January 13, 2002
Daily Care
Question from Altadena, California, USA:
Our seven year old daughter, diagnosed with type 1 diabetes about two months ago, is currently taking NPH only once a day (before breakfast) because of low fasting blood sugars, but we are confused about the bedtime snack. We usually have dinner at 6:00-6:30 pm, and her bedtime is 8:00 pm. We both work so having dinner any earlier is impossible. Since her blood sugar level is usually around 130 mg/dl [mmol/L] or at bedtime, we are concerned if we give a bedtime snack so soon after dinner, blood sugar might go even higher, but waking her up at 11:00 pm to give her a snack seems extreme. On the other hand, If we don’t give her the snack her level will certainly be low. Is this the norm? We stopped her evening 1 unit of Regular because it was causing her to have low blood sugar levels in the morning. What can we do?
Answer:
I wouldn’t suggest insisting on a bedtime snack if your dinnertime is later in the evening. The key is to provide what your daughter needs, avoiding hypoglycemia, and optimizing blood sugar levels. The bedtime snack is not an absolute rule. If you struggle with low blood sugars without the snack, then I would suggest changing her insulin dosing to avoid the lows. You may be interested in other long acting insulins such as Lantus (insulin glargine) rather than just using NPH in the morning. I would discuss this change and your current struggle with the bedtime snack with your daughter’s diabetes team.
MSB
