Shift Work and Diabetes

I’ve been gone from the “blog-osphere” for awhile. Life. Diabetes. Those two things in and of themselves can take up all of my time. Plus, I work in television news production which is a 24/7 operation. Yesterday my shift was from 8pm to 4am and I had to be back at work by noon today. This would be a challenge for anybody. Add Type1 diabetes to the mix and the challenge becomes a thousand times more difficult. There are numerous articles about the negative effects of shift work – webMD – but I don’t need those articles to know that shift work has many negative side effects. I do whatever I can to mitigate those negative effects.

When I was first diagnosed with diabetes, 36 years ago, the regular schedule of insulin shots, food and exercise were critical in maintaining good control. Even then, my schedule was less than regular I was able to establish a fairly structured routine and I credit that for my stellar control in the early days with diabetes. I was able to transition from television production; which often requires very early starts and very long days in various locations, sometimes with limited access to any food no less healthy food; to television post-production. Post-production generally starts a little later and I stay in one place with a refrigerator nearby. When I was doing Multiple Daily Injections (MDI) being near a refrigerator was a requirement. As an editor, the hours are also very long and I sit for long periods of time. Basically, television is not the best line of work for people with diabetes but having food nearby and staying active outside the edit room keeps my diabetes management under control. However, the lack of a steady schedule, eating take-out and delivery food all of the time and those long stretches of no physical activity make healthy living nearly impossible.

How to adapt? First and foremost, a healthy diet. That means bringing lunch and healthy snacks every day. Instead of doughnuts, cheeseburgers and pizza everyday eating homemade salads, leftover healthy dinners, fresh fruits and nuts make blood sugar control a little easier when I’m out in the world. Granted, it is not easy when everyone else is ordering fries and milkshakes but the trade-off makes hyper- and hypoglycemia less frequent. The one thing no one needs during a stressful work day is a severe hypoglycemic reaction that brings confusion and an inability to function efficiently or hyperglycemia that fogs the brain and slows the body. No one wants to have to call 911 during the day and I have always felt an immense responsibility to not burden my co-workers with my disease. That said, I am also very open about my diabetes. I tell co-workers that I have type1 and I also tell them how to deal with me if they notice hypoglycemia before I do… which, luckily, has never been necessary.

Secondly, blood tests and a continuous glucose monitor (cgm). There is no replacement for knowing what my blood sugar is. Before I had a cgm, I easily did 10 to 12 blood tests a day, right at my desk/console. With a cgm I still do 3 or 4 blood tests a day and I am very tuned in to my iPhone’s cgm display. If I am eating right and I am aware of my blood sugar I minimize any possibility for hypoglycemia. If I do get a low blood sugar alert I react immediately. I think reacting to the data is paramount to staying in control and not having co-workers have to deal with my negligence. Sometimes a low blood sugar is not negligence but not reacting quickly is. I am also on an insulin pump which has helped heighten my hypoglycemic awareness. The pump along with cgm alerts help tune you in to what you feel like when your sugar is falling or rising rapidly. Being aware of the subtle changes in mood or physical differences helps me stay in control throughout my day.

Finally, exercise. Admittedly, this is an area that I still struggle with. I ebb and flow with exercise. I try to get my 10,000 steps in everyday. Key word, “try”. Working in New York City helps since city working makes walking part of everyday so even on a bad day I am getting a minimum of 7,500 steps. I make sure I get up and walk everyday but sometimes the walks have to be short since I am in a deadline business. I must be mindful of getting enough exercise in to help manage my blood sugar. Regular exercise is paramount in maintaining good blood sugar control. In addition to all the walking I have also begun doing a daily or every other day strengthening routine. Find something that works for you and your schedule and stay on it.

Bottom line, shift work is difficult but it is manageable. I have worked shift work into my diabetes life successfully if somewhat reluctantly. Do I love it? No but I do love the work I do so I am able to adapt to the shifts as they come my way. I work with my healthcare team to build a shift pattern for my basal rates and an adaptive bolus schedule for my shift work. It is not always easy but, Life. I do what I have to do and pay close attention to what I need to do it successfully.

Stay positive and meet the challenges head on.

 

Catching that train

Before I was diagnosed with type 1 diabetes in 1983, I paid close attention to train and bus schedules. When I commuted between Long Island and New York City, I knew when every train left the station. I knew which ones were express and which ones were local. I knew what train I could catch based on what time I left the office. Things have changed. My penchant for tracking times has been refocused. Now I can tell you what time I bolused. How long until my insulin peaks. What time I should do a blood test. In general, focusing on every minute of every day to pay very close attention to where my blood sugar is. Those are the scheduled times that I worry about now. The bus or the train? I don’t even know what the schedule is and even better, I don’t care. I walk to the bus station at the end of the day and I hop on what ever bus is going to my town. I have enough numbers and calculations on my mind managing diabetes 24/7/365.

The importance of finger sticks

Living with Diabetes: Test your blood sugar. Every day. Multiple times a day. Click Here.

Awareness

I recently saw a headline that said something like no need for Awareness, need for more progress toward a cure. Who could argue with that? Life being what it is, I did not click on the article at the time. I think it was a chapter of JDRF that posted it and now, of course, I can’t find it. The headline itself got me thinking, however. Of course anyone who lives with diabetes, type 1 or type 2, yearns for a cure. Type 1s, in particular, long for a day without finger sticks, pump site injections & continuous glucose monitor site injections, if you’re lucky enough to have access to these fantastic technologies. I don’t know anyone who enjoys the constant invasive nature of this disease. Yes, get us a cure as soon as possible. A cure. Not more technology. So I have no argument with the initial impact of that lost headline. Awareness, however, is something that could very possibly act as the much needed catalyst to that elusive cure.

The organizations that provide services for people with diabetes have done a very poor job in raising awareness. Why does that matter?

First, raising awareness is key to getting the nearly 8 million Americans who have not been diagnosed, diagnosed so they can take the necessary steps to saving their lives. The brilliant Breast Cancer Awareness campaign has helped to reduce deaths from Breast Cancer by  36%. This reduction includes improved treatments but it also includes early detection which can be traced back to an aggressive awareness campaign. When you see a pink ribbon you know what it stands for. You have no idea what visual image represents diabetes. If a diabetes awareness campaign can get people who don’t even know they have diabetes into proper treatment we can reduce mortality from diabetes related complications significantly. Who could be against that?

Secondly, I believe, raising awareness also raises money. Money sorely needed for research. Research that will lead to a cure. One of the most irritating things to me is going to the American Diabetes Association or the Juvenile Diabetes Research Foundation web sites and being immediately asked for a donation. This is, in my opinion, a crass way to raise money and it is a constant, non-stop occurrence. These organizations give little information as to why they need this money before they ask. That, my friends, is a huge turn off. In addition, there is very little coming back to us in the way of information about how that money is being used and what benefit it has toward the average person with diabetes.

Third, diabetes is an epidemic that costs our healthcare system upward of $250 Billion. That’s Billion with a “B”. An awareness campaign can help to reduce that number for sure. With nearly 8 million people not diagnosed it will, at the very least, get some of those people diagnosed. That in itself will save the costs incurred from the devastating medical results of untreated diabetes. The amputations, heart attacks, strokes, kidney failure, blindness and other debilitating maladies that untreated diabetes causes can be reduced if we make a national effort to get these people diagnosed.

During November, National Diabetes Month, there was very little attention paid to diabetes in the national media. It seems that Mo-vember has moved in to November and boldly pushed diabetes aside. Granted, this year International Diabetes Day was marred by the horrific events in Paris but a month is 30 days and there was very little seen on television about diabetes in the midst of male hosts sporting their unshaven faces for Mo-vember. I, as a prostate cancer survivor, applaud this aggressive campaign. I mourn, however, for the complete lack of attention paid to diabetes. A disease that affects nearly 30 million Americans. A disease that affects far more of our population than almost any other disease. Why is no one aware of that?

I believe we need a National Diabetes Awareness Campaign. We need our “pink ribbon”. We need to raise more money for a cure. We need to diagnose the undiagnosed. We need to let people know about the progress toward a cure. We need to show that a $250 Billion healthcare bill cannot be tolerated in a country whose healthcare costs continue to rise.

A diabetes awareness campaign certainly couldn’t hurt and by the metrics of other diseases and their campaigns, it would definitely help.

Diabetes Awareness Month 2015

Click here for our :30 Diabetes Awareness Month 2015 spot

Top 10 Things Diabetes Has Done For Me…

Top 10 good things diabetes has brought into my life.

  1. A family who’s love and concern for my health is apparent everyday
  2. The amazing people I have met on my journey with diabetes
  3. Healthy eating
  4. Exercise
  5. Discipline
  6. Focus on health in general
  7. Seeing doctors and healthcare professionals regularly
  8. Appreciating sweets in the special occasions they were meant for
  9. Expanding my knowledge of alternative ways to satisfy the “sweet tooth”
  10. Being healthier than many of my friends without “health concerns”

November is National Diabetes Month

33 years after the life changing diagnosis, what can be said about diabetes that has not already been said? Still, regrettably, the apparent superficial regard for rampant diabetes in our culture is devastating to those who do this dance with diabetes 24/7/365, no break… none. No, really. There is not one moment we are not calculating; blood sugar, the next meal, the supply of carbs available, where is the closest source of carbs and how long will it take to get there? How long to actually get those carbs into the system. Not being one of this exclusive club, imagine for a moment that in addition to everything that we do in life; imagine that on top of that, there’s this little demon inside waiting for the moment when he could literally KILL YOU! To combat the demon a small voice is developed, deep inside that constantly inquires about a number that would accurately represent, in milligrams/deciliter, the actual blood sugar reading of the system at that particular moment in time. Can it be done? If not for the absolute need for survival could anybody do that every minute of every day? Out of necessity, it is clear, it can be done and by literally millions of people. Each of those people has their own, additional, story. Stories that define, beyond superficial impressions, the meaning of balance, management and control. Control, Ha!

It is true, that a vast majority of people with diabetes are type 2. It is also true, that so much more needs to be done in every aspect of healthcare relating to diabetes. All cases of diabetes, diagnosed and un-diagnosed,  in the United States alone, are nearing 30 million people. It is also estimated that diabetes will increase by 64% in the next 10 years – http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html – The need in our society to think about what we eat on a daily basis is beyond epidemic proportions. One of the most depressing things about a Disney vacation is the physical state of our fellow citizens. Diabetes is telling us something. Diabetes, perhaps, is here to thin the heard. The herd is not listening. The truth is, diabetes, type one or type two, ignored or dismissed will kill you, one limb at a time, if you let it. For the lucky ones, a denied state of diabetes will take them out in one massive stroke at the ripe old age of 60 or less. To put a dollar amount on this? Nearing or surpassing $250 Billion annually and that’s just in this country. The irony is, of course, it does not have to be this way. There are things that can be done to avoid that.

Diabetes is hard. That much is true. The best thing that can be said about diabetes is that it teaches discipline, moderation and self-reliance. Especially for type ones. For a type one there is no choice. Care for the disease or die. It is clear. Type two people are presented, perhaps, with a little less urgency but it will kill them just the same. Type two people, more often than not, have been walking around in that condition for years before being properly diagnosed. Years of elevated blood sugar takes its toll on those tiny capillaries that supply blood and nutrients to the brain and extremities. Nothing in our system responds well to elevated levels of sugar. Of those 30 million people with diabetes previously mentioned, 8.1 million or 27.8% are walking around totally unaware that a demon is plotting their demise. These are real  people and they deserve some attention. These are not people to be vilified for eating too much or sitting on the couch too long. These are people who, at every turn, are urged to super-size. A 16 ounce serving of nutritionally empty soda is not enough. We are encouraged for 25 cents more, to get the 20 ounce size. These bigger and bigger portions are killing us. The cost to our society for ignoring this epidemic will certainly increase in dollars but more importantly, it will continue killing our families, our friends, our neighbors, and ourselves.

Diabetes is killing us. November is National Diabetes Awareness month. Donate a small amount  to a group helping people with diabetes in your community. There are people with diabetes in your community that can’t get the medication they need each and every day. Maybe you can help someone this November.