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Somogyi phenomenon — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Somogyi phenomenonUSMLE Step 3

A 16-year-old with type 1 diabetes has fasting glucose 210 to 250 mg/dL despite normal pre-bed values. Continuous glucose monitoring shows glucose remains 105 to 125 mg/dL from midnight to 3 AM and then rises steadily between 4 AM and 7 AM without preceding hypoglycemia. Which adjustment is most appropriate?

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Correct answer: C — Increase or retime overnight basal insulin using continuous glucose data

The best answer is “Increase or retime overnight basal insulin using continuous glucose data”. The CGM pattern demonstrates dawn-related early-morning hyperglycemia, not rebound after nocturnal hypoglycemia. Basal insulin timing or dose is adjusted carefully using overnight data; a bedtime snack can worsen the rise, and basal insulin must never be omitted in type 1 diabetes.

Reference: ADA Standards of Care in Diabetes: https://diabetesjournals.org/care/issue/49/Supplement_1