Rebound hyperglycemia is any incidence where blood sugar drastically spikes following a low blood sugar.
This can happen for a handful of reasons including: over-correcting a low, excessive insulin use, hormonal response, or nocturnal hypoglycemia.
Those living with diabetes are more prone to rebound hyperglycemia, especially those who are on insulin, as they experience more severe fluctuations in their glucose levels.
This reaction can unfortunately cause disruptions in glucose control and can lead to worsening overall management.
It is extremely important to recognize if rebound hyperglycemia is happening frequently and make the necessary adjustments to manage it.
Let's explore rebound hyperglycemia, why it’s happening and ways to prevent and or manage it!
What is Rebound Hyperglycemia?
As explained above, rebound hyperglycemia is when a person’s blood sugar has a sharp spike following a period of low blood sugar. This can happen during any time of the day or night and can be triggered by several different things.
The Somogyi effect is a specific form of rebound hyperglycemia and happens overnight as a result of an undetected low blood sugar that leads to a high glucose in the morning.
This happens as a normal response to the low blood sugar, by the body's counter-regulatory hormones.
If this isn’t properly identified, it may be mistaken for insulin resistance; therefore it is important to know and recognize the symptoms and warning signs of rebound hyperglycemia.
Symptoms of Rebound Hyperglycemia:
Sudden High Blood Sugar Levels
Fatigue and Weakness
Headache
Increased Thirst and Dry Mouth
Brain For or Difficulty Concentrating
Irritability or Mood Swings
Hunger or Cravings
Sweating (some may experience as residual effect of the low)
Warning Signs that Suggest Rebound Hyperglycemia
High Blood Sugar Following Overnight Low (Somogyi Effect) - common in basal insulin users and those on insulin pumps.
Blood Sugar Spike After Treating a Low
Glucose Rollercoaster All Day
The Feeling of Being “Off” Even After Glucose Stabilized
Causes and Risk Factors of Rebound Hyperglycemia
An overcorrection of a low blood sugar is one of the most frequent reasons for rebound hyperglycemia to take place.
What often happens is when a person experiences low blood sugar, sometimes they consume too much glucose in an attempt to correct the low and stop the horrible symptoms of the low.
I truly get it, low blood sugar is an absolutely horrible feeling, but this yucky feeling may be amplified if the low is over-corrected and then a sharp spike occurs right after.
Excessive insulin use, such as a high basal rate or a bolus miscalculation, such as phantom carbs, is another cause of rebound highs.
Another cause is a natural hormone response by your body releasing counterregulatory hormones, which is called the Somogyi effect.
How to Identify and Prevent Rebound Hyperglycemia
Identifying rebound hyperglycemia is very important because it helps you and your healthcare team to know how to properly manage and correct this extremely frustrating issue that often becomes a cycle.
Using a CGM is very helpful because it can help you to identify patterns and trends and isolate the incidences to differentiate between rebound hyperglycemia vs other high blood sugar levels.
Preventative strategies can be implemented once the rebound highs have been identified and the specific reasons have been targeted.
Here’s a list of a few preventative strategies:
Adjusting Insulin Dosing - Nighttime basal insulin, whether on a pump or MDI may need to be reduced as this may be causing overnight lows and in turn, rebound highs. Also, proper bolus timing and or accurate carb counting should be assessed to ensure efficacy.
Effective Hypoglycemic Treatment - Accurate correction for lows, following the rule of 15’s (or if on a closed loop insulin pump - 10 grams) and waiting for 15 minutes to recheck blood sugar should be implemented to avoid overcorrecting with excess sugar intake. Using glucose tabs is often more effective vs candy, soda, or juice.
Lifestyle Modifications - Having more structure around meal planning and ensuring balanced nutritional intake can significantly improve glucose management and decrease fluctuations. Also having regular exercise that is not too extreme or intense, without excessive corrections, could greatly decrease the incidence of rebound highs.
Monitoring and Recognizing Patterns - Keeping a detailed log and tracking glucose trends can vastly improve this as well because it will enable them and their healthcare team to adjust therapy based on the identified patterns.
Managing Rebound Hyperglycemia When It Happens
First, it is important to determine if it is a true rebound high and not caused by something else like insulin resistance or the dawn phenomenon.
Confirm with CGM that there’s a sharp drop followed by a rapid spike within 1-3 hours. If the high is following a recent low, it is likely a rebound.
Then, avoid overcorrecting with too much insulin, as this can lead to insulin stacking, especially if you try to aggressively correct. Instead, if you are on MDI, use your correction factor for the correct dose.
If you are on a closed loop insulin pump, try to trust the automated delivery and wait 3 hours before deciding if you want to try taking additional insulin, unless the pump suggests otherwise.
Drink 16 - 24 oz of water as high blood sugar can cause dehydration and this will help flush excess glucose. Light movement like walking for 15 minutes can also help naturally lower blood sugar without the need for more insulin.
Avoid intense exercise though because this can have the opposite effect due to stress hormones.
Lingering insulin resistance can also be a result of rebound hyperglycemia and it can cause your glucose to stay elevated despite insulin corrections. Try not to panic, but instead, give the insulin some time to work.
If rebound hyperglycemia is happening frequently, this can be a sign that you need to make some adjustments to your diabetes management plan with your healthcare team.
Learn from the experience and stop the cycle of overcorrection.
If you have been experiencing rebound hyperglycemia, didn’t realize that’s what it was, and would like help to identify the pattern and work to make positive changes, reach out to speak directly with me today.
Let’s jump on a call and make a plan together! Book your FREE call here.
Meet the Author
 Hi! I’m Beth, a Registered Nurse and Certified Diabetes Educator. I provide diabetes coaching for newly diagnosed people with diabetes and also work with people who have been living with diabetes for some time. With 1:1 coaching, you will feel empowered and supported to confidently manage your diabetes effectively - without it controlling your life! I can help you make sure that you feel good, stay in optimal health and take care of your well-being at all times. First call is on me! Let’s talk. |
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