Diabetes and work

Ive had diabetes for 11 years and been on the pump for the past 5 years. I recently started working as a waitress and have been having problems with my diabetes at work. When I work I cant seem to keep my blood sugar up, It drops to about 38 mg/dl and I cant get it back up. I even suspend my basal the whole time so that I dont get any insulin. My doctor told me I should probably think about a job that isnt so “fast paced” but where I live (a very small country town) its hard to find a job. so my question is what should I do? any advice is greatly appreciated.

I have been a waitress in a few restaurants. The best thing you can do is eat a protien and fatty snack before a shift (i.e. peanut butter sandwich) and reduce your basal. It was not uncommon for me and the other T1 I worked with to have a reusable container constantly filled with a diet coke/regular coke mix just to keep our BS up during the dinner rush. Ce la vie.
There is just no one solution to this, just experiment with a snack before your shift and keep something quick on hand.

I waitress from time to time and I do know that feeling - rush, rush, rush and then I crash!

I find that having a largish meal, with lots of slow acting carbohydrates and a small pudding helps keep me going. I know, I know, pudding. Not allowed! Yes, it IS allowed if you know you are going to be very active for a sustained period! Also I have a sandwich or something stashed away, where clients cannot see them, warn your colleagues that it is not to be moved or thrown away and a small box of candy and a bottle of water and another of high sugar drink or something so that you can dip into whatever is needed for the occassion. I tend to rush around when waitressing and will quickly nip back to the corridor behind the bar, grab a mouthful, swallow it and then come back and smile sweetly and continue. If I need a break, I will ask for one in order to get my sugars back up. It is hard sometimes, depending on whom I am working with, but then you ask them, which is better? For me to get orders wrong, lose my rag with customers because I am low, collapse? Or give me 5 to keep my strength up. Most are very understanding. You can always return the favour when they need a break and cover for them.

And reduce your insulin. You are not going to die of a high (if you could get high as a waitress) over a shift. You can always start it up again at the end of the shift. I wish you well and look forward to hearing the results of your experiments.

I am not in food service but do work in a fast active job requiring me to move fast and do lots of pushing and lifting. I burn through anywhere between 45-70 carbs a night. I try to go in to work at around 110-130 range and will drop to the 70-85 range within a hour. Break out peanut butter sandwich #1 or other quick eat around 20-30 carbs. Check sugar in a hour 110ish if over cut back on drink (summer time is going to kill me). I check about ever hour to hour and a half at work snack on cashews and maybe eat a cliff bar or another sandwich during the shift. In your situation I would look at grabbing a plate of french fries or a dinner roll or two. If management complains point out the rules which should be posted someplace in your work area for the American with disabilities act. But look at snacking about 15-20 carbs an hour on average watch your liquid intake(at least for me it causes a crash).

Your doctor’s “advice” leaves something to be said about your doctor. He/she is basically saying be less active which is not only not good for you as a diabetic, I would call it BS(not blood sugar). If you asked for advice on how to run 5 or 10ks I would hope your doctor would encourage it and not tell you to basically to do something else. Look on here I am sure there are many threads that focus on extended work outs and keeping within range,

I agree with all the posters. I do not work as waitress, but I am a public school speech therapist who moves around a lot going to get kids, walking around, playing with the kiddies. I keep glucose tabs and smartieis stashed in my room, I eat a breakfast filled with plenty of protein and some fat ( like non low fat cottage cheese and fruit, cheese omelettes), and I always have lunch as the biggest meal of the day. My co-workers are very understanding, and will watch my kids if I have to take a quick low-sugar break. The School administrators, secretaries, and school nurses have been good in helping me out on those rare occassions ( like maybe 3 in 10 years) where I needed assistance at work for hypoglycemia.



And I agree about your doc… Is he a GP who has NOT had much expereince with active type ones?That is what it sounds like. Go to him to issue your “scripts”, then YOU just do what you need to do.Read Pumping Insulin and Think like a Pancreasavailable cheap on Amazon.

This economy is too tight, particularly for young people, to keep looking for an “ideal” less fast-paced job. But if you can, look for a doctor who is more well-read and acquainted with type one medical paradgms and treatment. Anyone in your small town , such As CDE’s or Nutritionists, familiar with working with type ones/type two’s on insulin.? I know they are hard to find and wish the best for you.



God Bless,

Brunetta

Speech therapist bless your heart even more Brunetta. You have to deal with kids like me hyperactive, high pallet, with a serious North East accent. Found it easier to never say my Rs and THs still come out as Fs or Ss. But my speech therapist never gave up on me.

I’ve been in the South to long I just used the phrase “bless your heart” without thinking. I already say Ya’ll whats next.

Jim, I never give up on my kiddies, that is why I love woking with the darlings Thanks, too for your kudos to the profession. but I am retiring in june after “31.7 years”. Time to do some other fun things.

How are you and your darling babies at home.?

and do not worry about the and the north east accent and particlar speech sound idiosyncracies: It is ok to say “Brodda” for brother, depending on your line of work ( not a public official, radio/TV announcer,m or CEO) or “wiff” for ‘:with". depending on where you are or who you are with. I am a southwest Ga girl and I do know how to "code switch’ ( talk in the back yard and the boardroom) and I bet you, Jim. can do that too.



God Bless,

Brunetta

I waited tables back in the early 90s. I found it ok as I didn’t work anywhere they had breakfast so I’d work doubles but eat breakfast right before I went into work, around 10:00 or so, and then ride that until the end of the lunch shift, 2:00 or so and then eat again right before I went in for the night shift? I was also taking R though which, come to think of it, might be better suited to covering 3-4 hour shifts like that?

It may be too that you could be able to adjust your insulin regime? I had a lot of problems when I was (guesses) in my early 20s, so perhaps I was running low a lot @ work but would fight it off w/ spigot drinks.

I didn’t pay close attention to theories or procedures at that time but Brunetta’s recommendation of “Pumping Insulin” and TLAP is very good. It may seem sort of dorky, guests are always “Think Like a Pancreas? What the sam hill is that?” but I think they are really informative and interesting books that will explain exactly what to do. I read them before I got my pump but am thinking of reading them again now that I sort of have the hang of it? I picked them up and flipped through them the other day and they are really full of fascinating info. Best $15 you can spend I think? Both have good charts, formulas and explanations of either cutting insulin or taking carbs for exercise, or both? I would look at waitressing as “moderate” [the AMA provides categories for different types of exercise] unless you are dealing with > 8 tables in which case you are probably really hustling? Even a difference in a station could make a difference. In one place the ‘closers’ were quite a bit farther away from the kitchen so it was more active?

You want this job and I don’t think there is any reason you can’t figure this out. Well, what I’m going to say has gotten me strange comments before, but let me just say it.



Running around like a waitress makes you an “Athlete.” And being paid to do it means that you are a "Professional Athlete."



So why not get serious about this and do what an athlete would do? What would an athlete do? They would eat before the “event” taking some level of bolus for the event. Would the suspend their basal for the whole long event? No, that can lead to sudden crazy highs. Would they reduce their basal? Yes. How would they handle lows during the event? They would expect lows and be prepared having fasting acting carbs and longer acting protein to keep that blood sugar sustained, sometimes timing the carbs, every 15 minutes or hour (the EXCarbs system from Walsh in Using Insulin can help).



The book “The Diabetic Athlete’s Handbook” is an outstanding source of information, it is available at many public libraries, and the author Sheri Colberg has a web site with lots of information.



ps. Thanks in advance to those who wish to comment on the merits of waitressing as a professional sport.

I would say that the relevant sections of TLAP and Pumping insulin are more concise than Sherri Colberg’s book though? I didn’t find that as handy as I thought I would although I agree that it is chock full of interesting information, particularly the sections about biology.

Thank you for the professional athlete comment :slight_smile: I’ve been serving on and off full time/part time for 20+ years.

I am Type 2 and can only imagine what is happening to you. When I started my basal insulin it was hard for me to figure out how much to use. It turned out I had 3 options for different days, days I was off, days I worked lunch (which was usually very slow for us) and weekend night or brunch shifts.

While figuring this all out I had my bag of goodies stashed at the corner of the bar (they didn’t want me testing in the server station because it was open to the dining room). My candy of choice, usually glucose tabs, my “meal” for the night. Meal in quotes because I wouldn’t eat a proper dinner just take a bite or two every hour. The first couple of weeks our bartender would keep a shot glass full of OJ for me also. I think I scared him the first time I crashed and came to the bar for coke white as a ghost and shaking. I was fortunate to work with a very good team of people and was well supported through out the process. Hope you have that also!

Dr. Bernstein in his book mentions two house painters on insulin who use snacks to keep their sugar constant during work. One eats 1/2 a blueberry muffin every hour and the other 1 chocolate chip cookie every hour. He says this works because these foods have a mix of fast acting and slower acting carbs. Jessica and Anonymous Jim both mentioned peanut butter sandwiches which would probably fit into the slow/fast carb category, with the addition of fat which is a slower acting energy source.



In case you are not familiar with Dr. Bernstein he is an advocate of low carb eating for diabetes control, so these foods would normally be on his forbidden list. This just demonstrates you need to be pragmatic in your approach to diabetes.



Although your level of activity is probably higher than these painters, perhaps this will help.

Phooey on your Dr.! There isn’t any reason why we can’t figure this out, Diabetes doesn’t have control over our job choices! = ). When you suspend your basal the whole time - are you starting with the suspension when your shift starts? Remember that your insulin peaks in 2-3 hours (depending on your insulin in the pump) So, you will have the basal insulin there for the first 2 hours of your shift. Any basal change, should be done Prior to your shift.

AND, if you ate within the two hours before your shift, you will still have the active insulin from your bolus to cover the carbs you ate. When you get active, this insulin ALSO becomes more effective. So, you should use LESS insulin with that meal.

Pop is a great way to bring sugars up, and easily accessible at most restaurants, too. It doesn’t take much, though!

I think from a practical sense you are right. I look at Sheri Colbergs book as answering my relentless and irritating questions of “Why.” TLAP and Pumping insulin just get right down to it and give you the “How.”

I drive an hour to get to my endo (Columbia, Missouri), but the past year Ive been goin through them trying to find the right one for me. Plus money is tight and my insurence isnt that great so Ive got bills out the ying yang right now slowly but surely gettin them paid.

Thank you all for your information. My basal rate is 0.5 and hour and a half before I go to work and I eat toast and eggs aswell. Im having a hard time with this because I havent been controlling my diabetes like Im suppose to but have started making changes the past 4 months with controlling it. I will keep posing different methods I try to help fix this problem. So once again, THANK YOU ALL for helping me with this.

I don’t have a physically active job but I have one that is high stress and where I find myself in cloistered proceedings for long periods of time. I have had my bg drop low in the middle of an investigation or deposition. I have learned that higher fat options prior to those sessions help. A peanut butter sandwich on low carb bread seems to do the trick. Then I don’t do a combined bolus. Rather I take 1/2 of a regular bolus. It seems to work. Although sometimes I end up slightly higher than optimal. – it’s not obscenely high and can be brought down easily with a correction immediately after I am out of the session.

I waitressed my way through Uni but while on MDI. I’ve only been on the pump for only 7 months but getting the hang of it. I use to decrease my Levemir dose and my humolog. You could try a temp bolus (-40%) starting 60 minutes before you start work. Have a high protein meal before work and lots and lots of snacks. Waitressing is like an aerobic workout so enjoy the weight loss that comes with it.