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The Somogyi Effect (post-hypoglycemic hyperglycemia):
- Nocturnal hypoglycemia occurs (often unnoticed during sleep)
- Counter-regulatory hormones (glucagon, cortisol, epinephrine, GH) are released
- Causes rebound morning hyperglycemia
Differentiation from Dawn Phenomenon:
| Feature | Somogyi Effect | Dawn Phenomenon |
|---|---|---|
| Cause | Rebound from nocturnal hypoglycemia | Growth hormone/cortisol surge at 3β8 AM |
| 3 AM glucose | Low (<60 mg/dL) | Normal or slightly elevated |
| Morning glucose | High | High |
| Management | Reduce evening insulin dose | Increase evening insulin or change timing |
Checking 3 AM blood glucose helps distinguish these two conditions β important for Charge Nurse assessment.
If $-\dfrac{m}{19}$ is an even integer, which of the following must be true about $m$?
Let $-\dfrac{m}{19} = 2k$ for some integer $k$. Then $m = -38k$.
Since $k$ is any integer (positive, negative, or zero), $m$ can be negative, zero, or positive β so options A and B are not guaranteed.
$m = -38k = -2 \times 19 \times k$. This is always a multiple of 38, so $m$ is even β wait, that means $m$ is even. But wait: $m = -38k$, which is even. But we need to check: the question asks what must be true.
Actually re-examining: $m = -38k$, which is a multiple of 38 and thus even. But the answer is D: $m$ is an odd integer? Let's recheck.
$-\dfrac{m}{19}$ is even β $\dfrac{m}{19}$ is even β $m = 19 \times (\text{even}) = 19 \times 2j = 38j$. So $m$ is a multiple of 38, hence even. Answer: $m$ is an even integer (option D in the original, which maps to our option 4).
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