I've never worked the 3rd shift for a long period of time, but I worked the 7p-7a shift in our ER for 2 weeks, and worked 3p-3a for a few months. I almost exclusively work 11a-11p these days, but there are a few tricks I've picked up along the way.
I had a lot of the same apprehensions about diabetes control and the late night shifts so you're not alone.
Recommendations from my experience:
- Any adjustments made to basals need to be eased into. Don't make all the drastic changes upfront until you work that shift a few weeks and get a feel for what hours you're gonna sleep when you get off work so you can adjust the basals accordingly. If you make drastic changes up front you're probably going to run into a lot of lows/highs.
- The basal profiles on the Paradigm can be your best friend for a job like this. It'll allow you to set a pattern of basals for an "A" day, "B" day, etc. Set the "A" day as your normal, off-work day where you get up/go to bed at normal hours. When you get a feel for what you want your basals to be on the nights you're working set the B day profile for that and turn it on an hour or two before you go to work.
I'm currently on shots, but if I was on my pump I'd be using that feature like crazy b/c my basal needs differ so drastically from when I'm working on the floor vs. being home.
- If you want to make a slight basal tweak before your 1st day drop the rates from 11p-4a a bit just to keep you on the higher side. Nothing sucks more than going low while taking care of a patient at a new job. From 4a-7a your blood sugar-raising hormones might start kicking in so you might see a rise in BGs around then and may not need a lower basal (dawn phenomenon-ish). Night shift jobs usually jack with the circadian rhythm and hormonal release, pushing it up or pushing it back a bit...so don't be surprised to see high numbers early or late morning after a few weeks.
- Depending on when you do dinner prior to work, try not to bolus for a meal right before going to work. Not saying skip the bolus, but rather plan the meal in such a way that the insulin isn't hitting its peak activity right as you start working. I fight this a lot, and I'll find myself going low like an hour into my shift (ex: eat breakfast/bolus at 10a, go to work at 11a, bolus is hitting its peak around noon causing my sugar to drop more than I need in that situation)...but I don't get up early enough to adjust my eating time, so I've just gotten into a habit of a granola bar around that time.
The rest are more just about hospital jobs in general vs. a specific shift:
- Have a meter that you leave at work. Don't worry about taking one
back/forth from home, car, etc that you may accidentally forget.
- Hydrate, hydrate, hydrate. Gatorade is my go-to fluids at work. Helps hydrate, keeps my blood sugar up amidst all the activity, and it's "healthy" compared to drinking diuretics all night (soda, coffee, tea). It sucks working in that environment while thirsty/dehydrated.
In case your infusion set craps out on you, or if you need to take a
shot for whatever reason, just remember that you work in the
perfect environment for a temporary fix. Steal an insulin syringe and
draw some insulin out of your reservoir if you can't get the infusion
set fixed just to hold you over until you get home.
using pens I've had times where I've taken the wrapper off my last pen
needle and accidentally dropped it on the floor with the needle exposed.
No way I'm using that sucker. So I've gone to our med room and stolen
an insulin syringe...I'm not going to sacrifice my health to save the
hospital $5 when I see patients freeload all the time in the E.R.
- Lastly...this one I still struggle with...I hate, hate, HATE having to excuse myself from things due to diabetes so I'll usually wait way too long to treat a low. I pride myself on working hard, and I'd rather take care of an extra set of dr's orders before taking care of myself. It's a "put the patient's needs before your own needs" mentality, ya know?
But after a 1.5 years in the ER now I've come to realize that my coworkers, nurses and doctors alike, are totally ok with me stopping in the middle of something, even if it's a critical duty, to sit down and drink some juice. It embarrasses the crap out of me, but I've had to sit on my ass for a few minutes a few times to recollect myself, even once in the middle of a coding patient. The thing my charge nurse always says is that I'm useless to others if I'm passed out low somewhere, so he wants me to eat whenever I need and take care of myself 1st before others.
Moral of the story: being new on the job you always wanna go that extra step, or skip meals to seem like a super worker, but DO NOT ignore the diabetes in attempts to impress your boss/coworkers. They'll understand, even if they don't verbalize that on the 1st day.
Just don't take hour-long lunches. You don't wanna be that guy. :)