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DIABETES AND JOB: PILL TREATMENT AND VARIABLE WORK PATTERN
Pill treatment
People on pill treatment may also wonder what to do if they work shifts. If you are taking a once-daily dose of a long-acting oral hypoglycemic (such as chlorpropamide) and you take it in the morning every day regardless of when you are sleeping or working, you may find your blood glucose level dropping much too low during a sleeping day and rising too high during a working night. If you take it before ‘breakfast’, whether this is in the evening or morning, you may take two pills within twenty-four hours on one of your changeover days. Again, your blood glucose level may drop too low. This may not happen if you are on a very small dose of chlorpropamide, but you should keep a careful eye on your blood glucose level whatever dose you are on. It may be easier to manage shift work with short-acting pills such as tolbutamide or glipizide. These should be taken at meal times, whether during the day or at night. In practice, the simplest solution seems to be small doses of a short-acting hypoglycemic pill at each meal time.
Variable work pattern
Some jobs, for example medicine, sales work or journalism, have an unpredictable work pattern. It is often impossible to know how much energy you will need from one day to the next and, in some jobs, even where you will be. If you are moving from a fixed routine job to a variable one, you may be startled by the disruption this causes in your glucose balance. In some cases, people with previously well-balanced diabetes find they have high glucose levels one hour and are hypoglycemic the next.
There are various ways of coping with this and to some extent the method you choose is influenced by your diabetic adviser. Generally, it is easier to take a long or extremely long-acting insulin (for example, Ultratard) to provide some background insulin throughout the day and night and to add small, frequent amounts of rapid-acting insulin to this as required. The same principle applies to food. Eat a steady amount of high fibre food during the day to provide a relatively constant carbohydrate input and boost this by more rapidly absorbed carbohydrate to cover periods of exertion. Frequent blood glucose tests are needed, particularly just before you begin an activity during which hypoglycemia would be dangerous, such as driving.
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