Working as a nurse on a fast-paced unit poses physical and emotional challenges that are unique to the profession. Type 1 Diabetes (T1D), an often invisible chronic medical condition where the pancreas does not secrete insulin, poses additional challenges in this quickly-moving clinical environment. Given the challenges of hospital work on blood sugar control and caring for yourself at the same time as your patients, I have put together a guide to help you T1D nurses keep your blood sugars in range surrounding your shift!
A Little About My T1D PMH
I was diagnosed with T1D 26 years ago, and I currently wear a T-slim insulin pump on control IQ with a Dexcom Continuous Glucose Monitor (CGM). Similar to others living with a chronic medical condition, my relationship with my T1D has had its ups and downs. For as long as I can remember, and for the early years in my nursing career, I lived with an elevated Hemoglobin A1c. I was standing in my own way from asking for help, and I felt guilty that I couldn’t care for myself despite taking care of sick patients daily. I masked this guilt and pain of feeling lost through bubbly smiles and unhealthy habits. Working with T1D Health Coach, Lauren Bongiorno, gave me confidence to make radical changes in how I take care of myself.
I share this journey of the last couple years of my T1D management because I approach my nursing shift T1D management very differently now. The following T1D nuggets of information help me feel my best at work. When I feel empowered and am proud of my diabetes management, I know my clinical decision-making is stronger, and I am a more compassionate nurse to my patients. Not all diabetes management is the same! We know as nurses there are many different types of diabetes, and their treatment plans vary extensively. This information is specific to Type 1, insulin dependent, diabetes. And, as always, please consult your diabetes team prior to making adjustments in your own T1D management.
PRE SHIFT
8 hours of sleep: This not only gives me energy to make it through the 12 hours, it also helps with my insulin sensitivity the following day. I will give myself additional insulin the following day if I don’t get enough pre-shift sleep!
Meal Prep: This is a must for me! I enjoy consistency in the food I eat at work as I know exactly what these foods will do to my blood sugars. I would rather not do bolus calculus in the middle of a busy day for donated pizza, doughnuts, or take-out Thai food, so I try my best to prep my food! Nut mixes, apples with peanut butter, plant-based yogurt, pretzels with hummus are some of my go to mid-shift snacks!
Caffeine: Insulin to cover caffeine is a must for me. After some trialing, I have found the right amount of insulin to cover my morning coffee. On days I forget, I can be sure to see some arrow ups on my CGM while getting patient report! Also, I have noticed that walking into the hospital gets my sympathetic nervous system going, the flight or fight response is ready to play for the day! To help prevent hyperglycemia related to this stress response, I will give 1 unit of insulin if my blood sugar is over 100 when I clock in for my shift.
Check your supplies! The night prior to dayshift or afternoon prior to nightshift, I will check my pump battery and charge it if it is less than 50%. I will draw up a new insulin pump reservoir if my insulin is less than 60 units, anticipating a mid-shift infusion site/insulin cartridge change. Due to the ever increasing insulin prices, I try my best not to waste a unit of insulin and will therefore wait to change out my insulin when I am empty, despite the inconvenience of being at work. 12 hours is a long time to be away from your home diabetes supplies; always have back ups in the event a pump site falls out or you misplace your insulin pen!
MID SHIFT
Pre-bolus: A little louder for the people in the back-- pre-bolus your meals just like you do on your days off! Gosh, this is so much easier said than done. I am trying to get in the habit of pre-bolusing my 10am/pm snack prior to my last room I am giving meds to. When we can take our breaks is often unpredictable, but I am trying to have more courage to pre-bolus consistently, as I know I feel better when I let my insulin start working prior to my carbs. I often will let my lunch buddies eat first while I cover their patients and give time for lunch bolus to kick in.
Hydration: I will start a water bottle first thing in the morning and work to refill a couple times throughout my shift. I put it in the same spot in the breakroom, and if I’m passing by I will swing in for a couple chugs. Water helps my insulin sensitivity and makes us all feel better – yet as nurses we often are midway through our shift and realize we are way over our ‘due to void’ hour! Let’s normalize staying hydrated as nurses, eh?!
Self-Advocate: I have an unwritten contract with myself that I will remove myself from patient care if my blood sugar is dangerously low. I do not enter COVID+ rooms if my blood sugar is below 100 with any arrows down. It is much harder for me to feel a low in an N95, shield, and gown under the bright lights! If you are working a new contract or get pulled to a new floor, let your Charge Nurse know you may have to step out of the Rapid Response or patient care to carb up. Just like we advocate for our patients, we also must advocate for ourselves!
CGM use: I need to be able to check my insulin pump or phone throughout my shift and see not only what my current blood sugar is, but also where it is coming from and where it is going – this makes me feel secure. This technology takes the guesswork out of estimating your blood sugars, something that is a lot harder while running around answering call bells. Change your CGM the day prior if it will expire mid-shift as there’s no time for the calibration period during your shift! I have immense gratitude for this technology; it catches my out-of-range blood sugars early so I feel my best delivering patient care. If I am experiencing a stubborn high blood sugar and my shift allows, I will walk the staircase in my building on my break to help get my insulin on board working!
POST SHIFT
Pre-bolus post shift meal: I’ve said it before, I’ll say it again… let your insulin get going before you eat your fridge for your post shift late dinner/breakfast! Pre-bolus and hop in the shower to get the shift germs off while your insulin starts working! If you’re on a closed loop system, look to see if your pump has decreased recent basal, and add back missed insulin prior to your post shift meal.
Log your day: I have learned to put down the hammer and pick up the magnifying glass when looking at my blood sugar log. At the end of a stretch of shifts, I often will look at my Dexcom Clarity app to review any blood glucose patterns. Focus on making a change to one part of your shift the next time you go to work, whether it be pre-bolus, more hydration, checking CGM more, to strive for more in-range blood sugars. Make notes in your phone at the end of your shift with what worked well and troublesome hours to focus in on during your next shift. The Diabetic Health Journal is a helpful resource I have used to log my days and notice any patterns with how food, movement, stress are influencing my blood sugar.
Breathwork/Yoga Nidra:I have recently incorporated breathwork and Yoga Nidra practice into my T1D management, and I am noticing the benefits it is having in both my diabetes and in my nurse self-care! Our nervous system is working very hard during our shift managing all the stressors of our jobs while also working with our endocrine system to keep our blood sugars in range! When you focus on your breath you can increase your self awareness, help your nervous system manage different stressors, and clear your mind.
Evan Soroka describes Yoga Nidra in her book Yoga Therapy for Diabetes as the fourth state of consciousness, a state that helps us surrender, manage energy, and allow us to be a witness while staying present. I often end my work days with a breathwork practice and then laying on my yoga mat under a blanket surrounded by candles listening to a Yoga Nidra guided practice. The practice of remaining aware in this relaxed state is helping me be more present in my T1D care at work despite the many stressors. The practice of establishing a witness in Yoga Nidra is helping me learn that I am more than the challenges of my T1D diagnosis, I am more than the stressors of being a nurse, and this helps create more space between myself and T1D nurse life so that I can have the freedom to radiate as my truest self.
Rest on your days off: Ask for help where you need it. Add a Nutritionist, Yoga Therapist, Diabetes Health Coach to your medical team. Just because you are a badass nurse who cares for others doesn’t mean you don’t need help as well. Just like as a nurse we are continually learning, as a nurse living with T1D you are forever learning more about yourself. It took 24 years after I was first diagnosed with T1D to begin to see that I am more than my diagnosis. I was able to see that caring for myself is one of my superpowers. And when I made changes to my T1D management during my shift that helped prevent roller coaster blood sugar patterns, I felt more empowered in my nursing work.
