How to avoid hypoglycemia during 12 hour shifts?

[Hoozdo]

Question for other diabetic nurses -

Do you take your insulin and/or hyperglycemic agents at work?

I find that I can't or I will go hypoglycemic and it ain't pretty! I work ICU and I really don't have the luxury to eat at a certain time or snack at will. I know most of you other nurses have this problem too. I know exactly what I can eat and come home with a glucose level of 98 - 105. What I can eat is 1 package of vending machine peanut butter and cheese crackers, 1 protein bar, and unlimited water.

Unfortunately, I am loosing mega weight on this diet I have devised for myself. My glucose is great, but I can only afford to lose about 10 more pounds.

BTW, I am a type 2, 5 foot 9, weight 130, HgbA1C 6.0, and take glyburide on days I am not working.

All input welcome. I am thinking I probably need to see a dietician and I also am thinking I need to increase my protein/fat intake during work. Maybe I can start eating mixed nuts while charting.

[Hoozdo, ADN]

the new drug, januvia, has no contraindications or dose adjustments based on liver function. dose is 100 mg daily taken without regard to meals. also can be used it pts with renal failure (reduced dose). action of januvia is glucose dependent, so will not produce hypoglycemia. this might be a good drug for you.

januvia sounds like a great choice. i will speak with my doctor about it!

your glyburide dose is max allowable dose. dose can be as low as 1.25 mg up to max of 20 mg/day. rx info from pdr states can be given once daily for doses up to 10 mg/day. higher doses can be divided and taken with breakfast & dinner. my question is if you have had low bg, why are you on max dose? why couldn't you take 2.5mg, eat breakfast, and go to work does have note to give at lower dose with decreased renal or hepatic function (similar statement is in pdr info for actos).

i only take the glyburide on days off when i don't have much physical activity!

insulin is actually more flexible than oral antihyperglycemics. dose can be adjusted in very small increments depending on ac bg and amt of carbs in meal. best would be humalog, novolog, or apidra before meals and lantus at bedtime. but there are more choices (of po meds) available to you other than glyburide. check bg 2 hrs after start of meal to assess response to meal.

i have been on/off insulin ever since my transplant. there was about a 2 year period in which i needed no hyperglycemic agents.

have you always been so thin?

no, only since i started nursing last january and running my butt off

was any wt loss related to very high bg at some time in the past (onset of dm, for example)?

no. the onset of my diabetes began with my liver transplant. at first it was believed it was due to solumedrol/prednisone use only. i was weaned off all steroids and the diabetes continued. it is a side effect in 20% of patients that take prograf (fk506, tacroliminus) for an immune suppressant!

is it hard for you to bring food from home (fruit, cheese & crackers or pita bread, 1/2 sandwich or yogurt? you certainly owe yourself a more healthful, less restrictive diet!

good luck

thank you for all of your comments. you have been very helpful to me!:kiss

[vickynurse]

I was dx with type 2 just last week with an A1C of 7.7. Of course, I had to check my own fasting & 2hpp just to convince myself of the dx. I've not yet started the metformin, but glad to know that it won't cause hypo-g. That is my biggest immediate fear.

Does anyone use a pda resource to manage diet? Is counting carbs the best way to go?

[vickynurse]

I was dx with type 2 just last week with an A1C of 7.7. Of course, I had to check my own fasting & 2hpp just to convince myself of the dx. I've not yet started the metformin, but glad to know that it won't cause hypo-g. That is my biggest immediate fear.

Does anyone use a pda resource to manage diet? Is counting carbs the best way to go?

Sorry, just realized this question should go on another thread. Good luck to you.