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October 7, 2009

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Question from Fairfax, Virginia, USA:

I am a new RN working nights, 7 p.m. to 7:30 a.m. and on an insulin pump. I have had diabetes since age 12 and am now 25 and have used a pump for the past six years. Since I now work three or four nights a week, my testing schedule is very different than it was before when I could test four to six times a day and sleep through the night. I'm finding that I can test at 7 p.m., about 4 a.m., then at 7:30 a.m. Because of how busy my patient load can be, I am eating dinner at about 5 p.m., eating a small snack at about 1 a.m., a small meal at 4 a.m., and breakfast at 9 a.m. My husband wants me to push for a day schedule so I can sleep better and stay on a regular schedule with diabetes, but I do not have the option to work days. I am very healthy otherwise, no diabetes complications. I experience lows only once or twice a week and maintain levels between 80 and 160 mg/dl [4.4 and 8.9 mmol/L], with levels up to the 250s mg/dl [13.9 to 14.3 mmol/L] sometimes. Can I remain healthy with diabetes while having no consistency in my sleep/wake schedule? Can working nights be detrimental to my long-term health?

Answer:

There is no absolute answer to your question. I would say that as long as you do not sacrifice control for your shift work, and you don’t become run down for lack of sleep, you can remain healthy. However, this does take some work as each time you transition from one schedule to the next, your body needs some time to make the shift. What I find from my patients who are nurses and are doing exactly what you are doing is that there is some sacrifice in control. They often work these hours because they have to. In other words, they cannot easily move to another schedule doing the same work and therefore, choose to stay in there current position doing the best they can. The problem I find is that lows continue to develop when pump users get involved with their patient care and are not able to monitor regularly or do so at odd hours that do not mirror eating patterns. I think there is additional consideration in this situation for the use of a continuous glucose monitor. This device can provide instantaneous readings, trends, and will also alarm at absolute levels, both high and low. This might be a consideration for you if you decide to continue in your current position.

JTL