[kemist]

I think I need a protein based snack before I go to bed (when I take my Lantus shot) to prevent my BG from dipping into the 2.3 mmol/l range around 3-4am.

Just wondering, what kind of Protein type bedtime snacks would be appropriate? Is weight gain going to be a side effect of having bedtime snacks?

As a general rule, I try to have my sugar at around 8 mmol/l before bedtime but I do need something I can eat that will release very slowly and not boost my sugar up too quickly.

any recommendations?

Id like it to be as healthy as possible..

thanks,

kemist

[Musqua]

Hi there Kemist:

I also am on Lantus ( 48 u) at bedtime. I usually have a glass of skim milk a small piece of cheddar cheese & a couple of arrowroot biscuits. I find that usually tides me over until bkfst. :

Heather W. Your Canadian friend )

[DeusXM]

Um....if you don't want your BG to lower during the night then I don't think a protein based snack is going to be much help, since protein has no effect on BG. You need carbs, plain and simple.

If you want slow-releasing carbs then you'll need something with a high GI, like white bread, or pasta. I usually have a sandwich, something like cheese on toast. Soup with croutons or toast isn't a bad idea either

Weight gain shouldn't be a problem since it's only a few extra calories, but if you're seriously worried about putting on weight then you might want to consider reducing your insulin intake. One of the jobs of insulin, along with processing glucose, is to help store fats. Less insulin, less fat. Obviously you'll have to reduce your food intake accordingly to prevent your sugars going too high, and of course that will also have a positive effect on your weight. It would also probably eliminate your need for a snack to prevent nighttime hypos too.

[notme]

I have also found protein to help during the night. I use an insulin pump so I don't need a bedtime snack usually. I check my blood glucose before bed and if I am below 125 I eat protein in the form of peanut butter and celery or something similar. Protein like all foods do convert to sugar, they just do it over a much longer period of time. Seems to keep things stable for me during the night.

Nancy

[kemist]

Originally posted by DeusXM
Um....if you don't want your BG to lower during the night then I don't think a protein based snack is going to be much help, since protein has no effect on BG. You need carbs, plain and simple.

If you want slow-releasing carbs then you'll need something with a high GI, like white bread, or pasta. I usually have a sandwich, something like cheese on toast. Soup with croutons or toast isn't a bad idea either

Weight gain shouldn't be a problem since it's only a few extra calories, but if you're seriously worried about putting on weight then you might want to consider reducing your insulin intake. One of the jobs of insulin, along with processing glucose, is to help store fats. Less insulin, less fat. Obviously you'll have to reduce your food intake accordingly to prevent your sugars going too high, and of course that will also have a positive effect on your weight. It would also probably eliminate your need for a snack to prevent nighttime hypos too.

I totally disagree with two things you mentioned:

- Carbs with a High GI will release slowly?!
I thought complex carbs (which have a lower GI) release more slowly because they require your body to break them down more.

If I eat white bread or pasta before i go to bed (with a BG of say 8.0 mmol/l) I am sure to send it skyrocketing.... this would definately cause me weight gain requiring a shot of short-acting.

- How can protein have no effect on BG?
This can't be true.

Please explain.

kemist

[lgvincent]

Years ago I was taught to eat some protein after coming out of an insulin reaction to help avoid having another one. I would think that protein and fat would both have an effect on blood sugar, since they both provide calories and I thought calories, regardless of source, were burned to provide energy. I have found the calories from carbohydrates to be of short duration while the calories from protein to be burned at a much lower rate, maybe due to being released slower or something like that.

For a bedtime snack, I used to eat peanut butter although now I usually eat cheese. One ounce seems to work fine.

[DeusXM]

GI - Glycemic index ie. sugar. Protein, since it is NOT a sugar, cannot affect GI.

Low GI products are low in carbs. You asked for slow releasing carbs, which include white bread, and pasta. High GI products have, pound for pound, more carbohydrate, but in general (unless it's sucrose/glucose etc) they release SLOWER, which I believe is what you were asking for. White bread and pasta will affect your BG, but if you want to stop going low in the night, you are going to have to raise your BG or cut your insulin. The trick is not to eat too much.

Once again (and I can't reinforce this enough), protein simply CANNOT affect your BG levels since amino acids are completely unrelated to any carbohydrate. Protein will help you build muscle and contribute to your calorie intake, but it cannot affect your carbohydrate or BG levels.

Calories DO burn to provide energy, but they are unrelated to carbohydrate levels. This is the principle behind the (fatal) Atkins diet. You can eat nothing but protein and you'll still have energy, but you'll be in ketosis which will kill you in less than 3 months. Your body's preferred source of energy is carbohydrate and there's nothing you can do to change that.

Peanut butter is NOT protein since it is predominantly made of sucrose, a carbohydrate,which is why it stops you going low. If you want to stop having hypos in the night you are going to have to raise your BG or drop your insulin. The sad fact is that if you have good control over your BG and you are diabetic, you are likely to put on weight. The trick is to get a balance between weight and sugar levels. Like I said, drop your insulin and food intakes if you want to maintain or lose weight.

If you don't believe me, consider the following: starchy products such as rice, potatoes and white bread all have high GIs. They're also the most complex carbohydrates. Therefore they release more slowly (which is why these foodstuffs used to be considered to the 'diabetic diet'), but overall they have a greater effect on BG levels. Put simply, a bar of chocolate and a baked potato will affect your BG by a similar amount. But the baked potato will affect it more slowly, since starch is a more complex carb than glucose.

Protein CANNOT convert to sugar, it converts to essential amino acids in your body, so it cannot affect glucose. If you want to stop going low at night, you need to eat something that's got a combination of carbon, hydrogen and oxygen. Maybe fruit might be a good answer?

[notme]

Hi Deus,

I certainly don't want to discount what may work for you, but I think your research for most of us is a bit flawed.

ALL foods that you eat will convert to glucose. You are correct that some foods (high glycemic index foods) will effect your blood sugar more quickly, but proteins will convert over a longer period of time.

I have an issue with Dawn Phenomenon. My blood sugar at some time during the night will drop dramatically and then my liver tries to compensate (usually over compensates) and I will wake up with high blood sugar. Even if I go to bed with a blood sugar reading of 110, by morning I can be in the 200's even if I eat nothing before bed or during the night. I have overcome this issue with the insulin pump by dropping my basal rate at about 3 pm. For someone not using a pump, this is impossible. The other alternative is for them to eat a protein before bed and a protein with a simple carbohydrated if their blood glucose is low at their bedtime reading. Many protein bars and snacks have been made for this purpose. I prefer to make it myself.

This was a suggestion from Medtronic MiniMed for middle of the night lows.

"If a low occurs at bedtime, follow the simple sugar with a more complex carbohydrate and a protein (crackers with peanut butter). "

Another article I found by the Joslin Diabetes Center confirms the use of protein in preventing night lows.

"In the present study, the standard snack was the only snack composition that was effective at preventing nocturnal hypoglycemia at all bedtime blood glucose levels without significantly impacting overall nighttime and morning glycemic control, especially at bedtime blood glucose concentrations <7 and 13 7-10 mmol/l. Because the aim of this study was to ensure minimal disruption of participants' usual routines, no attempt was made to further modify the usual insulin dose regimens, including bedtime insulin. Further research is encouraged to determine the efficacy of meticulous titration of insulin dose, in the absence of a bedtime snack, on nocturnal glycemic control.

Although the small sample size in this study limits generalizability of the findings, we feel confident, given that the results were both clinically and statistically significant, in making the following recommendations for the management of adults with type 1 diabetes treated with lispro insulin before meals, especially at supper, and NPH insulin at bedtime: no bedtime snack seems to be necessary at bedtime (10:00 P.M.) blood glucose concentrations >10 mmol/l. For bedtime blood glucose concentrations <10 mmol/l, a bedtime snack is necessary. For a bedtime blood glucose concentration of 7-10 mmol/l, a standard, cornstarch, or protein-rich snack is beneficial. For bedtime blood glucose concentrations <7 mmol/l, a standard or protein rich-snack is beneficial."

If your current method of treating hypo's at night is working for you, by all means, I wouldn't change a thing.

I have found protein to be the answer for me in preventing night lows. I can now go to bed with a reading of 94 and not worry about waking up high in the morning.

The peanut butter I am using is Maranatha Organic Peanut Butter. The Nutrition facts on the label say it is a total of 7 grams of Carbohydrate, 2g Dietary Fiber and Sugar is only 2 grams. It has 8 grams of protein. It has no sugar added. It does however have 16 grams of fat per 2 tablespoons and has 190 calories. Caution is necessary to avoid weight gain issues. I find one tablespoon to be plenty on my stalk of celery.

Give it a try Deus.....maybe it will work for you!

Nancy

[DeusXM]

It's a good point, but even MiniMed says you need a complex carbohydrate. I won't dispute that protein converts to glucose, since I'm not clued up enough on nutrition, which means I've got something else to go and research this week (as if I haven't got enough with exams already...)

I too have had massive problems with the dawn phenomenom. I've done readings just before I have my evening snack, at had bgs of less than 6mmol/l, woken up at 2 and got a reading of 6-7, and then woken up the next day and found I've skyrocketed to above 10 and I've got a sore head.

I guess this sort of thing is exactly what the Glucowatch was invented for.

[kemist]

is there a way to get the protein, without the fat??

ex: peanut butter, cheese, all have high amounts of fat.

maybe i will check out some low fat protein bars at GNC and try a small piece of that.

[Andrea]

I don't eat a bedtime snack, so i don't have a lot of imput on that, but i can give some insight as to the theories.

I agree with others that you are going to want to eat some carbs that will take a while to digest, because otherwise your blood glucose level will just spike and stay elevated or spike and then plunge, neither of which is the desired effect. Yes carbs are a good idea, but it is an excellent idea to add some protein or fat to the carb to help slow the absorption. Ice cream is a bedtime snack that has long been recommended for children with type 1 diabetes as the fat slow the absorption of the carb and it can help prevent lows at night. And for the treatment of hypoglycemia, of course we need to treat it immediately with a fast acting carb (high on the glycemic index), but then IF it is going to be a while until the next meal or snack, it is also a good idea to follow up with some slower acting carb (low GI) and or some carb/protein combo (like half a peanut butter sandwich).

All foods that we eat do not turn to glucose. Carbohydrates are the body's favourite source of energy and if there are enough carbs available for the body's energy needs, it will only use those carbs for energy. However, IF the body is not getting enough glucose (energy) from the carbs we eat, it will use other sources for energy. Generally the second target is protein.

Protein that we eat CAN be used for energy but the body prefers to use it for things like building proteins and hormones in the body and cell repair. If a meal or snack is eaten with NO carbs whatsoever, we still need to take some insulin for that meal because eventually some of the protein we eat will be turned into glucose and that glucose still needs to get from the blood stream into the cells.

Now on the subject of fat, i am experiencing a memory lapse for one of my 2nd year nutrition courses, (anyone please feel free to correct me if i am wrong), but i don't think that DIETARY fat can be turned into glucose. Of course we all know that BODY fat can be used for energy if there are no other sources available, which is what happens when we go into ketoacidosis when there is a lack of insulin in our bodies. The glucose may well be available, but the body can't use it in a situation where there is a relative lack of insulin. So the body breaks down fat in order to get energy (and of course the bi-products of this fat breakdown are those nasty ketones!! )

Back to that bedtime snack... I think the long and the short of it is that each of us has to figure out what works for us individually. It may be a combination of food at bedtime and an insulin dose or timing change. Perhaps more people will give you an idea of what they do. Since i wear a pump, i can simply change my basal rates if needed to deal with nighttime lows/rebounds or with the dawn phenomenon.

Andrea

[kemist]

Thankyou Andrea, for confirming what I believed to be correct. DeusXM had a few things backwards which was throwing me off.


kemist

[rzrbks]

Andrea

Back to that bedtime snack... I think the long and the short of it is that each of us has to figure out what works for us individually.

This is where I'm in agreement with everybody. Since joining this Forum of Individualists, the one constant is that there isn't a constant.

Path A works for this one, Path A plus an addition works for that one, Path A plus an addition plus 1.1 works for another one.

Seems that each of us needs to make suggestions, (root for our favorite) and hope that we can help that question asker.


As for bed-time snack, I vary, sometimes it's an apple (+cheese once in a while), sometimes cheese and crackers, sometimes chocolat Grahams, chipolata (Sausage) rolled up in bread. Whatever I'm in the mood for that hits the Carb count and sometimes protein that I need that night.

[DeusXM]

DeusXM had a few things backwards which was throwing me off

Admittedly I was wrong with my blanket statement that protein cannot turn to glucose but Andrea actually backs me up when in my belief that the most important thing in dealing with bg is carbohydrate, but we'll leave it at that.

Perhaps it would be more relevant to find out to what extent protein affects bg. I still think it's going to be minimal.

[notme]

This article does a good job of explaining the Dawn Phenomenon and protein.

http://www.diabetic-talk.org/dp.htm