I have been doing some web-reading about ‘night eating disorder’, and wonder if I have it. I have always found breakfast a problem. I am 36, and have been type 1 for nearly 30 years. After years of lying to doctors, or making promises I broke, I just stayed honest: I don’t do breakfast as I should. Breakfast is a slice of toast, sometimes with tinned tomatoes, sometimes with other stuff: about 20�grams of carbohydrate. I am not a big lunch person: a sandwich and a cup of soup, or a salad (35g carb to 50g carb). Then, in the evening, I eat 70 to 140g carb, at 8�P.M. – midnight.

Now, I have never felt this is abnormal eating. I take the right amount of insulin to cover the food. (I have been doing this all my life, since I discovered that one could match food to carb, and come out even).

From what I have read, this eating pattern is typical of night eating disorder (and also I have read that diabetics are prone to eating disorders of all kinds) — but (and, to my mind, it’s a huge but) the only people who seem to have a problem with this pattern (other than doctors I saw ten years ago, who focused on the lack of carb at breakfast time). Is it a problem to eat this way (given that I have proved that my HbA1c and hypoglycaemia incidence do not improve if I eat ‘normally’)?

There is nothing “right” or “wrong” about a given pattern of eating. Normal eating patterns vary dramatically from person to person. Usually, the details only come to light and are criticized when there is a reason (like diabetes) for health care providers to be made aware of their deviation from the mythical “norm.”

In deciding whether your eating pattern is problematic, ask yourself a few questions (other than the ones relating to your diabetes management which you have already explored): Do you have a good level of energy throughout the day when you don’t eat much? Are you troubled by hunger during the day? Are you gaining unwanted weight? Are you aware of restraining your eating earlier in the day or are you just not very hungry? Are you eating “out of control” in the evening or just responding to a heartier appetite at that time of day? It is the cycle of restrained eating followed by out of control eating that constitutes an eating problem or disorder, not the times and amounts eaten per se.

If your energy level is good, you are not troubled by hunger during your day, and you are not gaining unwanted weight (eating heavily just before bed and then taking the insulin needed to control the resulting glucose surge can favor weight gain — the same is true of people who do not have diabetes and eat most of their calories late in the day) and you have not established a pattern of artificial restraint followed by uncontrolled consumption, then it is my guess that you are simply following a pattern that is normal for you.

Your final comment regarding your glycohemoglobin and hypoglycemia episodes “not improving” on a more “standard” eating pattern, suggest to me that you may not be entirely satisfied with these aspects of your management. If not, then you may want to take a closer look at the carbohydrate coverage factor you are using to match insulin to food, and at whether your basal insulin doses are optimal for you (can you skip or at least delay a meal without having a hypo? if not, then your basal insulin level is probably too high). You may also want to consider a switch from Regular to Humalog for meal coverage, if you have not already done so. In our experience, it is a much superior insulin for carbohydrate specific dosing. Using it clarifies the breakdown between the basal and the bolus insulin doses and can result in less hypoglycemia between meals and overnight due to its shorter duration of action (if the basal doses of U or N insulin are correct).

BB