Morning hyperglycaemia

Excessive dose of insulin leads to overeating and obesity it also leads to hypoglycaemia (especially nocturnal), that may be followed by reboimd morning hyperglycaemia that is mistakenly treated by increased insulin, thus establishing a vicious cycle (Somogyi effect). 

The administration of metformin at bedtime instead of supper time may improve diabetes control by reducing morning hyperglycaemia (Ravina and Minuchin, 1990). Metformin was not distinguished from tolbutamide in elderly diabetic patients, except in that it was associated with weight loss (Josephkutty and Potter, 1990). 

MK-678 (L363,586) (58), a cyclic hexapeptide, lowers fasting and postprandial hyperglycaemia in IDDM patients, after i,v, or intranasal delivery [301], and, taken intranasally at bedtime, can abolish the morning... 

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