dizziness, which can abruptly disappear after taking carbohydrates with food,
• The dream is disturbed, becomes disturbing and superficial, nightmares are often seen,
• There is a constant feeling of fatigue, drowsiness,
• In the morning it's hard to wake up, a person feels broken,
• There may be visual disturbances in the form of fog in front of the eyes, shrouds or flashing of bright points,
• Sharp mood swings, more often in a negative direction,
• Increased appetite, weight gain.

Such symptoms are an alarm bell, but can not become a clear reason for diagnosing, as they are signs of many diseases. A complete picture of the processes occurring in the body can be tracked using analysis.

Diagnostics

To diagnose "Somodzhi syndrome" help such signs of the disease:

• The appearance of ketone bodies (acetone) in the urine,
• Sharp and frequent fluctuations in glucose levels from low to high and back during the day,
• Obvious or latent hypoglycemia,
• Improving the level of sugar in colds,
• The course of diabetes mellitus deteriorates with an increase in the insulin dose and improves with a decrease.

Diagnosis of Somogy syndrome in most cases is difficult even for specialists, not always consultation of the endocrinologist can give immediately correct results. This is due to the fact that the patient's symptoms and disorders occurring in his body can signal both an overabundance of insulin and its deficiency. Clinical pictures in these processes are identical, chronic overdose can be detected only with constant supervision by a specialist and careful examination of the analyzes. The diagnosis is made on the basis of such indicators as typical clinical manifestations, frequent hypoglycemic conditions, high index of fluctuation of glycemia.

Differential diagnostics

When diagnosed, Somogy's syndrome is easily confused with the manifestations of the "morning dawn" phenomenon, since the symptoms of these two pathologies are identical. However, there are significant differences. The phenomenon of the "morning dawn" is found not only in diabetic patients, but also in healthy people, it manifests itself as a dawn hyperglycemia. This is due to the lack of a basal level of insulin because of its rapid destruction in the liver or with increased secretion of the counterinsulant hormone in the morning. Unlike Somogy's syndrome, the manifestation of this phenomenon is not preceded by hypoglycemia. To establish the correct diagnosis, you need to know the level of glycemia from two to four o'clock at night, in a patient with chronic overdose syndrome it is reduced, and in a patient with daylight hyperglycemia it does not change. Treatment of these diseases is directly opposite: if in the first case the dose of insulin is reduced, then in the second - increase.

Features of diabetes mellitus in Somoji syndrome

The combination of diabetes mellitus with the syndrome of chronic insulin overdose (CIPI) has a deleterious effect, the disease is particularly difficult. Against the background of getting constantly overestimated doses of the drug, hypoglycemia acquires a latent form. Somozhi's syndrome with diabetes affects both the general condition of the patient and his behavior.

Sharp mood changes for no particular reason - a frequent occurrence in such a disease. If you are engaged in some occupation or game after a while, a person suddenly loses interest in everything that is happening, becomes listless and apathetic, indifferent to external circumstances. Sometimes there may be unmotivated resentment or aggression. Very often there is an increased appetite in the patient, but despite this, sometimes there is a sharply negative attitude towards food, a person refuses to eat. Such symptoms occur in 35% of patients. More common complaints include fits of weakness, dizziness, headaches, sleep disturbance. Some note sudden and short-term vision impairment (in the form of a veil before the eyes or bright "flies").

Treatment

Treatment of Somogy's syndrome requires a correct calculation of the insulin dose. To do this, the amount of the drug administered must be adjusted, it is reduced by 10-20% with strict monitoring of the patient's condition. How long does Somogy's syndrome last? Depending on the 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 it is not. Just reducing the amount of injected drug does not improve the course of diabetes, it requires complex treatment. It affects the diet (normal amount of carbohydrates consumed with food is normal), physical activity. Insulin is administered before each meal. Only an integrated approach can yield positive results in combating Somogy's syndrome.

Forecast

A timely syndrome of chronic overdose of insulin has positive predictions. It is important to monitor yourself, for body signals, any changes in your condition, and if you feel unwell, seek medical help immediately, for example, at the Endocrinology Center at Akademicheskaya (Moscow). In the favorable outcome of the treatment, the main role is played by the professionalism and experience of the doctor. With an undiagnosed syndrome, unfavorable predictions: an ongoing overdose of insulin will only worsen the patient's condition, the course of diabetes mellitus is aggravated.

Prevention

The main directions of the prevention of ARPI include a set of measures.

• With diabetes, a diet that is competently matched to the patient and which guarantees compensation of carbohydrate metabolism must be strictly observed. A person should plan his diet, be able to calculate the carbohydrate value of food consumed, if necessary, make an adequate replacement of the product.
• Insulin therapy is carried out at the doses required for a particular patient. The doctor's task is to correct, if necessary, the patient-to watch the manifestations of his organism.
• Constant physical activity is necessary for diabetes, especially if the patient has a sedentary lifestyle or has a sedentary job.
• Continuous monitoring of the course of the disease, consultation of the endocrinologist on an individual schedule and as needed.
• Adequate assessment of the state of the body, well-being, rapid detection of suspicious symptoms.
• Creating conditions for self-monitoring in everyday life, studying the principles of self-control by patients and family members.

Somoji Syndrome in children

Children with diabetes can not always monitor changes in their body's condition, often this is not possible, so monitoring the course of the disease is caring for the parents. It is necessary to watch closely the sleeping baby, since the action of insulin is mainly at night, and the behavior of the child can tell a lot. With the manifestation of the syndrome, sleep becomes restless and shallow, accompanied by noisy breathing. A child can cry or cry in a dream because of nightmarish dreams. Awakening is heavy, right after it there is confusion.

All these manifestations are a sign of hypoglycemia. All day the child remains sluggish, he is capricious, irritated, does not show interest in games or studies. Apathy can arise unexpectedly, unreasonably, in the course of any occupation. There are often unmotivated outbreaks of aggression, mood changes become unpredictable. Often children with the syndrome suffer from depression. Treatment is carried out on the same principle as in adults. The Center for Endocrinology at the Academic, for example, helps children to cope with Somogy's syndrome.