For ages, people with diabetes have made sure to eat something before bed to keep their blood sugars up during the night. The trick has been to eat just enough to sustain blood sugar while not overeating. A nutritionist may recommend a half sandwich before bed, but the patient might fix himself a sixteen-layer sandwich like Dagwood Bumstead does in the comic strip. Overeating can lead to high blood sugars during the night and weight gain over an extended period.
In an effort to solve this problem, two companies have released special bedtime snack bars. These can provide long-lasting glucose control within a low-calorie, controlled package. The snack bars, called NiteBite and Z-Bar, use uncooked cornstarch for delayed carbohydrate absorption, providing an early morning reinforcement of glucose.
Francine Kaufman, MD, Director of the Comprehensive Childhood Diabeteic Center at Children’s Hospital, Los Angeles, presented an abstract at the 1996 ADA Conference in San Francisco, showing the positive results of a study she conducted with uncooked cornstarch. She divided a group of 79 volunteers into two groups. Before bed, one group ate a snack bar containing uncooked cornstarch, while a control group ate a similar snack bar without cornstarch. Kaufman recorded the blood sugar levels of both groups at regular time intervals and compared them. The mean blood sugars of the control group were much lower after five hours than the blood sugars of those who had eaten the uncooked cornstarch snack. Hypoglycemic episodes were also reduced, with only three percent of the volunteers who ate the cornstarch bar experiencing hypoglycemia compared to the 15 percent of volunteers who ate a control bar.
Kaufman used her research to design Z-Bar, which she now distributes through Baker-Norton Pharmaceuticals. NiteBite is distributed through Medical Foods, Inc. Both bars are similar in their composition of ingredients. Both have an average of three grams of fat. NiteBite has 100 calories and three grams of protein compared to Z-Bar’s 110 calories and five grams of protein. The most significant difference between the two bars is the use of sugar as an ingredient. Z-Bar uses approximately eight grams of sorbitol, while NiteBite contains 10 grams of sucrose. Sorbitol has been known to cause gastric reactions such as flatulence and diarrhea, according to DIABETES HEALTH board member Beth Beller, RD, CDE.
“People with diabetes have been trying to figure out what to eat before bed forever. It’s one of the great controversies of our time. From the studies I’ve done, I don’t think simple sugars such as sucrose should be included in a snackbar,” said Kaufman. She asserts that she used a prototype of the Z-Bar in her study, and that she has no affiliation with NiteBite.
Stacie Bell, a Doctor of Science in Nutrition at Harvard Medical School, endorses the NiteBite snack bar, and looks at the addition of sugar as a bonus. “From the research out there, we’ve seen that uncooked cornstarch works as an extended carbohydrate. We’ve taken that knowledge and gone one step further. With a small amount of simple carbohydrates, a person has a supply of sugar to balance the insulin at every phase. The sugar provides an initial glucose burst, then the protein kicks in, followed by the delayed absorption of cornstarch. The person is covered throughout the night,” said Bell.
DIABETES HEALTH Board Member Phyllis Furst, RN, MA, ANP, CDE, is not impressed with either bar. Given the choice, she would recommend a natural snack. “I’d recommend a half sandwich, a glass of milk and a couple graham cracker squares,” said Furst.
But portion control remains a problem. One of the most popular midnight snacks is ice cream. The high fat content in ice cream delays digestion while providing glucose in the early morning hours. The only problem with such a strategy is that a half scoop of ice cream before bed can quickly become a scoop or even two scoops.
“Who eats a half cup of ice cream?” Bell asks. “Given the opportunity to eat, people will overindulge. Their nutritionist will tell them to eat a peanut butter sandwich before bed, and the person will use half the jar on one sandwich. With a snack bar, you know exactly how much you’re getting every time.”