Insulin in the Somogyi Phenomenon

To the Editor: The November 8th article by Bolli et al.¹ illustrating the existence of the Somogyi phenomenon appears to contradict their previous findings. In the June 28th issue,² Bolli and colleagues elegantly described 20 patients with insulin-dependent diabetes mellitus (IDDM), 11 of whom had marked rebound hyperglycemia despite blunted epinephrine and glucagon responses. The authors agree that there is “considerable evidence” that even in the absence of clinical autonomic neuropathy, prolonged hypoglycemia results from a blunted counterregulatory response, and they conclude that marked rebound hyperglycemia correlates best with low free plasma insulin levels. However, in the November 8th issue,.