From the Guidelines
Late night eating is not essential for survival in Type 1 diabetes, but it may be necessary in specific situations to prevent dangerous low blood sugar (hypoglycemia) during sleep. People with Type 1 diabetes who take insulin, particularly longer-acting insulins like glargine (Lantus), detemir (Levemir), or NPH, may experience nighttime hypoglycemia which can be life-threatening if severe 1. A bedtime snack containing 15-20 grams of carbohydrates paired with protein and fat (such as crackers with peanut butter or a small apple with cheese) can help maintain stable blood glucose levels overnight. This is especially important for those who have experienced nocturnal hypoglycemia, exercise vigorously in the evening, consume alcohol, or have hypoglycemia unawareness. The protein and fat in the snack slow digestion, providing a gradual release of glucose, while the carbohydrates offer immediate glucose.
Some key points to consider:
- The necessity for late-night eating should be determined based on individual blood glucose patterns, insulin regimen, and in consultation with a healthcare provider 1.
- Strategies to prevent hypoglycemia during exercise, after exercise, and overnight following exercise include reducing prandial insulin dosing for the meal/snack preceding exercise, increasing carbohydrate intake, eating bedtime snacks, using continuous glucose monitoring (CGM), and/or reducing basal insulin doses 1.
- Initial response to treatment for hypoglycemia should be seen in 10–20 min; however, blood glucose should be evaluated again in 60 min, as additional treatment may be necessary 1.
- For individuals requiring insulin, the total carbohydrate content of meals and snacks is the priority and determines the premeal insulin dosage and postprandial glucose response 1.
However, not everyone with Type 1 diabetes needs a bedtime snack, particularly those using insulin pumps or continuous glucose monitors with alarms. It is crucial to weigh the benefits and risks of late-night eating and make informed decisions based on individual circumstances and healthcare provider guidance.
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.