Preventing and Managing Diabetes
Diabetes is on the rise in America, and shift workers are right in its path. Over three quarters of shift workers report not exercising regularly, and almost the same amount can not say they maintain a healthy, nutritious diet. Many cope with the demands of a mixed up sleep schedule and long shifts by drinking cup after cup of caffeine and eating sugary foods to boost energy levels, and yet energy to exercise still stays out of reach. All these factors greatly increase the risk of diabetes, which can be genetic or developed and can strike at any time of life. Night shift and shift work lifestyles bring plenty of health and safety issues along with them, so the individual shift worker is left to manage their health and weight as best they can despite the obstacles.
According to the American Diabetes Association, 23.6 million children and adults in the United States, or 7.8% of the population, suffer from diabetes. While an estimated 17.9 million have been diagnosed, unfortunately, another 5.7 million people are unaware that they have the disease. In addition, there are 57 million Americans who have pre-diabetes. A study published in the March 14, 2002, issue of the New England Journal of Medicine found 25 % of very obese children and 21 % of very obese adolescents had pre-diabetes. Increased age is a factor; diabetes may occur at any age, but 80% of cases occur after age 50.
In short, there is an epidemic of diabetes in the United States.
There are four major types of diabetes:
Type 1 Diabetes
This type results from the body’s failure to produce insulin. Insulin is a hormone that allows glucose to enter the body’s cells to feed and energize them. About 5-10% of people with diabetes have type 1 diabetes.
Type 2 Diabetes
This type results from insulin resistance (the body fails to properly use insulin), combined with a related deficiency of insulin. Most people diagnosed with diabetes have type 2 diabetes.
Gestational Diabetes
About 5-10% of women with gestational diabetes are found to have diabetes, usually type 2, after pregnancy.
Pre-diabetes
When a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes, they are diagnosed with pre-diabetes.
Symptoms of Diabetes
• Frequent urination
• Thirstier than usual
• Feeling tired and run down
• Weight loss without trying (more common with type 1)
• Excessive eating
• Poor wound healing and infections
• Tingling or numbness in hands, legs or feet
• Blurred vision
• Dry, itchy skin
• More challenged mental state: lethargy, agitation, forgetfulness
Causes of Diabetes
• A person can inherit diabetes, particularly if both parents are diabetic.
• Improper nutrition, low protein and fiber intake, and/or a high intake of refined food products can contribute to a person developing diabetes.
• Being overweight causes increased insulin resistance: body fat more than 30%, body mass index greater than 25, waist girth 35 inches in women or 40 inches in males.
• People with sedentary lifestyles are more prone to diabetes, when compared to those who exercise thrice a week who are at low risk.
• Physical injury or emotional disturbance is frequently blamed as the initial cause of the disease.
• Diabetes can be drug induced.
• Many studies have reported that there is a direct relation between hypertension and diabetes.
Shift Work Implications
Shift workers can be at increased risk for diabetes. Only 27.5% of shift workers report that they have good nutritional practices. Almost 80% of shift workers ages 18-24 report not being aware of, or not having, good nutritional habits. Also, 77% of shift workers report not exercising regularly (1). However, as noted later, the risk of developing diabetes can be significantly decreased with better nutrition and exercise. And, the impacts of inherited diabetes can be managed and minimized with better diet and exercise as well.
Testing for Diabetes
The primary tests for diagnosing pre-diabetes or diabetes are a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.
Preventing Diabetes
Studies show that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5-7 % of their body weight. This requires healthier eating and getting more exercise. A good exercise routine will involve 30 minutes of physical activity 5 days a week.
There are some great resources available on the National Institute of Health website (National Diabetes Education Program) . Also see the American Diabetes Association website at http://www.diabetes.org/diabetes-prevention/how-to-prevent-diabetes.jsp.
Some good eating habits from the American Diabetes Association:
• Eat lots of vegetables and fruits, especially non-starchy vegetables such as spinach, carrots, broccoli or green beans.
• Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
• Include dried beans (like kidney or pinto beans) and lentils in your diet.
• Eat fish 2-3 times a week.
• Choose lean meats like cuts of beef and pork that end in “loin” such as pork loin and sirloin; remove the skin from chicken and turkey.
• Choose non-fat dairy products such as skim milk, non-fat yogurt and non-fat cheese.
• Choose water and calorie-free “diet” drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
• Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats.
• Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
• Watch portion sizes.
When starting to exercise start slowly with a low-impact exercise such as walking, swimming, or biking. Then gradually build up the amount of exercise time. For example, start with five or ten minutes and add a bit of time each day. Exercise specialists suggest stretching for five minutes before and after each workout regardless of how intense it is.
Studies have shown that people with pre-diabetes can prevent or delay the development of type 2 diabetes by up to 58 % by making changes to their lifestyle that include modest weight loss and regular exercise. The expert panel recommends that people with pre-diabetes reduce their weight by 5-10 % and participate in some type of modest physical activity for 30 minutes daily. For some people with pre-diabetes, intervening early can actually return elevated blood glucose levels to the normal range.
Managing Diabetes
Once diabetes is diagnosed, it needs to be managed. Proper management requires a consistent focus, which is further challenged by working shift work. Even when diabetes is well managed, shift work can increase the risk of a hypoglycemic incident. This is because working shifts outside the normal daily routine impacts the body’s “circadian rhythms”, which regulate daily processes such as hunger and fatigue. When you start eating and sleeping at different times, it disrupts your body’s internal clock and affects blood glucose control.
Good diabetes management means that blood glucose levels are kept as close to normal at all times. This requires more frequent testing of blood glucose, particularly if employees are working at jobs with greater risk of higher impact accidents, such as driving for work or operating machinery. Employees may need to take time out for frequent testing while on the job. Fortunately, by using blood glucose meters, you can get results in less than 30 seconds. Newer meters also provide better glucose control by automatically recording trends in blood glucose and keeping track of averages per meal.
Hyperglycemia (high blood glucose level) can occur for a variety of reasons such as the omission of medication or excessive consumption of food or alcohol but it occurs most often during periods of stress or illness. The typical warning signs of hyperglycemia include fatigue, insomnia, nervousness, mood swings, faintness, cold hands and feet, forgetfulness, mental confusion and heart palpitations.
Hypoglycemia (low blood glucose level) occurs when a person with diabetes takes too much insulin or diabetes medicine or skips meals. Typical warning signs of hypoglycemia include feeling dizzy and weak, sweating, being excessively hungry, having a headache, blurry or double vision, a pounding heartbeat, anxiety, and changes in personality, like being more irritable than usual.
If untreated, both hyperglycemia and hypoglycemia can lead to seizures, unconsciousness, brain damage, or death.
Diabetic employees who have changes to their work schedules should meet with a diabetes healthcare professional to adjust their medication dosages to new mealtimes that result from schedule changes. They should keep up with mealtimes and snack times. Even when working the night shift, employees should continue with their regular exercise routine, however it fits into their day. Employees should test their blood glucose levels even more often at the point where shift changes occur. Diabetic employees should pay attention for potential symptoms of hyper and hypoglycemia.
For more information about managing diabetes, refer to the National Institute for Health: Principles for Controlling Diabetes for Life.
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(1) Circadian Information, LLC Health in Extended Hours Operations
©2008workingnights
This material is provided for personal, non-commercial, educational and informational purposes only and does not constitute a recommendation or endorsement
Tags: chronic problems, diabetes, fitness, obesity, restless leg syndrome
