Bedtime Snack Recommendations for Type 2 Diabetes
A bedtime snack containing 15-30 grams of carbohydrate with protein is recommended when bedtime blood glucose is ≤9 mmol/L (≤162 mg/dL) to prevent nocturnal hypoglycemia in patients using insulin or insulin secretagogues. 1
Specific Snack Examples
Carbohydrate-Protein Combinations
- Whole grain crackers with cheese (approximately 15-20g carbohydrate plus protein) provides sustained glucose release 1
- Half sandwich with lean protein (turkey, chicken, or peanut butter on whole grain bread) delivers 15-30g carbohydrate with protein 1
- Greek yogurt with berries (¾ cup plain Greek yogurt with ½ cup berries) provides approximately 20g carbohydrate plus protein 1
- Apple slices with peanut butter (1 small apple with 1 tablespoon peanut butter) contains approximately 20g carbohydrate plus protein and fat 1
Specialized Options for High-Risk Patients
- Uncooked cornstarch-containing snack bars (such as Extend Bar with 30g total carbohydrate including 5g uncooked cornstarch) produce a lower and delayed nocturnal blood glucose peak at 4 hours, reducing nocturnal hypoglycemia by 70% compared to conventional snacks 2, 3
- Bedtime uncooked cornstarch supplement (0.3g/kg body weight) specifically prevents mid-nocturnal glycemic decline without adversely affecting HbA1c 3
When to Provide a Bedtime Snack
Clear Indications
- Bedtime blood glucose ≤9 mmol/L (≤162 mg/dL) in patients on insulin or insulin secretagogues requires a bedtime snack to reduce nocturnal hypoglycemia risk by 44% 4
- After medium or high-intensity exercise during the day, as exercise increases nocturnal hypoglycemia risk 5
- Following daytime hypoglycemia, which increases the likelihood of nocturnal hypoglycemia 5
- When using alcohol, as alcohol should be consumed with food to reduce nocturnal hypoglycemia risk 1
Patient-Specific Risk Factors
- Younger patients with lower HbA1c levels have higher nocturnal hypoglycemia risk and benefit more from bedtime snacks 5
- Patients with hypoglycemia unawareness require consistent bedtime snacks when glucose is ≤9 mmol/L 4, 6
Important Caveats
What NOT to Use
- Protein alone should NOT be used to treat acute or prevent nighttime hypoglycemia, as ingested protein increases insulin response without increasing plasma glucose in type 2 diabetes 1
- Avoid simple carbohydrates alone (candy, juice, soda) as bedtime snacks, as they cause rapid glucose spikes followed by drops 6
Monitoring Requirements
- Check bedtime blood glucose before deciding whether a snack is needed—this is the critical decision point 4, 6
- Consider 3 AM glucose monitoring in high-risk patients to assess nocturnal patterns and snack adequacy 4, 6
Common Pitfalls
- Do not routinely provide bedtime snacks to all patients—only those with bedtime glucose ≤9 mmol/L or specific risk factors benefit 4
- Bedtime snacks may cause slightly higher morning glucose (approximately 9.6 vs 7.8 mmol/L), but this trade-off prevents dangerous nocturnal hypoglycemia 4
- Recognize that nearly 50% of severe hypoglycemic episodes occur at night during sleep, making prevention critical 6