Third Shift

Happy Monday everybody :)...blahh lol

So I am starting my new job as an RN next week and I'm going to be working third shift, which I have never done before. I'm really nervous about what it's going to do to my BS, especially because I have a really good routine right now. Any suggestions or pointers from any of you third shifters out there on how to keep good control????


Congratulations on your new job!  I'm in nursing school right now, so I hope to follow in your footsteps someday. 

The toughest part about 3rd shift is that you probably won't keep the same hours on your days off.  I didn't like that in the past when I had late night jobs.  The good thing about 3rd shift is that you usually have more flexibility, so it's easier to get away and test your blood sugar and/or treat a low.  Make sure to tell your supervisor you're type 1 so he/she understands if you need to take a break. 

Do you use an insulin pump?  They are ideal for 3rd shift and for an active job where it's hard to get a break.  If you don't use one you may think about it for the future.

With any new schedule blood sugars can be erratic.  Test a lot.  Especially important the first few days when you're excited about the new job because excitement often drops bs.  You may even want to let your blood sugar be a little higher than normal for a few days to give you a cushion.  

Hope it goes great. 

Thanks I am very excited. Third shift was definetly not my first choice, but ya got to start somewhere. Yes I'm on a pump and I have the CGM which is very helpful. Another thing I'm worried about is that I'm only part time so my schedule will be on third only 2 or 3 days a week. So it will be interesting!

Good luck in school! I loved nursing school :) You definetly have alot of knowledge going in being T1 lol Let me know if you ever need help or just someone to vent to!

Thanks so much! 

Between the pump and CGM you'll be fine.  So glad there will be another diabetes expert working in healthcare.  Any type 1 or type 2 patient you help will be blessed to have your first hand expertise.  Good luck!

Congrats on starting your first RN job !! I'm in a similar situation, I just started my first LPN job last week.

I had two 11p to 7:30am shifts last week as part of orientation. I kept my BS level a little high so I wouldn't run into any issues. Typically I do not eat during those hours (I'm usually in dreamland, lol) but I took a small snack with me just to be safe. Not sleeping was the hardest part for me.  I'm not positive what shift(s) I will end up working, I am also part time.

I tested every time I took a break.

Good Luck to you !

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 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. 

With me 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.  :)

Thanks everyone! I feel alittle better after talking to my Endo yesterday too.

Ideen-holy response! lol Thank you so much for your input :)  It's funny because I used to be the same way about excusing myself due to sugar issues. When I was in class I used to be so afraid that my sugar would drop and I would have to get up in the middle of lecture to treat, so I used to purposely keep it high during class time. Looking back its funny because half the time I would sit there shaking my leg because my sugar was so high I had to pee every 30 min! lol  Which was probably way more attention drawing!  But when it comes to patients its so true that you are useless if you're passed out somewhere.  My endo also recommended the pattern A and B. I think that will be the first thing I try.  Again thanks so much for the response. :)                                                                               

Sorry about the insanely long response, but I kept thinking "ooh, she should prob do this...and this...and this" so I kept adding haha.  I would have killed to know some of that stuff beforehand so I hope you don't mind overkill.

And I'm glad the endo brought up the A/B day deal.  I feel validated haha.

What kind of unit are you going to be working in?  Is this your first experience post nursing school?

My sister works 3rd shift as a nurse, started last Aug. - she is not T1, but she says the hardest part is managing her sleep between days she works and days she is off. It is not uncommon for her to go almost 24 hours w/o sleeping - always with her shift first - she knows if she has to work that she MUST sleep. But when there is fun stuff to do during the day, then she puts it off. So as others have said, test a lot and find a sleep schedule that works for you. Sleep IS important for EVERYONE's health.