Bedtime Snacks And Extra Insulin

[TheClockworkDodo]

A question for other people who are type 1 - do you have a bedtime snack, and if so, do you have extra fast-acting insulin to cover it?

When I was first diagnosed I was told by one DSN that everyone with type 1 must have a bedtime snack to prevent hypos during the night. So I got myself into the habit of doing this (with an effort, because any change to the way I eat effects my ME) - usually a couple of ryvita, which is about 15g carbs.

Then I was told by another DSN that I didn't have to continue having a bedtime snack after the first year - but could have a small one - such as a couple of ryvita - as my BGLs are usually pretty low (and that I should inject extra Novorapid if they were high). So, having got myself into the habit of eating at night, I continued to do so as it was easier than making the effort to stop, and only injected extra Novorapid if my BGL was over about 8-10.

Then I saw a consultant who was horrified that I eat at night, and said I should have an extra injection of fast-acting insulin to cover it! So I started injecting an extra one unit or half unit of Novorapid at night most nights, especially if my bedtime reading was over 6 or 7, with the aim of my morning fasting reading being 4 or 5.

Then, having moved house, I saw new DSN here who was horrified that I inject extra fast-acting insulin at night and said that I should stop - that injecting one unit or a half unit was pointless and it doesn't matter if my morning fasting reading is 8!

Hmmm 🙄

Has anyone any thoughts, please?! I have gone back to advice of second DSN and am injecting extra Novorapid if over about 8 at night. I don't feel comfortable with high morning readings, but then I am so used to having low BGLs I feel better when my BGL's 3 than I do when it's 8 anyway. I have no idea what my blood sugar does overnight normally as I am never awake enough to test it - I only wake up if I'm hypo - but am concerned if I don't inject for what I'm eating then it might be going really high.

Oh - my slow-acting insulin is Lantus and I inject that at night. Current DSN says I shouldn't inject Novorapid at the same time because they will both peak at once, but I have no evidence of this (ie I don't hypo in the night if I inect Novorapid at night).

 

[Northerner]

Personally, when I was first diagnosed, I used to have a snack if my level was below 6-7 before bed, but never injected novorapid for it. Over time I adjusted my lantus to avoid night hypos and was able to stop having the snack also because my levels became more stable overnight. I would (and still do) inject my last novorapid, for my evening meal at least 5 hours before bed so that there would be no chance it would still be circulating during the night. I took these precautions chiefly because I live alone and there would be no-one to know if I had a bad night hypo, so I wanted to restrict as far as possible the risks of it happening (although even then I sometimes, very rarely, get unexplained drops 7-8 hours after injecting 😱). I would only correct a high level at night with extreme caution and have rarely needed to do it (I'd only do it if levels were in the teens. The DSN who says 1.5 units doesn't do anything is patently wrong - some people are far more insulin-sensitive than others, so a correction of that size would be perfectly fine for a lot of people and achieve the desired effect 🙂

I think the main point is, how safe is your situation, and how good is your knowledge and experience of how to minimise risks? People can be very different, so hard and fast rules are hard to apply, you can really only work from general principles i.e. you have a problem, here's a possible solution, try it, it worked, use it again. So it's more about knowing how diabetes works for you and what strategies you can apply to work round problems 🙂

Some people find it nearly impossible to control things smoothly overnight, especially on injections, so sometimes a pump can really help when you need varying basal needs, plus you can do things like extended boluses, temporary reductions in basal etc. I'm one of the lucky ones who doesn't need to do that.

 

[Pumper_Sue]

In answer to your question no I don't have a bedtime snack.
As you are using MDI you shouldn't need to snack unless your blood sugar is on the low side. 🙂

 

[Dasroots]

I've never snacked unless my BM's where on the low side but then I wouldn't inject. I would only do a correction if my BM's where in the teens and I would only inject a couple of units.

 

[Matt Cycle]

Agree with Sue. When I was first diagnosed (29 years ago now) I was on two injections of Humulin I and snacks were part of the regime. Mid-morning, mid-afternoon and before bed. Blood testing was a bit more haphazard then though using BM sticks without meters. After a year of that I moved onto MDI and was told to inject before eating and no need for snacks unless blood sugar was low. I've stuck to that ever since.

 

[AlisonM]

No snacks for me either, unless I'm below 6.0 at bedtime which, I've learned, means a night hypo is almost a certainty for me. That may change now I'm on MDI, it's too soon to say for sure.

 

[Robin]

Since I got my Libre, and I can see exactly what the pattern has been overnight, I have discovered I decline slowly until 3am, then rise again til I wake. I do this irrespective of whether I've had a bedtime snack or not. I used to take my Lantus at bedtime, but brought it forward to 6pm, so that I didn't have a Lantus peak during the night, because I thought that's what might be causing my 3am slumps, but apparently not, it's just my body!

 

[Northerner]

Since I got my Libre, and I can see exactly what the pattern has been overnight, I have discovered I decline slowly until 3am, then rise again til I wake. I do this irrespective of whether I've had a bedtime snack or not. I used to take my Lantus at bedtime, but brought it forward to 6pm, so that I didn't have a Lantus peak during the night, because I thought that's what might be causing my 3am slumps, but apparently not, it's just my body!

The liver usually slowly declines its trickle of glucose until around 3 am, then starts to increase gradually towards dawn, so it sounds as if your body is working as expected (apart from the one obvious exception! 🙄) This is why a 3 am test is usually the best time to spot your lowest likely level overnight hence my poem 'The Three AM Club'

At dead of night when all are sleeping,
Shadows through the room come creeping,
Seeking blood from those who slumber,
Hoping for a perfect number.

What beasts are these, with hair so wild,
Who would disturb a sleeping child?
What brings them at this witching hour?
What misbegotten, ghostly power?

Some phantom from the nether lands
With sharpened lancets in their hands?
A ghoulish, half-lit apparition,
Intent on some demonic mission…

In other houses, adults sleep –
For them, their slumber is so deep
Alarms will wake them with a shock…
Synchronised at Three O’ Clock!

Three is not a time for resting!
Three’s the time for glucose testing!
Join us till we sleep again,
The club that meets at Three A.M….!

 

[TheClockworkDodo]

Thanks everyone for your replies, and I love your poem, Northerner Yep, I would be one of those deep sleepers setting an alarm, which wouldn't be fair on my partner, because he already has trouble getting back to sleep if he's woken up at 3am, and I wouldn't be able to sit up if I were woken up at 3am (low blood pressure!), so he'd have to be awake enough to get up and lift me into a sitting position, and then he'd have no chance at all of getting back to sleep ...

The one thing I don't think I made clear in my first post is that I have the choice of either eating a snack every night or never eating a snack - eating a bedtime snack only if my BGL is low and not otherwise is just not an option because it would have too adverse an effect on my health for un-diabetes-related reasons.

So if I shouldn't need to snack unless my BGL is low, then it sounds as though I have to continue to snack every night in case there's a night when my BGL is low (there often is). In which case I should probably continue to inject Novorapid to cover the snack on the nights when my BGL isn't low. That being the case, how high do you think the BGL should be before I need to inject? - 7? 8? Higher?

Northerner - it was half a unit or one unit my DSN thought was pointless, not one and a half units - but the principle is the same. Half a unit should take my BGL down from (say) 8 to 5.5, and if I'm going to be snacking I'd much rather be 5.5 and snacking than 8 and snacking!

 

[Annette]

TCD, how would changing what you eat affect your other problems? IE, have a ryvita if your bloods were a bit low (say, below 7) and don't jab, but have something other that was lower/zero carbs if above? (I'm thinking a melba toast, as there's virtually nothing in one of those, but I'm sure there's a better alternative.) And then only correct if your numbers were much higher, say over 10.
Not sure if you need the carbs or just the action of eating something for your other reasons.

 

[everydayupsanddowns]

I think the conflicting advice you have had is probably due to people being used to recommending bedtime snacks for the older (much more peaky) intermediate insulins that were used to cover basal.

If your basal is as properly adjusted as it can be (and bear in mind that as others have said Lantus may well be mini-peaking just when your BGs are likely to be lowest) then you shouldn't need to snack unless you want to. Basal testing guide here is worth a read: http://www.diabetes-support.org.uk/info/?page_id=120

I prefer going to bed without much in the way of rapid insulin active if possible so would probably not choose to snack/inject at bedtime as a routine as it just adds another potential error into the mix. I do correct high BGs before bed, but have a more cautious correction ratio to try to err on the safe side.

 

[TheClockworkDodo]

Thank you both for your replies, and thanks for the link, Everyday 🙂

Annette - I don't so much need the carbs as something solid, otherwise I'll be too hungry to sleep. I'm a natural grazer, and my various other digestive problems require me to eat little and often, which is obviously not ideal for a diabetic!

Just found Melba toast on a supermarket website and it says 15g of carbs, which is twice that of a Ryvita, so that doesn't sound suitable for me, but I could always eat a TUC biscuit with some cheese if my reading's high at night - or do it the other way round, drop my insulin and eat the TUC and cheese every night unless my reading's low.

 

[Annette]

Obviously I'm not thinking of melba toasts - cos what I am thinking of is about 2g per biscuit. No idea what I am thinking of though!

 

[TheClockworkDodo]

🙂 Never mind, I got the general idea! TUC biscuits are 3g carbs, and not sufficiently filling on their own, but with cheese they'd do.

 

[Northerner]

🙂 Never mind, I got the general idea! TUC biscuits are 3g carbs, and not sufficiently filling on their own, but with cheese they'd do.

I'm afraid I couldn't stop at one with Tuc biscuits... 😱 Have you tried Belvita biscuits? I was sceptical about them when they came out and said they were 'slow-release' but (for me, at least) it does seem to be true. They are 8.5g carbs, so possibly a bit high for you 🙂

 

[KookyCat]

Oat biscuits are good too, with a bit of peanut butter they feel quite substantial, they're about 4g per biscuit (the savoury ones, plain or cheese) and I would eat one of those with a dollop of nut butter before bed if I need to eat. They are in fact my magic hypo avoidance food because they release nice and slowly so I carry them to nibble on when I'm doing a lot of walking, and I don't need insulin for one biscuit with nut butter.....I'm talking myself into an oat biscuit now 😉

The belvita biscuits also work well for me....predictably I usually have them with nut butter, did I mention I like nuts?

 

[DeusXM]

Short answer? No, and eating a bedtime snack to 'maintain' your blood sugar levels overnight is bad diabetes practice, and bolusing for that snack defeats the point of eating it in the first place.

Longer answer....

...in theory, with a modern basal insulin or a pump, there is no reason at all to eat food specifically to maintain your blood sugar levels. Eating to maintain blood sugar levels regardless of whether you're actually hungry is 'feeding the insulin' and is a very effective way of gaining weight extremely quickly - which is why it's bad practice.

I personally do not eat a bedtime snack to maintain my blood sugar levels because I have refined my basal insulin intake to ensure that in general, the blood sugar I go to bed with is the blood sugar I wake up with. I realise that I'm fortunate but I've also worked to get to that position.

As a general rule, anything to do with preventing hypos should involve adjusting your insulin and anything to do with preventing hyper should involve adjusting your diet - not the other way round.

If your BG is repeatedly going low in the night, you've got too much insulin in you and that should be where you make the adjustments.

As for covering your snack with bolus insulin - that just completely defeats the point of having the snack in the first place. Let's follow the logic - your insulin levels are high enough that they cause your blood sugar to drop in the night, so you eat something to raise your blood sugar to offset the excess insulin....and then inject even more insulin!

If you're having a snack because you're hungry, then yes, bolus. But I'd strongly advise getting out of the habit of using food to keep your blood sugar above a certain level. Where possible, everything to do with diabetes treatment should focus on how you can reduce the amount of insulin you need to achieve the blood sugars you need.

 

[Pumper_Sue]

Thanks everyone for your replies, and I love your poem, Northerner Yep, I would be one of those deep sleepers setting an alarm, which wouldn't be fair on my partner, because he already has trouble getting back to sleep if he's woken up at 3am, and I wouldn't be able to sit up if I were woken up at 3am (low blood pressure!), so he'd have to be awake enough to get up and lift me into a sitting position, and then he'd have no chance at all of getting back to sleep ...

The one thing I don't think I made clear in my first post is that I have the choice of either eating a snack every night or never eating a snack - eating a bedtime snack only if my BGL is low and not otherwise is just not an option because it would have too adverse an effect on my health for un-diabetes-related reasons.

I see you asked about buying a pump, if you were allowed to purchase a pump how are you going to set it up properly?
Having a pump you need to basal test and basal testing requires you to skip meals and also test through the night every two hours over a couple of nights.

As to having to snack due to other health problems, why can't you have a carb free snack if your blood sugars are not low enough for carbs?

 

[Annette]

🙂 Never mind, I got the general idea! TUC biscuits are 3g carbs, and not sufficiently filling on their own, but with cheese they'd do.

Went and looked in Tescos. Melba Thins, come in boxes of 'portions' which are 15c each. The 'portion' is a wrapped packet of 6 biscuits. So you could eat, perhaps, 2 of those with some cheese or something, 5g carbs, may be low enough not to need a bolus, but filling enough to keep your tummy happy. (I knew I wasn't going mad...on this occasion 😉 )

 

[TheClockworkDodo]

Thanks Annette - I'll have a look at those and at the other biscuits people have mentioned and see if any are suitable for my food intolerances!

And thanks everyone else for your thoughts - sounds from what a couple of people have said that I was originally given out-of-date advice related to older types of insulin - however, since I am always hungry at night and it would be difficult to change my eating patterns again I'll just think about reducing the carbs so I don't need to inject extra Novorapid for them.

There is no risk of my putting on weight (well, maybe if I sat on the sofa eating cakes all day I might just manage it ...) so that's not a problem.

Sue - no, it wasn't me asking about insulin pumps - maybe someone else?