Managing Night Shifts

Illuminated blue clock

It has been just over fifteen years since I was diagnosed with type 1 diabetes, and two years since I became a registered nurse. My desire to become a nurse stemmed from many things, but most influential in my decision was my experience with T1D. Now two years into my career, it turns out the very thing that influenced my choice of profession has proven to be among the most challenging parts of my job. Diabetes is never a walk in the park, but in the past few years I have encountered an array of new challenges while working as a night nurse.

When it was time for me to graduate from nursing school and head out into the real world, I had all the same anxieties as my fellow graduates. Was I properly prepared to care for my patients? Would I be able to apply all that I had learned in the past four years to whatever situation may be thrown my way? Would I even be able to find a job? And of course, how would I safely manage my diabetes while working in a high-stress, fast-paced environment, all the while proving myself as a new nurse?

I was lucky enough to land a job at a hospital in Boston, and was slowly adjusting to life post-college (as much as I might not have wanted to admit it.) I was starting to get into the routine of my new job—or so I thought. I quickly discovered that routine was far from the norm in the acute care setting I was working in. Each shift was different from the next, and there was no way to predict how things were going to go. Working nights meant a lack of sleep, a lack of seeing the sunshine, a weird eating schedule, and as an added bonus, that 2:00 a.m. nausea that no one warns you about. Most importantly for me, it meant a new perspective on diabetes management.

Nightshift photo 1

It came as a shock that in only a matter of shifts, everything I knew about caring for my diabetes seemed to no longer apply to me. Working three nights out of seven, and constantly changing from a night schedule to a day schedule, it became near impossible to keep my blood sugars in control. I quickly learned what foods would help maintain my blood sugar while caring for my patients during a busy shift, and what foods wouldn’t spike my blood sugar while I slept during the day. I experimented with different basal rates for my nights at work and for my days off. It felt like I was starting from scratch, despite having lived with T1D for more than half of my life.

The most challenging part of all was learning to let go of what I knew about my diabetes care, and being open to a new way of management. My CGM became my most important tool. Instead of focusing on glucose patterns week to week, I focused on what was happening in the moment. With my varying routine and activity level, it made more sense to react to specific blood sugars at the time they were happening. My CGM makes it easier for me to keep a constant eye on where my blood sugars are going, which has helped me to reach the ultimate goal of preventing as many high and low blood sugars as possible.

Despite all of the changes to my diabetes care, the one thing that has remained constant is the importance of my support team. My family, friends, co-workers and care team, all play a role in helping me continue to successfully care for my diabetes, despite the added difficulties working nights presents. As always with diabetes, nothing is perfect. I still haven’t mastered how to control my blood sugars while keeping up with this weird schedule of mine. I will continue to live with diabetes in the best way that I know how, with the support of those important to me. While it may make it more challenging, diabetes does not prevent me from providing compassionate and comprehensive care to my patients, and I look forward to continuing to do for a long time to come.

Caroline McEnery–carolinemc

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