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July 24, 2000

Meal Planning, Food and Diet

Question from Dorothy, New Jersey, USA:

My son is six years old and has had diabetes for two years. We are wondering what suggestions you may have for good and yummy nighttime snacks to prevent nighttime lows. We know to include a protein: how do you feel about ice cream (fat free, sugar free, frozen yogurt)? What's best at night?

Answer:

It’s clear that you understand that the job of that nighttime snack is to cover the insulin acting overnight, in order to prevent middle of the night hypos. That’s a lot to ask of a snack, especially with a six-year old, who I’m presuming goes to bed pretty early. Most foods just don’t last something like 6 hours after they’re eaten. A snack that includes a good amount of protein and fat has a better chance of continuing to release glucose to the bloodstream over such a long period of time than a snack that is mostly carbohydrate. Fat helps by slowing down the emptying of the stomach.

Most ice creams and yogurts with which I’m familiar don’t have enough protein to fill the bill and the fat-free varieties are even less likely to help because they leave the stomach very quickly.

Some people swear by very low glycemic index foods (things that are digested and absorbed very slowly) as the perfect bedtime snack, but these are things like beans and lentils that not too many 6-year olds can get delighted about. Here in the Southwest where people love Mexican food, a lot of kids grow up eating refried beans which work well for some people — either alone or with some cheese on top or in a small burrito. A reasonable alternative is a half peanut butter (or cheese) sandwich with a few ounces of milk

The difficulty of making this work is what led researchers to develop slow-release products like the “Extend Bar.” The uncooked cornstarch in these products puts a stable floor under blood sugar that lasts several hours. If you can find a brand and flavor your son likes the taste of, you’re in business. An Extend Bar (or similar product) could be used consistently as the bedtime snack or as an occasional alternative for snacks that include protein and fat with their carbohydrate, to add variety.

BB