The good news? You got the job. The bad news? You’re working the midnight shift.
“It used to be that shift work was a barrier for people using insulin and for some people taking diabetes pills,” says Dr. Sora Ludwig, associate professor of medicine, section of endocrinology and metabolism, St. Boniface Hospital, University of Manitoba, Winnipeg. “With the advent of rapid-acting synthetic insulins which more closely mimic what insulin in the pancreas normally does, however, people with diabetes now have greater flexibility and control.”
“With diabetes you can do anything,” adds Karen Janssen, a diabetes nurse educator at Mount Carmel Clinic in Winnipeg. “Tell your employer, ‘Yes, I am a person with diabetes and with a bit of thought, education and a plan, I can do a great job.’”
A new attitude
One of the biggest changes in recent years regarding diabetes management is taking responsibility for your own care. “It’s not just the doctor taking care of your diabetes,” points out Janssen, “Now, your diabetes team supports you and you make your own decisions.”
Put a plan in place
Obviously, this move towards self-support and self-care also means that you need to know a lot more about your disease to manage it well. Even if your diabetes is well managed, for instance, shift work will increase your risk of a hypoglycemic (or low blood sugar) incident if you take insulin or certain diabetes pills. This is because the mental and physical stress that can result from shift work influences the body’s “circadian rhythms” which regulate daily processes such as hunger and fatigue. When you start eating and sleeping at different times, it disrupts your body’s internal clock and affects blood glucose (sugar) control.
For this reason, it’s essential that you speak to your diabetes team about your job so that a written plan can be put in place. Then, share that plan with your employer.
Asserting yourself with your employer is not about asking for special treatment, notes Janssen. “It’s about letting him or her know what things you need such as quick accessibility to food, regular meals, access to your blood glucose (sugar) meters and regular rest breaks.”
If you’re working shifts, you may never see your employer so your peers should know you have diabetes too, she adds. “Everybody needs to know where your hypoglycemia supplies are so that if you have a low, you can treat it and go back to work.”
Your plan also needs to spell out what constitutes a medical emergency and describe in detail what needs to happen. Similarly, make sure you wear some form of personal health identification so that people who don’t know you can respond if there’s a need.
Monitoring blood glucose (sugar)
Good diabetes control, which means that blood glucose (sugar) levels be kept as close to normal at all times, is important for preventing complications.
This requires more frequent testing of blood glucose (sugar), particularly if you’re driving for work or operating machinery. “It’s better that you test blood glucose levels every couple of hours to know how much insulin you need rather than risk a low and shut down the shop for a couple of hours,” points out Janssen.
Meal planning & snacking
Snacking and strict adherence to certain mealtimes may be critical to prevent low blood sugar incidents. If you are going to have any change to your work schedule, it is important that you sit down with a diabetes health-care professional to adjust your medication dosages to your new mealtimes. “Snacks and breaks are important for everybody, but most important for somebody on insulin and pills,” notes Janssen.
It’s important to keep physically active outside of work hours—even if you’re working the night shift. “Continue with your regular exercise routine, however it fits into your day,” advises Janssen. “It’s really important for your health that you determine when exercise will best fit into your new schedule.”
The combination of rapid and long-acting insulin analogues, known as a “basal/bolus regimen,” is also helping people with type 1 diabetes and those with type 2 diabetes who take insulin have a more normalized lifestyle. Rapid-acting insulin—which absorbs into the bloodstream very quickly—can be taken when you eat and the dose adjusted to compensate for the amount of carbohydrate you’re consuming. “With the rapid analogues, you can take insulin every two to three hours if you need to and, as a result, move your eating times from day to night very easily,” points out Janssen.
In addition, the new long-acting insulin analogues, which absorb much more slowly than the rapid-acting analogues, prevent swings in blood glucose that can happen during sleep. Usually taken once or twice a day, long-acting insulin can be taken at the new eating and sleep times without any repercussions. “It can be worked out and will provide more stability,” says Dr. Ludwig.
A word of caution
Despite all the latest advancements in the management of diabetes, there are certain situations in which other health concerns – perhaps complications related to diabetes – would preclude your accepting a job, whether or not it involves shift work. If you have foot problems, for instance, wearing steel-toed boots on a cold concrete floor for 12 hours is not for you. Similarly, if you have a heart condition, you should not be performing tasks such as heavy lifting. Speak to your physician if you have concerns about the possible health risks associated with the demands of your job.
Some shifts are worse than others
Even if you don’t have diabetes, shift work can put a strain on health. And some shifts are worse than others. The night shift can be the most stressful time to work. Similarly, rotating shifts are best if designed to rotate every two to three days and move “forward” (from mornings to afternoons to nights) and not the other way around. And always keep rest and activity in the same order, regardless of what shift you work.