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To the Editor.

John P. Sheehan, MD; David A. Sisam, DO
Arch Intern Med. 1985;145(3):575-576. doi:10.1001/archinte.1985.00360030227051.
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—While we agree with Dr Raskin's1 view that most posthypoglycemic hyperglycemia is due to excessive carbohydrate ingestion and/or cessation of insulin action, we think that true Somogyi phenomenon is definitely a clinical reality, however uncommon. As practicing clinicians, we are still at a loss to explain why some adequately insulinized persons develop rebound hyperglycemia subsequent to the ingestion of 10 to 15 g of carbohydrate for a hypoglycemic reaction, with this hyperglycemia abating spontaneously without "catch-up insulin." Prevention of recurrence of this event in appropriate cases can be achieved by appropriate reduction of insulin dosage, and it is noteworthy that if one endeavors to treat rebound hyperglycemia with appropriate insulin supplementation, one can precipitate profound hypoglycemia. It is further perplexing why some patients known to develop rebound hyperglycemia do not do it on a predictable basis given the same absolute degree of hypoglycemia in the absence of over-treatment. Clearly,


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