Let’s tackle the question of the bedtime snack first. If you have diabetes and have ever been hospitalized, you are probably familiar with the often unrequested delivery of the ubiquitous bedtime snack consisting of graham crackers and milk, or some equally uninspiring repast.
The genesis of this tradition has to do with the use of peaked intermediate and long-acting basal insulin. Until the year 2000, there weren’t any insulins that provided a consistent level of medicine throughout their duration of action. Meals and snacks were scheduled around the times the insulin was peaking. Many people used NPH, an insulin that peaks anywhere from four to eight hours after it is injected, as their basal insulin. Bedtime snacks were given to prevent patients from having low blood glucose reactions overnight.
Today, our basal insulins have the advantage of being peakless or flat. They provide the same amount of insulin every hour for the duration of their physiological life. This is a big advantage over some of the early intermediate- or long-acting insulins since it is no longer necessary to stick to a rigid schedule for meal times and a bedtime snack isn’t usually required.
Some people still use NPH insulin and, as many hospital food service departments are not privy to the medication inventory of their patients, they take a safety approach of providing bedtime snacks to all their patients with carbohydrate controlled therapeutic diets.
There are times when bedtime snacks are important. People who experience a lag effect from exercise may benefit from consuming a bedtime snack to avoid overnight hypoglycemia. In addition, blood glucose can drop precipitously overnight in some elderly patients. Eating a bedtime snack when glucose levels are below a certain threshold at night, for example, 120mg/dl, can help maintain euglyemia until morning in older adults.
Just as there is no one “right diet” for everyone with diabetes, there isn’t a one-size-fits-all to the snack question. Having small meals spaced throughout the day is one way to keep blood glucose steady, without too many bumps and dips in the road. Snacking prevents feelings of hunger and avoids potential low blood glucose events. It can also prevent overeating by limiting the time between meals.
However, snacking can also lead to excess calorie intake and weight gain if you eat several large snacks in addition to three or more full meals. Many snacks are highly processed and contain exorbitant amounts of sugars and fat. Calories from snacking in this fashion can add up quickly.
Snacking frequently (grazing) can also make it difficult to know if your pre-meal blood glucose is in range since you will never be in a “fasting or pre-meal” state. For people who use a pump, snacking that morphs into full scale grazing can predispose to insulin stacking (overlapping insulin boluses that can cause hypoglycemia).
Bottom line—snacking is up to you. If you choose to snack, choose healthy snacks, such as fruit, low fat cheese and whole grain crackers, nuts, vegetables and low fat dip.