Diabetes and Shift Work

Many professions employ workers who cover the “graveyard shift,” workplace hours that include overnight labor (such as hours between 7 p.m. to 7 a.m. or 11 p.m. to 7 a.m.). In fact, many places of business thrive by working around the clock to maximize productivity. Some institutions that provide services, such as health care, must stay open 24/7 to take care of their patients.

Experts estimate that over 22 million Americans work shift schedules — either rotating between night and day, or in many cases, working night shift exclusively. As a whole, these shift workers are at an increased risk for a variety of illnesses including sleep disorders, gastrointestinal problems, and depression. Shift workers with diabetes are especially affected because their blood glucose can veer way off-kilter for a variety of reasons, making diabetes self-management a priority.

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Circadian rhythms

Circadian rhythms occur when your body’s internal clock matches its function with external rhythms, such as cycles of daylight and darkness. Working the night shift may disrupt your usual body functions. When it is dark outside, your body expects that you will be asleep — not awake and working. You might think of the 24-hour “body clock” as the way that the nervous system prepares for daily activity. Your body clock is responsible for production of various hormones, such as melatonin, which makes you sleepy at bedtime; cortisol, which creates energy in the morning when you wake up in a fasting state; and insulin, which controls blood glucose in response to meals.

Night shift and diabetes

Data suggest that those who work the night shift either part time or full time are at an increased risk for insulin resistance (when the action of insulin is not as efficient), which is present in Type 2 diabetes. Furthermore, the disruption of the normal body clock that occurs when you are awake through the night hours can wreak havoc on blood glucose control when you live with diabetes. If your job functions are unpredictable, disruption in your routine may further impact your blood glucose. In addition, the physical and emotional strains of shift work can lead to stress, which triggers the release of several hormones that can raise blood glucose to higher than recommended levels.

Diabetes self-care considerations

Shift work may not be ideal, but it may be a necessary part of your job. When you are employed in a job that includes overnight shifts, you may need to consult your diabetes care team to ensure you can achieve the best possible blood glucose control. You may need to modify several aspects of your diabetes management plan.

Meal planning

Regardless of the type of diabetes you have, a cornerstone of optimal care is healthful eating. Check out the availability of healthy food and snacks during your shift since cafeterias, delis, and restaurants may not be open overnight, and your only choice might be to buy food from a vending machine or bring your own. Find out if there is a place to store food, including refrigeration, and then plan ahead by keeping some healthy options on hand. Make sure you have easy access to appropriate snacks whenever necessary. Take the time to meet with a registered dietitian who specializes in diabetes to help you manage your meals with shift work. For example, typical timing of meals such as a large meal at 6 p.m. may work OK; however, you may still need smaller meals throughout the night. And, your “bedtime” snack may actually be at 7 a.m., prior to your bedtime.

Movement

Record the amount of physical activity you perform at work and, if possible, the times that you perform the work. A diary may help. Physically demanding work may put you at risk for hypoglycemia (low blood glucose), especially if you take insulin and/or secretagogues (oral diabetes medicines that increase the production of insulin). Be prepared to treat low blood glucose with a preferred source of glucose, such as glucose tablets or glucose gel. Taking a 10- to 15-minute break to replenish your system of glucose — sooner versus later — will help you to get back to work in a timely manner. It is a good idea to educate your co-workers and supervisor ahead of time about your treatment for hypoglycemia, so that if an emergency occurs and you are unable to follow through with treatment on your own, they will be prepared to help you.

Sedentary work (work with very little movement), such as a desk job, may have the opposite effect and cause your blood glucose to be higher than your target level, especially after eating. You may be able to avoid this problem by getting up and moving at regular intervals. Try to move from your sitting position every 30 minutes. Also, don’t forget that regular physical activity is important to your overall diabetes treatment plan. So be sure and make time outside your shift schedule for exercise. You will feel better both mentally and physically.

Medications

You should have a well-thought-out plan regarding your diabetes medication. For example, if you have Type 2 diabetes and take oral medication, and you usually take your oral medication with breakfast and supper, then determine what time you will be eating those meals. The timing of your medication should be based on the meal time associated with the dose.

If you take a non-insulin injectable diabetes medication once daily, or once weekly, talk with your diabetes care team about a consistent time to take it when you are usually awake (whether or not it is a work night).

If you take insulin, adjustments will likely be necessary to calculate the right amount to cover the food you consume (your bolus, or mealtime dose), as well as ways to avoid hypoglycemia. Ask your diabetes care team if taking your bolus dose is acceptable just after you eat. That way, if your meal is interrupted, you can cover the amount you actually ate. You may find that you need a higher insulin-to-carbohydrate ratio when you eat during the night than when you eat at the usual meal times during the day.

If you wear an insulin pump, talk with your diabetes care team about adjusting your basal patterns for work versus non-work nights. The same may hold true for basal insulin that you inject. You may also find that your insulin will need to be reduced while you sleep during the day. Thus, it is important to make sure your dosages work for both daytime and nighttime sleep, based on your schedule.

Monitoring

Self-monitoring your blood glucose can help you identify patterns in your blood glucose and how changes (such as changing shifts, days off and/or changes in your meal times) are affecting your control. You can use this information to help you anticipate times when your blood glucose may be too high or too low so that you can prevent these situations from occurring. Whether you keep records by hand or by computer, be sure the information is accurate and reflects the correct time and day. Look at data over several weeks to get a big picture of how your control looks over time. Your diabetes care team may suggest a continuous glucose monitor (CGM). A CGM measures interstitial glucose on a continual basis to provide a big picture of your blood glucose. Always be sure to discuss your results with your diabetes care team to help you solve any problems with blood glucose, so you can make appropriate changes to your regimen.

Sleep disorders

Working night or rotating shifts places you at a higher risk for sleep disorders. If you are sleep-deprived, your ability to focus and your memory may be impaired. This may hamper your work and increase your risk for accidents. If you find yourself challenged to sleep during the daylight hours, and your blood glucose control is worsening, check in with your diabetes care team to discuss ways to adjust your diabetes self-management plan.

You may find the following suggestions helpful to improve your sleep.

• Try to avoid rotating shifts (alternating day and night shifts several days in a row), which can be especially challenging since your diabetes care routine would be changing back and forth on a regular basis.

• Control your environment. Try to keep your workplace bright to promote alertness during the night, and use heavy curtains or blinds to block out the sun during your daytime sleep.

• Avoid caffeine toward the end of your shift.

• Avoid heavy meals close to “bedtime,” whenever that may be. However, a light bedtime snack may help you sleep. Be attentive to your blood glucose control.

• Check your blood glucose prior to sleep to avoid low blood glucose while sleeping. You may need to set an alarm to check your blood glucose during your sleeping hours.

• If you use continuous glucose monitoring, you can set alarms to alert you if your blood glucose goes lower or higher than your preferred range while you sleep.

• Minimize sleep distractions. Your sleep area should be away from noises such as the phone ringing and the television playing.

Finally, make sure your family and friends are aware that you work the night shift. If you have pets, make sure someone else takes care of them during the day to avoid sleep disruption. Keep as close to the routine for your sleep time as possible. Regular, restful sleep is important to your diabetes and your overall health.

Shift work takeaways

Shift work may be a necessary part of your life. Take the time and plan for your diabetes care needs, keep up your appointments with your diabetes care team, and educate your family and friends about your routine. When you feel your absolute best, both you and your job will benefit.

Want to learn more about working with diabetes? Read “Diabetes on the Job” and “Diabetes and Your Work.”

Disclaimer The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.