1. Mackenzie Krecsy
  2. Diabetes
  3. Tuesday, November 03 2015, 04:55 AM
  4.  Subscribe via email
I am having difficulty controlling my blood sugar while working night shifts (1945-0745). I typically take Humalog and Lantus for insulin, Humalog 1unit per 4 grams of carbohydrates at each meal and Lantus 22 units at bedtime.
I typically eat snacks throughout the night and take Humalog depending on the amount of carbs I eat, although I find I often don't take any because I do not want to be low while working... And then I take my normal scheduled Lantus around 2200.
When I get home from my shift, I am usually hyperglycemia. If I have breakfast before going to bed, I take my normal 1:4 ratio of Humalog but no correction dose to help lower my sugar because by late afternoon, my sugar is always hupoglycemia.
I am unsure of how to stop these drastic highs and lows, I'm thinking maybe I should take less Lantus at night and then an additional dose in the morning before I go to sleep but I am uncertain of what dosing would be correct... Any input would help, thanks so much!!
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Dr. Alice Cheng Accepted Answer
Thank you for your question.

Specific details about your insulin dose adjustments ought to be discussed with your diabetes care team which should include a diabetes nurse, dietitian and physician expert.

In general, when someone is having difficulty with glycemic control with shift work, one needs to consider:

- level of physical activity during the shift (to account for any lows),
- amount of carbs in snacks overnight and whether or not adequate insulin has been given for the carbs,
- recognize that different insulin carb rations are needed at different meals and different times of the day
- dividing the basal insulin doses to morning and night IF there is a lot of variability between AM and PM shifts.
- possibility of changing to insulin pump the therapy.
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  1. more than a month ago
  2. Diabetes
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