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Managing Diabetes during Night Shift

Night shift workers have been around since the early 1900s when the automobile, steel and other related industries deemed more profitable a round-the-clock work day than the usual nine-to-five hours. From a purely economical point of view, this made more sense and increased profits. Shift working was also necessary in the healthcare industry for continuous patient care in hospitals with nurses and resident physicians doing graveyard duty shifts.

More recently, the call center industry has gone global and we now have a majority of young, otherwise healthy individuals working after dinner hours until the next morning. This increasing trend of business process outsourcing (BPO) in the Philippines has seen over 200,000 BPO workers in 2006 alone.

True, working the night shift can be good for your wallet, but is it good for your health?

Health risks
Shift work is now a way of life for over 20 percent of the industrialized world. However, it is associated with obesity, increased triglycerides, low high-density lipoprotein (or the good type of cholesterol), diabetes and cardiovascular disease.

Several factors are thought to be at play but the underlying disturbance of our body’s internal clock may play the most important role. This internal clock of ours is termed the circadian rhythm.

The circadian rhythm is our body’s regulator that is linked to the light-dark cycle. In the most basic sense, we are programmed to function in different ways during daytime and during nighttime. The main stimulus for this would be light.
In fad, this is why daylight savings time was conceptualized—by moving back the clock, people are at work earlier and leave the office as it gets darker. Aside from just conserving electricity, people are also more alert physically and mentally—we get less productive when darkness sets in.

Notice how we are more active during bright, sunny, summer days but feel lazy when the sky outside is dark and gloomy. Much of our bodies’ hormones that control our metabolism run on this circadian rhythm, releasing more at times when they are needed and less when we are expected to be asleep. These hormones include cortisol, melatonin and insulin to name a few.

Our body secretes higher levels of cortisol upon waking up (at about 8 a.m.)—this ensures that we have energy to go about our daily chores at home and at work. Melatonin has been termed the “hormone of darkness” as it causes drowsiness—its levels peak in the middle of the night.

Environmental time cues obviously have an impact on the circadian rhythm. How bright it is during work time, or how dark and quiet it is when we are asleep, these cue our body on how much cortisol or melatonin is needed. This diurnal orientation of the endogenous clock is not lost even in nightshift workers.

Recent studies report an increased incidence of obesity, diabetes, gastrointestinal problems, high triglycerides, depression and cardiovascular problems in shift workers. Because of the growing number of otherwise young healthy citizens in the call center industry, this is obviously of some alarm.

Disruption of our natural circadian rhythm has been implicated as a main contributing factor for these health consequences. The circadian rhythms of many night-shift workers are not in sync with their imposed schedule.

One study looked at how workers on these graveyard shifts responded to a high-calorie meal. What was interesting was that blood sugar and insulin levels were higher during the night shift and it took two days of normal daytime shift to return to normal. These nondiabetic persons had a relative insulin resistance during their shift—that is, they were able to produce insulin but it didn’t work as well. This resulted in higher blood sugar levels.

Another study also showed that sleep deprivation caused alterations in the regulation of appetite. Shorter sleep duration caused lower levels of leptin and higher levels of ghrelin—these hormones control our appetite center. As a result, sleep loss increased hunger and appetite leading to overeating and weight gain.

The diabetes connection
Unhealthy eating habits, less time for exercise and disturbance in the glucose-insulin metabolism have been found to contribute to the higher number of shift workers with diabetes.

This means that for diabetics with already impaired insulin sensitivity, there is a greater risk of uncontrolled hyperglycemia or high blood sugar when working the night shift. Diabetics previously well controlled may see a rise in their blood sugar levels. Managing diabetes is difficult in itself. For diabetic patients who work odd hours, this becomes doubly hard.

Most medications are given in relation to the meals we take. These drugs were developed to peak immediately after a meal thereby controlling blood sugars and to have lower levels when we are asleep to prevent low sugars or hypoglycemia. The timing of medications becomes tricky when people frequently change shifts. As a result, most patients who were previously doing well will notice their diabetes getting worse.

Night shift workers with diabetes have to overcome several obstacles in order to maintain good glycemic control. First, they have to reverse their sleep/wake cycle in order to keep alert during working hours, and then try to get enough sleep even if the sun is shining bright outside. Next, they have to adjust their eating schedule, watch food intake, and exercise portion control.

These are easier said than done. Numerous health tips of eating light and staying away from caffeine-laden drinks and high fat foods are hard to stick to when the only available 24-hour restaurants serve anything but healthy food.

Night shift diabetes management
People with diabetes working the night shift will also need to adjust medication schedules and change timing of medications especially those that stimulate insulin release. Medications like sulfonylureas (glibenclamide, gliclazide, glipizide, or glimepiride) and insulin have to be given before meals. With shiftworkers, these actually need to be given before the shift or during dinner time for better control.

Meals also have to be timed in relation to the action of these medicines to prevent very low sugars that may occur if a meal is missed. Most other medications can be given after the heaviest meal of the day (or night).

Monitoring blood sugars with small, portable glucose meters are always a good idea when starting a new shift so your doctor can help by adjusting your dosages or medication schedules. Walking during breaks or stretching exercises at your desk could provide much needed exercise if you are sitting most of the time in front of a computer.

Nutritionists specializing in diabetes education recommend eating small, balanced meals before 1 a.m. Choose carbohydrates that are low in fat and high in fiber like whole grain bread, fruit and low-fat milk. Sandwiches are a good option rather than getting something from any of the fastfood outlets. For snacks, bring fruit, crackers, yogurt, pretzels or popcorn.

Caffeinated drinks are heavily consumed to stay awake but try to avoid these five hours before bedtime. At end of shift, have a light meal or snack before going to bed—this prevents you from being too full or too hungry and you’ll improve the quality of your sleep. After all, you need your rest for the next night’s shift.

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