From the Guidelines
Late night eating is essential for survival in Type 1 diabetes primarily to prevent nocturnal hypoglycemia (low blood sugar during sleep). People with Type 1 diabetes who use insulin therapy are at risk of blood glucose levels dropping dangerously low overnight, which can lead to seizures, coma, or even death if severe and untreated. A bedtime snack containing carbohydrates and protein helps maintain stable blood glucose levels throughout the night. Typically, a snack containing 15-30 grams of carbohydrates and some protein (such as crackers with peanut butter, a small apple with cheese, or a small bowl of cereal with milk) is recommended. The carbohydrates provide immediate glucose while protein offers a slower, sustained release. The exact timing and composition of this snack should be personalized based on individual insulin regimens, evening activity levels, and pre-bedtime blood glucose readings. Regular blood glucose monitoring before bed and occasionally during the night can help determine the appropriate snack. This practice is especially important for those using longer-acting insulins like glargine (Lantus), detemir (Levemir), or NPH insulin, which can peak during sleeping hours, increasing hypoglycemia risk.
Key Considerations
- The American Diabetes Association recommends that individuals with Type 1 diabetes participate in regular physical activity and eat a balanced diet to manage their condition 1.
- Bedtime testing of blood glucose levels is crucial to prevent nocturnal hypoglycemia, as symptoms may go unnoticed during sleep 1.
- A study published in Diabetes Care in 2018 emphasizes the importance of individualized meal planning and carbohydrate counting for people with Type 1 diabetes to improve glycemic control 1.
- Another study published in 2002 highlights the need for adequate carbohydrate intake during acute illnesses to prevent starvation ketosis and diabetic ketoacidosis in individuals with Type 1 diabetes 1.
Recommendations
- Eat a bedtime snack containing 15-30 grams of carbohydrates and some protein to maintain stable blood glucose levels throughout the night.
- Monitor blood glucose levels regularly, especially before bed and during the night, to determine the appropriate snack and prevent nocturnal hypoglycemia.
- Personalize the timing and composition of the bedtime snack based on individual insulin regimens, evening activity levels, and pre-bedtime blood glucose readings.
- Consider consulting a registered dietitian or a healthcare professional to develop an individualized meal plan that takes into account the person's lifestyle, preferences, and insulin regimen 1.
From the Research
Nocturnal Hypoglycemia Prevention in Type 1 Diabetes
Late night eating is essential in type 1 diabetes for survival as it helps prevent nocturnal hypoglycemia. The following points highlight the importance of late night eating in type 1 diabetes:
- Nocturnal hypoglycemia is a major concern in type 1 diabetes, and late night eating can help prevent it 2, 3, 4.
- A calibrated bedtime snack based on bedtime blood glucose level can be effective in reducing nocturnal hypoglycemia occurrence 2.
- Including uncooked cornstarch or alanine in the bedtime snack composition may provide benefits for preventing nocturnal hypoglycemia 2, 3.
- Individualized recommendations for bedtime snack intake are necessary, especially for patients at high risk of nocturnal hypoglycemia 2, 3.
Bedtime Snack Composition and Nocturnal Hypoglycemia
The composition of the bedtime snack plays a crucial role in preventing nocturnal hypoglycemia:
- A standard snack or a protein snack can help prevent nocturnal hypoglycemia, especially at bedtime glucose levels <7 mmol/l 3.
- Uncooked cornstarch or a conventional snack may not be effective in preventing nocturnal hypoglycemia 4.
- The need for a bedtime snack depends on the bedtime glucose level, and no snack may be necessary at levels >10 mmol/l 3.
Recent Developments in Nocturnal Hypoglycemia Prevention
Recent studies have explored new methods for preventing nocturnal hypoglycemia:
- Insulin degludec has been shown to reduce nocturnal hypoglycemia in people with type 1 diabetes prone to nocturnal severe hypoglycemia 5.
- Sensor-augmented pumps with predictive low glucose suspend technology can help prevent nocturnal hypoglycemia 6.
- Continuous glucose monitoring can help detect nocturnal hypoglycemia and guide treatment decisions 5, 6.