Somoji syndrome is a rare but insidious disease, especially known to people with diabetes. How to recognize it and can it be cured?
Somoji Syndrome Concept
In diabetes mellitus, the correct calculation of the dose of insulin is necessary, but it 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 a chronic insulin overdose syndrome. The American scientist Michael Somoji studied this phenomenon in 1959 and came to the conclusion that the intake of high doses of the substance into the body provokes hypoglycemia - a decrease in blood glucose. This leads to stimulation of contrainsulin hormones and a response - ricocheted hyperglycemia (increased blood glucose).
It turns out that at any time the level of insulin in the blood exceeds the required, which in one case leads to hypoglycemia, in the other - to overeating. And the release of contrainsulin hormones causes constant changes in the level of glucose in the blood, which causes an 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 used in 1922, after which comprehensive studies of its effect on the body began, experiments were conducted 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 there is a toxic effect of a large amount of the hormone on the body. In those far years, the drug was used to treat anorexia patients in order to increase their body weight. This led to constant changes in blood glucose levels, fluctuations from hypoglycemia to hyperglycemia. At the end of the course of treatment, the patient showed signs of diabetes. The same effect has occurred 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 later as Somoji syndrome.
Symptoms
How to independently understand that the body is exposed to a chronic overdose of insulin? Somoji syndrome is manifested by the following symptoms:
- there is a deterioration in overall health, weakness appears,
- sudden headaches, dizziness, which can abruptly pass after eating carbohydrates with food,
- sleep is disturbed, it becomes anxious and superficial, nightmares often dream,
- there is a constant feeling of tiredness, drowsiness,
- it’s hard to wake up in the morning, a person feels overwhelmed,
- visual disturbances may appear in the form of fog in front of the eyes, veils or flickering of bright points,
- sudden mood swings, often in a negative direction,
- increased appetite, weight gain.
Such symptoms are an alarming bell, but cannot be a clear reason for making a diagnosis, as they are signs of many diseases. A complete picture of the processes occurring in the body can be tracked using analyzes.
Diagnostics
The following symptoms of the disease help to diagnose "Somoji syndrome":
- the appearance of ketone bodies (acetone) in the urine,
- sharp and frequent fluctuations in glucose levels from low to high and vice versa throughout the day,
- overt or latent hypoglycemia,
- improvement of sugar level in case of a cold
- the course of diabetes worsens with an increase in the dose of insulin and improves with a decrease.
Diagnosis of Somoji syndrome in most cases is difficult even for specialists; it is not always the advice of an endocrinologist that can immediately give the right results. This is due to the fact that the patient's symptoms and 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 with the constant supervision of a specialist and a thorough study of the tests. The diagnosis is made on the basis of indicators such as typical clinical manifestations, frequent hypoglycemic conditions, and a high rate of glycemic fluctuation.
Differential diagnosis
When diagnosing, Somogy’s syndrome is easily confused with the manifestations of the “morning dawn” phenomenon, since the symptoms in these two pathologies are identical. However, there are significant differences. The phenomenon of "morning dawn" occurs not only in patients with diabetes mellitus, but also in healthy people, it manifests itself in dawn hyperglycemia. This is due to a lack of basal insulin levels due to its rapid destruction in the liver or with increased secretion of the hormone in the morning. Unlike Somoji syndrome, the manifestation of this phenomenon is not preceded by hypoglycemia. To make the 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 with Somoji syndrome
The combination of diabetes mellitus with chronic insulin overdose syndrome (ACSI) gives a detrimental effect, the disease is especially difficult. Against the background of constantly increasing doses of the drug, hypoglycemia takes on a hidden form. Somoji syndrome in diabetes affects both the general condition of the patient and his behavior.
Sudden changes in mood for no particular reason - a frequent occurrence with a similar ailment. With a keen interest in any business or game, after some time 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 there is an increased appetite in the patient, but, despite this, sometimes there is a sharply negative attitude to food, a person refuses food. Such symptoms are found in 35% of patients. More common complaints include bouts of weakness, dizziness, headaches, and sleep disturbance. Some note sudden and short-term visual impairment (in the form of a veil in front of the eyes or bright "flies").
Treatment
Treatment for Somoji syndrome involves the correct calculation of the dose of insulin. To do this, the amount of drug administered must be adjusted, it is reduced by 10-20% with strict monitoring of the patient's condition. How long is Somoji syndrome treated? 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 this is not so. Just a decrease in the amount of the drug administered does not improve the course of diabetes mellitus; complex treatment is necessary. It affects the diet (normalized 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 Somoji syndrome.
Forecast
Timely identified chronic insulin overdose syndrome has positive predictions. 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 at 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: an ongoing overdose of insulin will only worsen the patient’s condition, and the course of diabetes will be aggravated.
Prevention
The main areas of prevention of acute respiratory infections include a range of measures.
- In diabetes mellitus, a diet that is correctly selected for the patient and guaranteeing compensation for carbohydrate metabolism must be strictly adhered to. A person should 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 necessary for a particular patient. The task of the doctor is to make corrections if necessary, and the patient should 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 disease, consultation of the endocrinologist on an individual schedule and as necessary.
- Adequate assessment of the state of the body, well-being, rapid identification of suspicious symptoms.
- Creating conditions for conducting self-control in everyday life, studying the principles of self-control for patients and family members.
Somoji syndrome in children
Children with diabetes are not always able to track changes in their body condition, often this seems impossible, therefore controlling the course of the disease is the concern of the parents. Care should be taken to monitor the sleeping baby, since the action of insulin occurs mainly at night, and the child's behavior can tell a lot. When the syndrome manifests itself, its sleep becomes restless and superficial, accompanied by noisy breathing. A child may scream or cry in a dream 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 sluggish, he is capricious, annoyed, does not show interest in games or learning. Apathy can occur unexpectedly, for no reason, in the process of any activity. Unmotivated outbreaks of aggression are frequent, mood changes become unpredictable. Often children with the syndrome suffer from depression. Treatment is carried out on the same principle as in adults. The Endocrinology Center at Academic, for example, helps children cope with Somoji syndrome.