How to avoid hypoglycemia during 12 hour shifts?

Myxel67 · Jan 31, 2007

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.

You might ask your doctor to start you on Prandin or Starlix. Both stimulate insulin release from pancreas (same action as glyburide), but duration of action is short, so you take pill just before you eat--basically covers that meal only. Over time, all of these meds lead to the demise of beta cells, so you might want to look at something else.

Have you already tried a TZD (Actos or Avandia) and/or metformin? TZD makes muscle cells more sensitive to insulin--so reverses type 2's biggest problem. Metformin suppresses hepatic glucose output and also has a slight sensitizing effect.

New oral med is Januvia. It's a DDP-4 inhibitor. It works by inhibiting the enzyme that breaks down certain incretin hormones that promote glucose homeostasis. The incretin hormones stay active longer so your body actually regulates glucose better. No hypoglycemia, weight neutral. I've had a few patients who use it & they like it (100 mg once daily)

The 3 meds I mentioned all improve BG control without risk of hypoglycemia.

What is your dose of glyburide?

I take metformin whether I eat or not. I take Starlix just before meal--both at home and at work.

truern · Jan 31, 2007

I take metformin and so far I haven't had any real problems with my BG during my 12-hour shifts. However, I have a little breakfast, then I try to have a little something around 1030, and then have lunch around 1300...lunch being some protein, maybe some salad, a cheese sandwich if nothing else works diet-wise (wouldn't ya think hospital cafeterias would serve healthier food?!?)

Maybe you could ask your hospital nutritionist?? Ours is always helpful :)

Hoozdo, ADN · Jan 31, 2007

You might ask your doctor to start you on Prandin or Starlix. Both stimulate insulin release from pancreas (same action as glyburide), but duration of action is short, so you take pill just before you eat--basically covers that meal only. Over time, all of these meds lead to the demise of beta cells, so you might want to look at something else.
Have you already tried a TZD (Actos or Avandia) and/or metformin? TZD makes muscle cells more sensitive to insulin--so reverses type 2's biggest problem. Metformin suppresses hepatic glucose output and also has a slight sensitizing effect.
New oral med is Januvia. It's a DDP-4 inhibitor. It works by inhibiting the enzyme that breaks down certain incretin hormones that promote glucose homeostasis. The incretin hormones stay active longer so your body actually regulates glucose better. No hypoglycemia, weight neutral. I've had a few patients who use it & they like it (100 mg once daily)
The 3 meds I mentioned all improve BG control without risk of hypoglycemia.
What is your dose of glyburide?
I take metformin whether I eat or not. I take Starlix just before meal--both at home and at work.

Well, I just got home from work and glucose is my predictable 98 on my usual food with no glyburide. Your post is extremely helpful to me. I am on glyburide because my transplant center told me (7 years ago) that it is the only hyperglycemic that is easy on the liver.

I am thinking now that I probably need an endocrinologist appt. Your drug suggestions are certainly things I can suggest.

Thanks

PS - dose of glyburide is 10 mg BID. I can't take any within 24 hours of working or I will go hypo. It is easier to deal with insulin than what I am doing now....which is basically starving to control my glucose at work!

Hoozdo, ADN · Jan 31, 2007

I take metformin and so far I haven't had any real problems with my BG during my 12-hour shifts. However, I have a little breakfast, then I try to have a little something around 1030, and then have lunch around 1300...lunch being some protein, maybe some salad, a cheese sandwich if nothing else works diet-wise (wouldn't ya think hospital cafeterias would serve healthier food?!?)
Maybe you could ask your hospital nutritionist?? Ours is always helpful :)

Good suggestion, thanks! I work 7P - 7A so I never run into the nutritionist:roll

AuntieRN · Jan 31, 2007

I take Actos BID. I take it even when I am at work. I usually take one at 1000-1030 when I try to wolf down something for breakfast....then I take the second one between 1400-1500 when I try to wolf down something for lunch. My sugars still run anywheres from 90-170 usually by the time I get home. I used to take Metformin but it gave me bad leg cramps.....also...my charge nurses all know that I am diabetic...so they make sure I eat something no matter how little at least 2x during my 12 hour shift...can't have the nurse caring for the pts falling out is what they tell me. I have had to finagle my regime as I sometimes work 3-4 in a row then I am off 3-4. Good luck to you sweetie. I would consult my physician if I was you.

NaomieRN · Jan 31, 2007

the important thing is to use the glycemix index. low glycemic carbohydrates enter the bloodstream slowly and are best eaten before exercise. they provide sustained longer-term energy, and help maintain stable blood sugar levels during extended periods (greater than one hour).

[color=#330000]the glycemic index

[color=#330000] all carbs are not created equal!

[color=#330000]for a healthy low carb or low glycemic lifestyle.

[color=#330000]the lower the glycemic index a food, the less it will cause insulin surges (and weight gain). here is our list of commonly eaten foods, compiled from several glycemic indexes. on this index, glucose is the benchmark of 100. to control your carbs, choose foods at 50 - 60 or below whenever possible. if you are new to a low carbohydrate diet or a low glycemic diet, stay below 30 for the first two weeks, then add carbohydrates that are higher on the index gradually, until your weight loss stops. that way, you will be able to see which carbohydrates are safe for you! we are all different and react differently to various foods. *

if you need more help, you may send me a pm.....i will be more than happy to help

Trauma Columnist · Jan 31, 2007

The original poster is right on. Please see an endocrinologist. WIth your history of a liver transplant, getting advice via the internet (even if from other nurses) is NOT in your best interests. Good luck. Take care of yourself.

Myxel67 · Feb 1, 2007

I take metformin and so far I haven't had any real problems with my BG during my 12-hour shifts. However, I have a little breakfast, then I try to have a little something around 1030, and then have lunch around 1300...lunch being some protein, maybe some salad, a cheese sandwich if nothing else works diet-wise (wouldn't ya think hospital cafeterias would serve healthier food?!?)
Maybe you could ask your hospital nutritionist?? Ours is always helpful :)

Metformin will not produce hypoglycemia. Its primary action is suppression of hepatic glucose output. (not eating for long periods can actually produce higher BG than eating). If someone without DM takes it, it will not affect BG. (people without DM don't have inappropriately high output of hepatic glucose.

If someone without DM takes glipizide, glyburide, Amaryl, Starlix, or Prandin, it can produce hypoclycemia since these meds stimulate release of insulin from the pancreas.

Myxel67 · Feb 1, 2007

I take Actos BID. I take it even when I am at work. I usually take one at 1000-1030 when I try to wolf down something for breakfast....then I take the second one between 1400-1500 when I try to wolf down something for lunch. My sugars still run anywheres from 90-170 usually by the time I get home. I used to take Metformin but it gave me bad leg cramps.....also...my charge nurses all know that I am diabetic...so they make sure I eat something no matter how little at least 2x during my 12 hour shift...can't have the nurse caring for the pts falling out is what they tell me. I have had to finagle my regime as I sometimes work 3-4 in a row then I am off 3-4. Good luck to you sweetie. I would consult my physician if I was you.

Actos and Avandia are TZD's. This class of drugs will not cause hypoglycemia if used as monotherapy or if combined with metformin. TZD's are strong insulin sensitizers which make the muscle cells more sensitive to insulin. If a person using insulin has been taking Actos long enough for it to have full effect, she might need to lower the insulin dose to prevent hypoglycemia.

People who have become accustomed to living with elevated BG levels, may have S/S of hypoglycemia when BG is a nice normal 80 to 120. If BG is 170 several hours after eating, you might want to check BG two hours after the startof a meal. BG should be below 140. If not, meds may need to be adjusted.

Since TZD's don't lower BG directly, they don't need to be taken at mealtime Usually take entire dose at one time without regard to meals. Some people take them in the am, while others take at night. May induce ovulation, so increase risk of pregnancy. May also affect efficacy of BC pills.

Myxel67 · Feb 1, 2007

Well, I just got home from work and glucose is my predictable 98 on my usual food with no glyburide. Your post is extremely helpful to me. I am on glyburide because my transplant center told me (7 years ago) that it is the only hyperglycemic that is easy on the liver.
I am thinking now that I probably need an endocrinologist appt. Your drug suggestions are certainly things I can suggest.
Thanks
PS - dose of glyburide is 10 mg BID. I can't take any within 24 hours of working or I will go hypo. It is easier to deal with insulin than what I am doing now....which is basically starving to control my glucose at work!

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.

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).

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.

Have you always been so thin? Was any wt loss related to very high BG at some time in the past (onset of DM, for example)? 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

Myxel67 · Feb 5, 2007

the important thing is to use the glycemix index. low glycemic carbohydrates enter the bloodstream slowly and are best eaten before exercise. they provide sustained longer-term energy, and help maintain stable blood sugar levels during extended periods (greater than one hour).
[color=#330000]the glycemic index
[color=#330000] all carbs are not created equal!
[color=#330000]for a healthy low carb or low glycemic lifestyle.
[color=#330000]the lower the glycemic index a food, the less it will cause insulin surges (and weight gain). here is our list of commonly eaten foods, compiled from several glycemic indexes. on this index, glucose is the benchmark of 100. to control your carbs, choose foods at 50 - 60 or below whenever possible. if you are new to a low carbohydrate diet or a low glycemic diet, stay below 30 for the first two weeks, then add carbohydrates that are higher on the index gradually, until your weight loss stops. that way, you will be able to see which carbohydrates are safe for you! we are all different and react differently to various foods. *

if you need more help, you may send me a pm.....i will be more than happy to help

the glycemic index has gone in and out of vogue over the years. looking for the low gi isn't always the answer. for example, chocolate cake with chocolate frosting has a gi of 38. a twix bar is 43. the theory is that the fat in these foods causes the a delay in the absorption of the carbs. so if you want a baked potato which has a gi of 94, put lots of butter on it to lower the gi.