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Night shift advice

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danielmg

danielmg

Well-Known Member
Relationship to Diabetes
Type 1
Hello all,

I am due to start nights shift at work next Friday, and I am seeking any advice that may help with the preparation before hand, and during the shifts themselves.

I will be working 3 nights shifts in a row, followed by a week off work, then a further 4 consecutive night shifts. Each shift will be 12.5hrs in duration.

I did work 1 shadow night shift 2 weeks ago as a 'trial' to see how I would cope, however I do not feel as so I learned a great deal from it, other than now having a baseline of blood glucose results from which to base my future insulin doses/CHO intake on. The advice from my staff nurse on that occasion was to keep meal times the same (i.e. evening meal in the evening), and take my basal insulin (which I normally have before going to sleep) at approx. the same time whilst at work. I have made the decision to test my BG every 2hrs, and have a normal full lunch after approx. half of my shift.

I am going to contact the staff nurse again this week to see if I may be eligible for flash glucose monitoring (which would greatly help in this situation), and advice on how best to cope with the day-night switch, which I find to be quite difficult last time.

Any advice in the interim would be greatly appreciated.

Thank you all,

Daniel
 
Tagging @Lucy Honeychurch as she works nights and may be able to give you some advice, good luck 🙂 xx
 
danielmg said:
Hello all,

I am due to start nights shift at work next Friday, and I am seeking any advice that may help with the preparation before hand, and during the shifts themselves.

I will be working 3 nights shifts in a row, followed by a week off work, then a further 4 consecutive night shifts. Each shift will be 12.5hrs in duration.

I did work 1 shadow night shift 2 weeks ago as a 'trial' to see how I would cope, however I do not feel as so I learned a great deal from it, other than now having a baseline of blood glucose results from which to base my future insulin doses/CHO intake on. The advice from my staff nurse on that occasion was to keep meal times the same (i.e. evening meal in the evening), and take my basal insulin (which I normally have before going to sleep) at approx. the same time whilst at work. I have made the decision to test my BG every 2hrs, and have a normal full lunch after approx. half of my shift.

I am going to contact the staff nurse again this week to see if I may be eligible for flash glucose monitoring (which would greatly help in this situation), and advice on how best to cope with the day-night switch, which I find to be quite difficult last time.

Any advice in the interim would be greatly appreciated.

Thank you all,

Daniel
Click to expand...


Hi Daniel
I don't know what type of work you are doing but I work in a care setting and have my meter to hand and test whenever I feel the need. I'm on split doses of Levemir and this has helped with the early hours hypos I was getting on Toujeo.
I have less insulin resistance at night and my meter is set to reflect this (I carb count). I generally have a small dinner at 10pm, at about 1am I have a couple of oatcakes with cheese, salami, cherry tomatoes and a sugar free jelly with a few berries and cream, or melon and walnuts. 3am is chocolate time or a protein bar, then around 5.30 - 6am I have either toast, cereal or crumpets.
Always have hypo treatment to hand, my 'flashpoints' for hypos are midnight, 3 am and 6 am, this is why I tend to eat at these times.
Coping with the day to night switch is tricky, some people find it harder to sleep in the day than others. After my last night I try to get a few hours then get up, but can find it either hard to sleep that night or go to sleep ok but am wide awake at 4am! Some of my colleagues stay up all day after the last night, but that makes me feel ill. Working nights we are basically going against our body clock, some people just can't do it, with or without having this to contend with also.
As for the fgm whether you will be prescribed one depends where you live. I can't get one as I don't meet the criteria.
Good luck and let us know how you get on 🙂
 
Hi Lucy,

Thank you very much for your advice.

The job I have does present a few challenges, as I work within a hospital laboratory. This means I cannot test my BG or eat anywhere within the nearby area, and therefore I have to leave the lab to do either of these things. Also, I will be the only staff member covering the area in which I work, so I find it difficult to keep leaving the lab for short breaks, and feel rushed to get back whenever I do leave. Other staff are normally only allowed 2 x 25min breaks during this long shift as well.

My current insulin requirements are so low, but greatly varied (as i'm sure many can relate to) depending on many factors. I found on my shadow night that my BG levels were too high initially after my pre-shift meal, then had a rapid decline over the first 2hrs at work, and subsequently struggled (despite having small snacks) until I had my main lunch at approx. 01:30. After this, I felt slightly better, but was at no point during the shift feeling ok. Furthermore, this shift was fairly quiet work-wise, and I had someone else there to help as well.

I agree, everyone whom I have spoke to at work says how difficult night shifts are, and I am not convinced as yet I will be able to complete all of them. Even if I do, what good is it just to scrape through or suffer with erratic and unhealthy BG levels, and be unable to concentrate on my work. It seems completely un-natural for anyone to do night shifts, but especially so given the circumstances.
 
That doesn't sound ideal at all.
When I was first diagnosed I'd already been working nights for three years. When I had my return to work interview with my Manager I was told that they had to offer me day shifts, if I wanted them, as they had to make reasonable adjustments under the Disability Act. Do you want to work nights and If not can you not work day shifts? This site has a helpline which can give you advice.
 
It does seem a relatively short amount of time by which I am starting night shifts. I was only diagnosed about 8 months ago, and still trying to figure out basic things in relation to nutrition, exercise, and testing whilst out and about.

I have said that I wanted to at least give the night shifts a go, and my line manager knows that is very much a 'trial' to see how I will cope. I do feel as though I have been slightly pushed into doing them, plus maybe taking advantage of the fact I am not someone to say no, and tend not to complain about any problems i'm having. I do however think that If the shifts go badly, I then have a legitimate reason (evidence) for being taken off the staff rota and only doing day shifts for the foreseeable future.

I may contact the diabetes helpline (thank you Lucy for recommending this) and maybe gain some further advice on this issue.
 
Hi all (again),

I'm just seeking abit of extra advice after completing (barely) 3 nights this past weekend.

I did my best to make sure my BG was ok before and between shifts, however during the shifts it was completely different. I had consistently low BG readings (<5mmol/l) every time I tested, which worked out about 9-10x across a 12.5hr shift. This was despite having at least 20-25g CHO after every test, including over 100g CHO for my lunch. This was exhausting to test this much, and the constant need to keep having breaks to eat when I wasn't even remotely hungry. Even after having CHO after each test, I would only feel OK for approx. 30-45mins, then started feeling my BG dropping, plus shaking, high body temp, brain fog associated with this. Furthermore, the lack of sleep just compounded to this experience and made me feel even worse than I normally do when suffering with low BG levels.

I am due to speak with my line manager this week, as I am supposed to work another 4 night shifts from next Monday. I really do not know what is going wrong, but I do not think the constant testing, eating, worry of hypoglycemia and lack of sleep is sustainable when working for such a long time by myself.
 
Well, that suggests your basal dose wants decreasing a bit, doesn't it?

I take Levemir twice a day, and my evening dose is 50% higher than the morning one, so I'd guess if I were working at night that would cause hypos much as you describe. (So I'd be decreasing it, and maybe increasing the one that more covers when I'm asleep.)

However, I'm of course not a doctor (well, not a medical doctor); also I'm sure shift working messes up the body in various ways regardless of diabetes. So see what your medical team suggests. But it doesn't sound like what you're experiencing is inexplicable or (potentially, at least) unfixable.
 
I haven't been taking any basal insulin either before or during my night shifts. At the moment I only ever have 1 unit of basal insulin before bed.
 
danielmg said:
I haven't been taking any basal insulin either before or during my night shifts. At the moment I only ever have 1 unit of basal insulin before bed.
Click to expand...

Ah, OK. That makes my suggestion a bit useless then (apart from the one about asking your local team for help, which is obvious).
 
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