[Surviving Night Shift as an ICU Nurse with Type 1 Diabetes]

Nurses joke around about how working the night shift shortens your life spans and causes health problems - funny to say “night shift is killing me!” until you realize it is slowly sucking the life from you...not so funny anymore is it?

Now think about having diabetes - a disease with many varying factors - and I’m combining the two??

I will say - at the beginning it was a little difficult adjusting and was full of trial and error, learning, frustration, hope and defeat. Some days I felt like I was conquering my diabetes and would have my BG stay between 80-180 the entire shift but not know how I did it because the next night I would have wild swings below 80 and above 200.

Having my insulin pump and CGM to monitor and adjust my insulin ratios was very helpful. But just as important was my attitude - if I was worried about my BG every second of my 12 hr night shifts, I wouldn’t be able to take good care of my patients and all that stress would just mess up my blood sugars more! So I did the best I could with the data I had from each night shift and would gradually adjust my insulin doses with the help of my endo. Also, I give myself grace - because diabetes will always be a complex puzzle that we may never fully understand. Expecting perfection is unrealistic and only brings us down.

My key take-aways: Don’t adjust too much too fast. Don’t let those high blood sugars make you turn around and have the opposite problem by overcompensating. My endocrinologist gave me a scale to use as I adjust up or down.

For example, this is what my endo suggested for me: (Ask your endo what works for you!)

Go up or down by 1 unit when adjusting between 1-11, then by 2 between 12-24, then by 3 if you go above that. For example:

If you are consistently going over 250 mg/dl and then only dropping down to 180-200s after the meal and your current carb ratio is 1:15, try changing your ratio to 1:13 for the next time.

Tell your co-workers and friends you are diabetic - for your safety people need to know.

If they are interested and ask questions, educate them! I love it when people are curious because it is an opportunity to share and help them learn about Type 1 vs Type 2, insulin pumps, CGMs, and to get to know a diabetic in person instead of just hearing about the stereotypes.

Personally, while I am working night shift I need less insulin. My ratios are 1:14 and 1:18 throughout the night versus 1:11 and 1:14 during the day. My basal needs are also slightly less during night shift.

You’ve gotta just roll with it. Some shifts I have great blood sugars and other nights I’m either chasing lows or having to correct highs. And sometimes these nights I’m eating the exact same meals at the same times! It can be very frustrating at times to deal with sugars that don’t seem to have an easy answer as to why they are so all over the place. Talk about it! Find friends and family you can share your difficult times with who will listen. Share when it's tough and celebrate when it's going well! But don’t let yourself fall into a pit you can’t get out of. It’s okay to be sad or upset and to feel emotions - in fact it's healthy. As long as you feel them and do something about them and don’t let them keep you down in a pit.

Love and encourage each other and keep up the fight!

- Karlyn Vande Vegte, RN


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