Surviving Shift Work with T1D
Updated: May 14, 2021
Mission Control is located in the very center of a concrete building - literally on the middle floor vertically and horizontally in the middle of the vertically middle floor. I think that sentence was confusing, but you get it, the room is in the very center of a concrete box. As such, there are no windows to the outside world - for good reason. Several critical consoles (mine included) are staffed 24/7/365 which means someone is always working, even in the middle of the night. Every group staffs their consoles differently - my group rotates shifts, so even as a specialist I have several sets of overnight shifts each year. You can probably see why the "no-windows" thing is important.
Performing shift work is difficult even for a perfect specimen adult, but navigating sleep shifts and overnight hours alongside the maintenance of a chronic disease can be tricky. I've put together a few of my tips and tricks for performing shift work and not feeling like absolute crap. Hope these are helpful! Do you perform shift work? I would love to hear your tips too, add them in the comments!
1 - try out different methods for sleep shifting It definitely takes iteration to find the sweet spot for your personal sleep shift response. I have tried a gentle "shift" into overnights but found it annoying to plan my schedule for the transition days. My body also just doesn't want to shift unless its forced, so the plan that works best for me involves a lot of "pre-sleep". The night before I am set to start overnights I sleep normally (go to bed around 10, wake up around 6:30am to help get the kids to school), then I take a Melatonin (more on this later) and head back to bed for as long as my body will let me. When I wake up in the late afternoon (4 or 5pm) I'm ready to make dinner and have family time. Our shifts start at 11:30pm, so I start to get ready around 10:30pm (which lines up well with my husband's bedtime) and leave the house around 11.
2 - use technology to your advantage: insulin pump
In my opinion, insulin pumps are one of the best tools for T1Ds performing shift work. I love the options to setup different basal rate profiles for different types of days. I already have one set up for the mornings I plan to workout, my basal rate decreases an hour or so before I wake up in order to get my blood sugar in a range that allows a stable workout session. I recommend using a separate basal profile for days when you work nights, especially since your job during these periods may be more/less physically demanding than "normal" day shift days.
3 - use technology to your advantage: CGM
For me, the beauty of CGM technology is in the settable alarm limits. This feature is especially handy while working overnight for a few reasons. First, I like to dial in my limits during the off-nominal sleep period just to catch highs and lows that may be instigated by a lack of food/activity where food and activity would normally happen. It does interrupt my sleep period, but after a few iterations I was able to zero-in on basal rates that work well for my body. Second, its so handy to see how those overnight basal rates, food, and activity are working out during a busy shift, when I would normally be sleeping.
4 - sleep aids - inquire, enlist the help of a doctor and research
With small kids I don't really have a choice on when I sleep during night shift work - I need to fit in my sleep period while the kids are at daycare. Logistically, this looks like getting off shift around 8am, driving home and preparing for sleep. My pre-sleep routine includes driving home with two sets of sunglasses, taking Melatonin (after I arrive at home!), a warm shower and a little bit of reading to relax my mind. I also keep the house cool, the room dark and always snuggle in with my wiener dog - all things that foster a sense of bedtime for me, regardless of the sun's status.
5 - establish a workable eating schedule
I'm not a dietitian but I think its important to keep an open mind when determining your eating schedule during shift work. This goes hand in hand with number 1! Since I setup my sleep schedule to sleep during the early part of the day, right after I get off console, this generally means I eat 2 meals and 2 snacks. I usually eat a snack when I wake up, around 4pm. Dinner happens around 5:30-6, with my family. I eat my next meal during my console shift - anywhere from 2-4am, whenever I feel hungry. I don't really like to eat a full meal before I try to go to sleep so I generally skip "breakfast" and just eat a snack instead.
6 - light exercise during the shift
I find that sometimes my middle-of-the-night meal can raise my blood sugar more than normal, simply because my body is conditioned to be in a fasting mode at that time. Rather than risk over-bolusing and going low during critical mission control operations, I prefer to keep my blood sugar in the 100-130 mg/dl range and utilize light exercise periodically to level out any spikes. This can just be taking a brisk, 10-minute walk every orbit (every 90 minutes), or a few minutes on the stationary bike we have set up in our break room. There is also a great side effect to this tip - exercise helps keep you awake too!
I hope this list is helpful if you are nervous about managing type 1 diabetes during an off-nominal sleep shift. And as far as working in a room without windows - it's not all bad - we call it the windowless room with the best view in the world ;-)