Managing Diabetes and Shift Work

If you have diabetes, the sleep cycle disruptions of shift work can increase your risk of mental and physical problems. Shift work is defined as the hours that employees work that are outside the typical workday hours of 9:00 a.m. to 5:00 p.m. Due to the fact that shift work involves working night hours, the normal sleep cycle—sometimes referred to as circadian rhythm—is often disrupted.

Nearly 15 million people in the United States work a job that requires them to be there during the night shift. This number includes those who work regular night shift positions, as well as people with rotating shifts and irregular schedules. There is a growing body of evidence that shift work, particularly during the late-night hours, increases the risk of heart disease, cancer, and diabetes.

So, what can people do to prevent diabetes (particularly for those who have prediabetes) when working the night shift? How does sleeping irregular hours (such as during the day) impact a person’s metabolism and affect diabetes? And perhaps most importantly, how can people who already have diabetes cope with working the night shift while managing their illness?

Shift Work and Diabetes Risk

According to a report from CU Boulder and Brigham and Women’s Hospital (BWH) in Boston, those who work night shift (such as healthcare workers, security guards, and others who periodically work the night shift) have a dramatically higher risk of getting Type 2 diabetes than those who work only days.

A 2018 study, published in the journal Diabetes Care, discovered that the higher number of nights a person works, the greater the risk of having diabetes (regardless of whether a person is genetically at risk for diabetes).

Previous research at CU Boulder has shown that sleep deprivation and misalignment of body's biological clock (circadian rhythm) can impair glucose tolerance and insulin sensitivity (which is considered a precursor to diabetes). The study authors wrote, “While people may not be able to avoid working nights, maintaining a healthy weight and diet, and taking care to get enough exercise and sleep, is likely to mitigate its health risks.”

Emotional Impact

A 2019 research review, published by the American Journal of Public Health, found that those who work shifts that interfere with their normal sleep pattern are more at risk for developing depression than those who work a day shift job. Seven prior longitudinal (long-term) studies involving over 28,000 study participants, were examined to evaluate the impact of shift work on mental health.

The study authors found that shift workers were more likely to experience mental health problems than those who only worked the day shift. The study authors concluded, “Shift workers, particularly women, are at increased risk for poor mental health, particularly depressive symptoms.” The study authors also explained that the disruption in the shift worker’s circadian rhythm was the underlying cause of moodiness and irritability.

How to Manage Emotional Issues

When it comes to depression and other mental disorders, the first step in addressing the impact of shift work is to become aware of the problem. Many people are not aware of the impact that working nights can have on a person’s physical and emotional health. So, learning about the statistics may help some people to make different choices in their work schedule (when possible).

If you must work the night shift, it’s important to be aware of the common signs and symptoms of depression, these include:

• Feeling sad
• Not wanting to get involved socially/isolation
• Loss of appetite
• Sleep problems (which may be exacerbated by working nights)
• Loss of interest in hobbies and other activities once enjoyed
• Low energy level
• Difficulty concentrating
• Feelings of low self-esteem
• Thoughts of suicide

Circadian Rhythm, Depression and Diabetes

Your circadian rhythm refers to the body’s internal clock that cycles at regular intervals between sleepiness and alertness. It’s also known as the sleep/wake cycle. The hypothalamus (part of the brain that is involved in sleep, emotional activity, body temperature, thirst, and hunger) controls the circadian rhythm.

Another factor that has influence over the sleep/wake cycle is the level of outside darkness or lightness. When it’s dark outside, the eyes send the hypothalamus a signal to release melatonin. Melatonin is a hormone that is well known for its ability to cause sleepiness. So, your body responds to the cycle of day and night. Therefore, it can be difficult for shift workers to sleep during the day and stay awake at night.

Interestingly, your circadian rhythm also controls cellular metabolism by influencing levels of insulin and other hormones that work against insulin to raise blood glucose levels when necessary.

Physical Impact

Diabetes control is said to be more challenging for shift workers than it is for those who work regular daytime hours.

Shift work can physically affect people with diabetes in many ways by changing the time you eat, what you eat, increasing stress, and impacting the body’s natural sleep/wake pattern.

Your body's blood sugar levels can be impacted by shift work. Lack of sleep can cause hyperglycemia or hypoglycemia. It’s important for people with diabetes to prepare themselves in advance on how to manage their blood sugar levels at work.

A change in the time of day that a person sleeps can impact meal times. Shift work causes many people to feel hungry at different time intervals during the day, compared to when a person works a day shift. This can impact your diet, causing you to be more likely to grab something quick, such as unhealthy snacks or meals.

According to the author of a 2017 study presented at the Endocrine Society's annual meeting, “Diabetic individuals who work at night should pay special attention to managing their disease through healthy eating, regular exercise and optimal use of medications prescribed by their physician.”

Working night shift can also affect a person's energy level, making it more challenging to stick to a regular exercise program. A regular exercise routine is known to improve the mood and may even help promote sleep. Be sure to consult with your healthcare provider before starting any type of workout routine.

Social

Shift work often leads to social isolation for people who work and sleep at odd hours. Social isolation can lend itself to depression, which can worsen the cycle of an irregular sleep pattern. Staying socially active is important for those who work night shift; regular social interaction can lend itself to a slew of physical and emotional health benefits such as an improvement in mood. Interestingly, a 2017 study conducted in the Netherlands discovered that social isolation may even increase the risk of diabetes.

It may be helpful to consider getting involved in a support group for people with depression; chances are, you’ll encounter others in the group who work nights as well. Also, Meetup.com has information on local support groups for night-shift workers (as well as how to start your own support group).

A common phenomenon for shift workers is excessive sleepiness and “microsleep.” Microsleep is a temporary episode of drowsiness or sleep, which can last a few seconds or more, in which a person falls asleep and is unresponsive to sensory stimuli. When drowsiness and microsleep interfere with family interactions and leisure activities, it can put a strain on relationships. This type of excessive sleepiness goes beyond just zoning out temporarily; it’s a constant symptom that can interfere with a person’s ability to effectively work, study, or socialize.

Importance of Social Interaction

The inability to engage in social interactions and attend social engagements with friends and family often results in social isolation for shift workers.

It’s important for people who work nights to adjust their schedules to allow for time to engage socially with friends and family members on a regular basis. The National Sleep Foundation offers tips on how to maintain a healthy social life when working nights, including specific tips on healthy interaction with your partner and children.

Practical Considerations

There are steps you can take to improve your sleep pattern as well as better manage your diabetes when you have shift work.

Tips for Improving Your Sleep Pattern

Improving your sleep pattern may help you manage your diabetes better when you have shift work. Tips from Keele University include:

• Identify how many hours of sleep you need and map out a sleep schedule accordingly (most adults require seven to eight hours of sleep each day, but with age, this number declines).
• If you don’t get the number of hours you need, try to nap or at least rest (resting is still beneficial even if you don’t fall asleep).
• Try to go to sleep at different times of the day to see which works best for you.
• Record your sleep pattern in a sleep diary.
• Take a short nap or rest before your first night shift of the week.
• When coming off night shifts, have a short nap during the day (instead of sleeping all day) and then go to bed earlier that night.
• Once you’ve found a sleep pattern that works well for you, maintain it.

Tips on Diabetes Management for Shift Workers

The Dieticians of Canada offer these tips for managing diabetes when you are employed in shift work:

• Eat lunch around 12:00 p.m. and dinner around 6:00 p.m, regardless of the hours you work.
• Avoid eating large meals during the night (eating during the day and early evening will help to balance your blood sugar).
• Eat healthy snacks (instead of large meals) during your night shift if you get hungry to keep your energy level up and keep blood sugar levels from dropping too fast.
• Don’t wait until you are too hungry to eat something.
• Pack your own healthy snacks such as apples, cheese, yogurt, whole-grain granola, raw vegetables with hummus, nuts, and other high protein snacks (like black bean salads, lean chicken, and more).
• Choose low-glycemic index carbohydrates for snacks (such as whole wheat bread or crackers) instead of those made of white flour or sugary snacks.
• Avoid fried and spicy foods to snack on during your shift (fatty and fried foods make it more difficult to control your blood sugar).
• Don’t rely on snacks from vending machines.
• Avoid sugar-laden drinks, try to drink water whenever possible.
• Stay active, try to maintain a regular workout schedule before or midway through your shift (this will help improve mood, provide more energy during the work shift, and help with blood glucose control). 
• If possible, go for a walk during your shift or at least stretch out on your break.
• Be sure to talk to your healthcare provider and diabetes team about how to best manage your blood sugar levels when you do shift work.
• Follow the advice of your diabetes team or healthcare provider regarding how often to check your blood sugar, when to take your medications, the best time to eat meals and snacks, etc.

A Word From Verywell

A shift worker’s overall health and well-being may improve due to understanding how shift work impacts a person and implementing tools that help combat some of the adverse effects of shift work. Keep in mind that not everyone is ill-suited for shift work; some people have a certain circadian pattern that enables them to function better during shift work than others.

The important thing is to be aware of what might occur, such as hypoglycemia or hyperglycemia, and keep an eye out for signs and symptoms. When problems arise, be sure to reach out and talk to your healthcare provider, member of the diabetes team, and others and begin intervention measures as soon as possible.