Diabetes Talking

Question:

Hi, A meal plan usually consists of exchanges of fruit, vegetables, protein, etc.  The exchanges are about the same from day to day and are usually eaten at about the same times.  Counting carbohydrates is simply adding up the number of carbs in your meal and usually taking insulin in a ratio based on that number.  Carbohydrate counting is much more flexible because you can adjust your medication according to what you want to eat and when. I have been reading this group now for about two weeks. I have come across the terms  Are you on a "meal plan" or do you carb-count? Can someone explain to me the difference?? thanks! takecare maggi

–         … Sue  :-)                 For a healthy heart …                 Give your Faith a workout! "Sue’s Plain Vanilla HomePage" http://www.inconnect.com/~sue/

Response:

I am type 2, on oral meds at mealtime and Humalog when BG is high (It hasn’t been for several weeks — Yea!)  I work at a retail store.  My hours vary from day to day.  Sometimes I work 3p-12a, sometimes 10a-7p.  I just recently started on a meal plan.  I told my managers I had to eat at specific times and they were very accomodating.  Occasionally, a manager may forget to schedule my mealtime at the right hour.  I simply tell them about it and they change it.  I brought in the doctor’s slip with me and made sure that it was added to my personnel file.  Perhaps my situation is different because I’m not on MDI, but if I were, I would use my break to take the injection and use the monitor.  I carry glucose tablets with me in my pocket if I should get low in between meals.  Recently, there was an overnight inventory which I didn’t work because I knew that the lack of rest combined with the higher metabolism rate would wreck havoc with my levels.  They couldn’t say s*** about it because I told them that it wouldn’t be good for me.  Otherwise, there is no problem or interruption with my schedule.   It seems that the least your employers could do is schedule regular mealtimes for you.  If you don’t need regular mealtimes because of MDI, then they could make sure that you get regular short breaks. — E. Crystal Cornell "No Black woman can become an intellectual without decolonizing her mind." — bell hooks     / * /  * / * / * "You must sit in the center of the fire of your own being until the truth burns clear." — Unknown

Response:

– Hide quoted text — Show quoted text -(Tanstaafl) writes: Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse? As I understand it, the "Americans with Disabilities Act" says your employer is required to make reasonable accommodations for your medical condition.  And your doctor certainly should be on your side: trying to keep you healthy is his job. Johns Hopkins Medicine has a page with information about the Act as it applies to diabetics, at <http://www.med.jhu.edu/diabetes/fyi.html. — Type 2, d/x 3/98  Diet & Exercise    So far, so good!  :-)

Does anyone have a pointer to any information that relates to ADA requirements that would protect an employee from having his/her employment status put at risk because of the need to contain overtime to contain stress which raises BG and blood pressure? As a salaried employee in the aerospace industry the pressures can be intense and the hours long. It comes with the territory. But, it should not be demanded on a continuing basis to work 50 to 70 hours per week – peaks do occur. I clearly can correlate increases in BG and blood pressure to high stress/heavy workload. Anybody have any information? Thanks. Ron — Ron Klein

Response:

I have been reading this group now for about two weeks. I have come across the terms  Are you on a "meal plan" or do you carb-count?

Can someone explain to me the difference?? thanks! takecare maggi

Response:

Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse? the medics started me on 10 units of Humulin and 20 units of NPH in the morning and 10 units of each in the evening.  That has since been increased to 12/22 in the am and 15/15 in the PM.  I don’t know why I’m taking this medication and these quantities, I’m leaving that up to the medical professionals.  I started out at 411 mg/dl on July 13th, when this all started.  I am now running 100-125 pretty consistantly.  

You’ve been put on a pretty typical "starter" insulin therapy for Type 1.  And you have discovered its extreme limitations — i.e. lack of freedom to work, eat, play, etc. when you want or must. But be aware that there are alternative therapies to accomodate your life style and your work schedule.  One is the insulin pump — a pretty radical & expensive step.  The other is an "intensive" insulin therapy known as MDI (multiple daily injections), a kind of "poor man’s pump" in which you inject a moderate amount of timed-released insulin once or twice a day, plus a small amount of fast-acting insulin before each meal.  This allows you to choose your own mealtimes, what you wish to eat, the amount, etc.  It reverses the roles, putting you in charge instead of the insulin. However, both the pump and MDI are not for relative beginners to insulin therapy.  Managing Type 1 diabetes has a pretty steep learning curve. For example, you say you are leaving the details of what your insulin does to the "professionals."   I hope sooner rather than later you will discover that you *must* learn the medical details, because it’s *your* life.  It is absolutely indispensible to know exactly how insulin works — more specifically, how it works in *you.*  Everyone is different. Were I in your shoes, I would ask for a short leave of absence (2 weeks) during which I would learn everything I could about diabetes management and insulin therapies.  (A "medical leave?") Diabetes is one condition where knowledge truly is power. dkc David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/media.htm [To reply by e-mail, delete "removeme." -- including the extra "."]

Response:

I started a job about a month ago which involves a lot of evening shifts (4pm – 12am), as well as some days.  I’ve occasionally worked double shifts (16 hours).  I’m on multiple daily injections, so it hasn’t been a problem.  I just inject before I eat, whenever that is.  However, I am always able to eat when I need to.  That’s important.   Shiftwork is definitely possible, but you need to get a note from your doctor explaining that you MUST be allowed to eat your meals, as well as snack when you need to.  Surely your doctor will give you that much?  If that isn’t a "reasonable accomodation", then I don’t know what is. I think MDI (or pumps, as have been mentioned here) is definitely the way to go with shiftwork.  It doesn’t tie you to a regular eating schedule.  You’d have to start bringing your insulin kit to work – but I’d think that after the first day or two, the security would know you and it wouldn’t be a problem.  Your health is worth the extra hassle! =) – Hide quoted text — Show quoted text – I am hoping some diabetic shift workers can help.  I am into my 3rd week of taking insulin.  I am normally a dayshift worker, however there are rare cases when I get bounced to an off shift, such as this week I am working 11pm-7:30am.  Normally I take insulin at 5am and 6pm.  My glucose levels have dropped to the 150 area from an original 411 mg/dl. Now, my routine has been upset by shiftwork.  My MD was leary about writing a blanket "no shift work" medical excuse.  My employer (electric utility) is not very understanding.  I talked to the onsite company nurse, she would like to see a note from my MD before putting restrictions on my condition of work.  I don’t perform well to begin with on the midnite shift, and now I have a new complication.  I don’t take my insulin kit to work, too much hassle getting thru security (xray and metal detector and low iq guardforce).  Basically, I’ve been taking insulin at 11am, before a bowl of cereal and then to bed.  I take insulin again around 8:30pm and then dinner.  This has not been a fun week.  Oh yes, I have been forced to work a 10 hour day this week.  If my services are deemed necessary I can be forced to work through a meal period. Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

Response:

- Hide quoted text — Show quoted text – I am hoping some diabetic shift workers can help.  I am into my 3rd week of taking insulin.  I am normally a dayshift worker, however there are rare cases when I get bounced to an off shift, such as this week I am working 11pm-7:30am.  Normally I take insulin at 5am and 6pm.  My glucose levels have dropped to the 150 area from an original 411 mg/dl. Now, my routine has been upset by shiftwork.  My MD was leary about writing a blanket "no shift work" medical excuse.  My employer (electric utility) is not very understanding.  I talked to the onsite company nurse, she would like to see a note from my MD before putting restrictions on my condition of work.  I don’t perform well to begin with on the midnite shift, and now I have a new complication.  I don’t take my insulin kit to work, too much hassle getting thru security (xray and metal detector and low iq guardforce).  Basically, I’ve been taking insulin at 11am, before a bowl of cereal and then to bed.  I take insulin again around 8:30pm and then dinner.  This has not been a fun week.  Oh yes, I have been forced to work a 10 hour day this week.  If my services are deemed necessary I can be forced to work through a meal period. Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

You don’t specify whether you are a newly diagnosed type 1 or a type 2 of long standing who has just graduated to insulin.  In either case, you are in the beginning phases of learning how to live your life while taking insulin.  It will take a while. You also don’t specify the details of your regimen, but 2 shots/day of an intermediate acting insulin either evenly split or less at bedtime are among the most common beginning regimens. They are also among the most restrictive it terms of lifestyle, meal timing, variability in activity level, and schedule changes. There are a wide variety of insulin regimens some of which give you almost complete freedom to do anything you want, whenever you want to.  The tradeoff, there is always a tradeoff, is that you need to become more educated in the effect of food on your insulin requirements, the pharcokinetics of various insulins or innsulin pump programming, and the daily fluctuation of your body’s hormonal tides. You have two ways to go.  You can live with the restrictions imposed by a simple insulin regimen, use leverage like the  Americans with Disablity Act and Doctor’s letters to force your employer to accomodate you.  Or, you can lean on your doctor, or change doctors, until they give you enough education and a regimen that allows you to cope with your  work requirements. I am not advocating one or the other.  I have made a choice, but one of the most frequent errors you will find in m.h.d. is overgeneralization of personal experience.  Either route will require work, effort, and much dealing with frustration on your part. — Charly Coughran

Response:

Thanks to everyone for responding.  Actually I am familiar with ADA, and we do have a couple of people in our department of 50 that are on some type of work restriction.  I would rather work with the management of my department rather than go on a work restriction, but if necessary I may have no alternative.  In a high profile climate of a nuclear power plant, we are constantly reminded of the need to be at "our very best state of alert".  That’s hard to do when one is 100% healthy and working the midnight or "graveyard" shift, worse when you’re not healthy. To address Darrin Parker’s question, the medics started me on 10 units of Humulin and 20 units of NPH in the morning and 10 units of each in the evening.  That has since been increased to 12/22 in the am and 15/15 in the PM.  I don’t know why I’m taking this medication and these quantities, I’m leaving that up to the medical professionals.  I started out at 411 mg/dl on July 13th, when this all started.  I am now running 100-125 pretty consistantly.  I am watching my diet, I was educated on counting carbs.  I pretty much cut out a lot of potatoes, breads and no pasta.  I have lost some weight, maybe 10# (I’m 6′1", 235#, large frame).  I’ll admit I don’t every single crumb I put in my mouth, you can’t expect that out of a 39 yr old single guy who’s been used to pretty much eating and drinking anything I wanted.   Being Hispanic doesn’t help, it’s in the family, my fathers’ and mothers side.  My father is also diabetic. Basically I know there are other diabetic shift workers out there and I wanted to here from them.  I’m not the type that "wimps" out or looks for the easy way out of everything.  But this past week on midnight shift took a lot of wind out of this old boy’s sails. Thanks to all of you for your support, let’s pray for a cure!

Response:

I am hoping some diabetic shift workers can help.  I am into my 3rd week of taking insulin.  I am normally a dayshift worker, however there are rare cases when I get bounced to an off shift, such as this week I am working 11pm-7:30am.  Normally I take insulin at 5am and 6pm.  My glucose levels have dropped to the 150 area from an original 411 mg/dl. Now, my routine has been upset by shiftwork.  My MD was leary about writing a blanket "no shift work" medical excuse.  My employer (electric utility) is not very understanding.  I talked to the onsite company nurse, she would like to see a note from my MD before putting restrictions on my condition of work.  I don’t perform well to begin with on the midnite shift, and now I have a new complication.  I don’t take my insulin kit to work, too much hassle getting thru security (xray and metal detector and low iq guardforce).  Basically, I’ve been taking insulin at 11am, before a bowl of cereal and then to bed.  I take insulin again around 8:30pm and then dinner.  This has not been a fun week.  Oh yes, I have been forced to work a 10 hour day this week.  If my services are deemed necessary I can be forced to work through a meal period. Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

Response:

If my services are deemed necessary I can be forced to work through a meal period.

I’m SURE the idiots there would be really pleased to see you fall out on the floor.  Seems to me they need a little education on the subject.   I think the other poster is correct.  The ADA requires REASONABLE ACCOMMODATION where disabilities are concerned.  Allowing an insulin dependant diabetic certainly sounds reasonable to me!   Have you told your MD that your employer is this uncooperative and unconcerned?  YOUR health is at risk here.  If your MD is "leary" after he knows all the factors, find a real doctor who know’s what is at stake here.  Seems like you are surrounded by lack of reasonable concern. Bev

Response:

Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

As I understand it, the "Americans with Disabilities Act" says your employer is required to make reasonable accommodations for your medical condition.  And your doctor certainly should be on your side: trying to keep you healthy is his job. Johns Hopkins Medicine has a page with information about the Act as it applies to diabetics, at <http://www.med.jhu.edu/diabetes/fyi.html. — Type 2, d/x 3/98  Diet & Exercise    So far, so good!  :-)

Response:

Let me give you two alternatives. If you invoke the ADA law, you should be able to get REGULAR hours, NO EXCEPTIONS.  You may need a new doctor, and also a lawyer. The alternative is to go on an insulin pump.  It would let you do the shift work.  It will take a little time to learn how to use it.  And your shift work is the excuse you need for a prescription.  See http://www.minimed.com for more details. Ned  (Yes, I have a pump and love it!) – Hide quoted text — Show quoted text – I am hoping some diabetic shift workers can help.  I am into my 3rd week of taking insulin.  I am normally a dayshift worker, however there are rare cases when I get bounced to an off shift, such as this week I am working 11pm-7:30am.  Normally I take insulin at 5am and 6pm.  My glucose levels have dropped to the 150 area from an original 411 mg/dl. Now, my routine has been upset by shiftwork.  My MD was leary about writing a blanket "no shift work" medical excuse.  My employer (electric utility) is not very understanding.  I talked to the onsite company nurse, she would like to see a note from my MD before putting restrictions on my condition of work.  I don’t perform well to begin with on the midnite shift, and now I have a new complication.  I don’t take my insulin kit to work, too much hassle getting thru security (xray and metal detector and low iq guardforce).  Basically, I’ve been taking insulin at 11am, before a bowl of cereal and then to bed.  I take insulin again around 8:30pm and then dinner.  This has not been a fun week.  Oh yes, I have been forced to work a 10 hour day this week.  If my services are deemed necessary I can be forced to work through a meal period. Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

– Ned Kelly Computer Innovations, Inc (732)345-1250

Response:

Basically, how do other shiftworkers handle the hours, or do you finally get your MD to take your side and say shiftwork just makes things worse?

Rick, I;ve been doing similar "shift" work (more like on demand 24 hours a day 7 days a week) for years.  I am type I since age 9 in 1974. It would be useful if you’d tell us more about your treatments.  What type of insulins are you on?  WHY do you take shots when you do?  Are you on a "meal plan" or do you carb-count? An insulin pump is one alternative; although it appears that pumps are better suited for people with at least a few years’ expereince at managing diabetes. An alternative for you may be MDI (multiple daily injections).  Here, you take two injections of long-acting insulin, like UltraLente and then take injections of short-acting ONLY prior to eating or to adjust for high bg readings.  This is often called a "poor man’s insulin pump". For example; I take two injections per day (about 12 hours appart) of long-acting and this *just* covers my average basal needs.  If all goes well; I do not have to eat anyhing at all all day nor all night.  If or when I do eat; I just take the appropriate amount of short-acting insulin to cover the meal. For me the most practical way to deal with my situation (not unlike yours) is to  carry an insulin pen and Carb-count for meals. As long as you carry in your pocket an emnergency supply of glucose or snacks, in case of the unexpected low, you should not have to worry about 10 or 18n hour days with no food. Feel free to email me if any questions.  Note this is just my humble opinion and expereinces. Darrin Parker A lie, even minor, left unchallenged, will be accepted by the ignorant and  uninformed, as the truth. Check out:  http://www.geocities.com/HotSprings/Spa/4750/intro.htm  and go FORWARD to "The Article".

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When im reading the newsgroup I get the feeling that everyone in the US thinks that there is some "super"-cure that will be invented in short time, and perhaps there is, but  think its wrong to spread false hope. Everyone is waiting but if you consider the facts a cure is not likely to be invented in the near future. I know that the research has come a long way….but not that long. Any comments?

Response:

Let me give you two alternatives. If you invoke the ADA law, you should be able to get REGULAR hours, NO EXCEPTIONS.  You may need a new doctor, and also a lawyer.

Please: the ADA requires a *level* of support for disabled Americans, not absolute support. You still have to be able to do the job: if the job involves irregular hours, you will need to find some way to cope. The alternative is to go on an insulin pump.  It would let you do the shift work.  It will take a little time to learn how to use it.  And your shift work is the excuse you need for a prescription.  See http://www.minimed.com for more details.

Shift work is hard on us: it screws up our sleep cycles, eating cycles, etc. A pump may indeed help a lot, but it’s not an overall fix. I’ve done shift work on NPH and Regular: it wasn’t easy, but it was possible. —                                 Nico Kadel-Garcia, ne’ Garcia <PGP is obviously a good idea: look at who objects to it.

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