My son is 12 years old and is using Lantus 7.5 units at night with bolus injections of NovoLog based on the carbs he eats at each meal. At our last endocrinologist visit, the doctor told us that my son should not be eating a bed time snack and that people should eat dinner and be done eating for the night. I thought that is was important for a child with diabetes to have a small snack with some protein at night.

My son weighs 78 lbs. and is 4′ 10″. So now I feel like he is purposely trying to overeat at dinner because he knows that will be it for the night. He doesn’t want to be snacking on non-carb foods such as meat and cheese at bedtime. Do you think it’s right that a growing boy should not have a snack at night before bed?

Old dogma is hard to fade away…..

The dogma of a bedtime snack evolved from the use of NPH and Regular knowing when these various insulins peak. Evening NPH peaks in middle of night, and in order to avoid nighttime hypoglycemia, we used to give snacks at bedtime. This regimen does work!

Now the child is on a more physiologic insulin regimen with basal (Lantus – which does not peak) and then bolus with NovoLog based on food intake as you say. This is an attempt to mimic what happens in the non-diabetic. Are non-diabetics required to eat snacks? Of course not.

So I agree with you: As long as the glycemic control is good on Lantus/NovoLog and you are not having middle-of-the-night hypoglycemia, then I see little need for routine snacking.

But your endocrinologist may have a different plan and there may be issues to which I am not privy. Discuss your plans with your diabetes team.

DS