It’s 5 a.m. in Salzburg, Austria and 9 p.m. here in Arizona as I get ready to start my day. I slept in this morning after working a night shift at the hospital. I say “morning” because it is my morning, even though most of the Arizonans are winding down and ending their day.
I get a lot of questions about how I manage my diabetes when traveling through different time zones or when I work night shift and switch back and forth. I can tell you that it’s pretty easy…once you know the secret.
In general, management of diabetes is all about giving yourself insulin in a way that mirrors what a functioning pancreas would do. In order to do that, you have to understand what your body would do. Your body is constantly making and using hormones in order to function throughout the day, fall asleep at night, and restore itself. The hormone I want to talk about is cortisol.
Cortisol is the “stress hormone.” It’s one of the hormones released during that “fight or flight” thing you’ve probably heard about. The reason it is so important to understand how cortisol works is because it has a big influence on blood sugar levels. Increased levels of cortisol will cause an increase in blood sugar. This happens to diabetics and non-diabetics. For non-diabetics this increase in blood sugar is a good thing. If you get stressed or scared, cortisol increases which increases the blood sugar so you have the energy and reserve to fight the situation or run from a situation (hence the term fight or flight). It’s your body’s natural way of giving you a needed energy boost (amongst doing other things).
Cortisol levels also play a big role in preparing you for the day. Right before you’re about to wake up, cortisol levels steadily increase until you wake up. Due to this increase in cortisol in the early morning, it is normal to need more insulin as you are waking up. Non-diabetics do this naturally. You may have heard of this already, but by a different name: the Dawn Phenomenon. Since hormone release causes an increase in blood sugar in the early morning, us diabetics have to anticipate it and change our insulin accordingly.
I hope I haven’t lost you. That’s it for the science-y stuff. Now what does this mean for traveling and working night shift? Let me tell you..
Now knowing what we just talked about, imagine that your insulin is all set up for your regular day for you to wake up at 8 a.m., but then you go out of town and now you’re sleeping at a time that you are waking up at 3 p.m. Your cortisol levels are going to change with your sleep cycle, so you probably got a boost of cortisol right before 3 p.m., but if your insulin isn’t set up for that, you are going to have a high blood sugar.
Here’s the secret. In order to have good blood sugars with time changes, you have to match your insulin to what your hormone levels are doing. It took me a long time and a lot of trial and error to figure this out, but that’s really all there is to it.
With today’s technology and the capability of insulin pumps, your options are almost endless. I essentially have 3 schedules in my life. When I’m not working, I wake up around 8 or 9 a.m. When I am working, I work 3pm-3am or 6pm-6am, depending on what my role is in the ER. During each of these schedules, my hormones and cortisol levels are on a different time frame. Since I know that’s what’s happening, I have 3 separate basal rates that I activate depending on what I’m doing in my life that day.
In a similar fashion, if you are traveling to a place that has a 10 hour time difference (or any hour time difference, really), your insulin needs are going to be different. You have two options for adjusting for this:
- Change the time on your pump (or the timing of your basal insulin dosing) to match the time of the place you are going before you leave or when you get there.
- Gradually adjust the time on your pump to reflect the time that it feels to you. I talk about this in more detail in my Travel tips with Diabetes article.
I have found that option 2 works better for me. Whenever you are traveling or changing what time it is, think about what your body is doing and try to make your insulin match. I think you’ll have much better results than just “wing-ing” it!
Good luck! I’d love to hear what experience other people have with this and if you have other suggestions.