Reactive hyperglycemia, known as Somogyi phenomenon, results from the release of catecholamine, cortisol, growth hormone and glucagon in response to acute hypoglycemia induced by excessive insulin injection. Patients exhibiting Somogyi phenomenon are usually type 1 diabetics who are difficult to control by single dose of insulin injection. An abrupt onset during childhood or puberty with polydipsia, polyphagia and polyuria. Blood glucose fluctuates widely in response to small changes in insulin dosage, exercise and infection. Endogenous serum insulin is negligible or zero, thus it requires insulin replacement injection.
Microvascular atherosclerosis is absent until five years or more from diagnosis.
An insidious onset after 40 years of age with no clinical symptoms. Blood glucose fluctuation is less marked. Endogenous insulin secretion is maintained but insulin receptor sites are decreased, leading to hyperglycemia. It presents with a shorter history of peptic ulcer and higher serum gastrin levels.