Hi all! I’m wondering if anyone has experience working in a fast-paced healthcare setting (or something similar) and has advice about how to manage blood sugar at work. I’m currently in school to become an Occupational Therapy Assistant (woo!) and I could work in a variety of healthcare settings including acute care hospitals, skilled nursing facilities, pediatric outpatient clinics (lots of moving around and working with autistic kiddos and those with behavioral issues), schools, mental health facilities, and home health. There are a lot of possibilities – which is awesome – but I worry that I won’t be able to keep up or “pull my weight” in some of the more physically demanding and fast-paced environments. There are plenty of healthcare settings where things get so crazy busy that breaks and mealtimes are delayed or even skipped every now and then.
I was only diagnosed (type 1) last year (my 1st diaversary was 2 weeks ago! woop woop!) so I’m still relatively new at this, but at the moment I work as an aide at a physical therapy clinic and there have been a few times where I had to stop working with a patient to go treat a low and sit in the break room, waiting for my sugar to come back up. It’s awkward, and sometimes I feel like I’m a weak link and I feel bad that someone has to cover for me.
My question is, has anybody found anything that helps them thrive in a fast-paced work environment? Working in healthcare, I’m responsible for not only my own health but someone else’s, and they’ll be counting on me to be on my A-game. I’ve considered just not pursuing the faster paced settings, but I don’t want to give up on something that I could really love doing. I don’t want diabetes to hold me back, but I also want to be realistic and take good care of myself.
I’m currently on MDI. Lantus and Novolog (although apparently I’m switching to Humalog next script…thanks new insurance). My a1c is great, but I do have some swings in both directions and I struggle keeping my post-meal sugars below 140…at least as often as I’d like. Would a pump and/or CGM really make that much of a difference? (Either way…I want that Freestyle Libre ASAP when it becomes available in the US…like…NOW. )
I think that a CGM is definitely a helpful tool for you – and anyone on insulin. In your situation, you can set alarms such that they occur BEFORE you get into “trouble” (low or high), so that you avoid letting those lows or highs sneak up on you. CGM give you continuous feedback that you can leverage to your advantage. (For example, read Dr. Stephen Ponder’s Sugar Surfing to get idea on how to accomplish this).
As for a pump – for me, a pump has helped minimize lows, though there’s no guarantee that it it will help you. I was going low at regular intervals because my basal needs are not static throughout the day. On the other hand, the convenience that a pump offers might be helpful in the fast-pace environment you describe, since you don’t need to deal with shots, needles, etc., to take doses that you need throughout the day.
By the way, my (non-D) daughter is enrolled in an OTA program that starts in the fall. Occupational Therapy is a great field - I wish you lots of luck.
I’m with @Thas. The pump has 2 features which have helped me a lot:
Programmable basal rate to level out my BG regardless of meals
Ability to reduce or suspend basal when my physical activity is much higher than normal
It’s convenient to dose without needles, but I used to shoot through my clothes, and in public, so this wasn’t as ground breaking for me as the programmable basal - my Dawn Phenomenon is finally at bay!
The pump is not my pancreas though, and like MDI, I still find that I need to keep my brain engaged as part of the active control loop. It’s not ‘load with insulin and ignore for 3 days’. But I like it very much! My next upgrade will be a CGM, I hope.
I switched to a pump after ten years on Lantus/Novolog MDI. It’s definitely going to make life more manageable under the conditions you describe–or any conditions really. As others have said, it just provides a lot more flexibility for dealing with the unexpected–and for T1, the unexpected is the norm.
Be aware, though, that it’s not an instantaneous panacea. It helps a lot if you’re already carb-counting and bolusing accordingly, but it may take a couple of weeks to get it dialed in. My transition from MDI to a pump was pretty rocky actually, and though I don’t regret it, there are times when it drives me nuts… but that’s just the nature of the disease anyway. There are things to be aware of going into it: a lot more D paraphernalia to carry around for just-in-case, especially when traveling; there are a lot more failure points in the system that can leave you scratching your head and WTF-ing (that vial-and-syringe or pen injector stuff is very simple by comparison); and I find that the finer the tools are for controlling my BG, the more mind-space my BG and T1 status occupies–especially true after adding a CGM.
All of that is not by any means meant to be discouraging. It’s just that there is a LOT of pump enthusiasm around (not without reason) and I think you’ll do better with the transition if you have realistic expectations of what’s involved.
Best of luck and welcome to TuD. This is a really great community–hope you stick around!
I didn’t realize CGMs have ability to predict lows or highs! I thought they just sounded the alarm when you were already there. That’s awesome! Definitely pushes me more in the direction of getting one. Thanks @Thas!
Yes, I’m definitely trying to keep my expectations realistic, haha. Diabetes does already take up a lot of my mind space, so I’d have to consider that if I wanted to use a pump/CGM or combo. But a lot of my that mind space is stress/anxiety from worrying about unexpected lows or where my blood sugar is at any given time, and if I had better control and more confidence, that could be worth it.
My advice: get a CGM and become competent in its use. While a CGM can’t predict future blood glucose levels, your experience reading your trends combined with monitoring insulin on board, a key data piece from an insulin pump, and your knowledge of your activity levels will give you all the info you need to prevent unanticipated hypos.
You can excel in most fields of human endeavor but do not handicap yourself by “flying blind.” Use a CGM and become a student of your metabolic health. It will make all the difference!
Goals tend to be very personal based on your own experience of your D.
In my particular case I’m happy those rather few times I stay under 180 after a meal. hitting the low 200’s is not uncommon. And I’m no stranger to 300 or higher either.
I’ll try to remember what others have already said since I also don’t disagree with it.
I started using CGM about a year ago as opposed to having used a pump for about 19 years. When I ask myself the “If I had to choose only one …” question, the answer I think I am going with these days is I’d pick the CGM.
Using both is best in my opinion. But what the pump offers is the ability to fine tune your dosage, especially to stop your basal if that needs to be done. No matter what the advocates for MDI instead of a pump may say, once you’ve taken your basal insulin these is no way to suck it back out if your plans/needs change. A pump does offer greater flexibility by allowing you to dial things back … which is often what you want to do if you are unexpectedly active.
But CGM … if it works for you … lets you see a fuller, more nuanced picture. It can’t stop a hypo but it can warn you in advance that one is coming so you can deal with it. And if you really desire to try to “flatline” your BG after a meal, CGM can allow you to pre-bolus in a more meaningful way.
But I’ll repeat my previous caveat: CGM is only good if it is good for you. Not everyone has great results with it. The best way to approach CGM is to do a trial run for one to (preferably) six weeks before committing yourself irretrievably financially.
So those would be my recommendations, CGM first and then possibly add a pump later if it looks like you want the added flexibility. Have you looked at www.dexcom.com or talked to a dexcom pusher, er, ah, sales rep?
Definitely consider a CGM, independently of the pump decision. Well, except in the case of Enlight/Medtronic where it’s not standalone but part of the pump system. But with Dexcom there’s no need to have a pump (some pumps do integrate with it), and it’s really a separate decision. It can help you out on MDI as much as with a pump, maybe even more so, and also doesn’t burden you with a lot of extra bits and pieces of D-clutter you’re supposed to carry around. It DOES kinda take up a lot of mindshare since it’s giving you readings every 5 minutes. But it’s a huge boon to figuring out your patterns and responses to carbs, doses etc.
One of the reasons I recommend in this particular case CGM first & pump second, is the OP’s comments about struggling to stay under 140 and only having been coping with D for a year.
Perhaps a pump would be overkill for her at this stage? Maybe it never would be “needed” or maybe it is something which will seem more helpful to add on later?
Whatever the case, if she can use CGM then that would provide extra insight for questions about the pump.
The more I rant on about CGM the more I find myself wondering at the strange tangled web of bureaucracies which has apparently resulted in it currently being easier to get financial support/approval for a pump than for CGM. I mean, seriously! Doesn’t it make so much more sense for it to be the other way around?
Haha I haven’t talked to Dexcom at the moment, although I’ve looked into it on my own and have watched lots of youtube videos of people sharing their experience…etc. I’m still a full time student so I’m not sure I could afford it yet…but I will be able to once I’m working again. Maybe insurance will cover it, but I’m not too optimistic. I’m one of those people who plans uneccessarily far in advance, so I’m just trying to learn as much as I can about all of this stuff so that when I’m in a position to afford it, I’m ready.
And I think that’s part of why it’s easier to get a pump than a CGM. CGM’s are still considered “new” & “experimental” & “dubious” by those who make the payment decisions. I can remember when pumps were viewed the same way. It actually was not so many years ago …
Try pointing out to your endo that getting a CGM would go a long ways towards supporting his/her/its arguments about getting a pump. Maybe that will help him lobby on your behalf for at least trying one on a trial basis. Every little bit of knowledge usually helps, no?
I do not work I. The healthcare industry but I worked as a fast food manager for almost 30 years. While on MDI it was a nightmare because my insulins were always peaking at meal times when I should have been working instead of eating. When I finally went on a pump it was a game changer for me. It wasn’t easy at first but I have said a number of times, my pump has made my life much easier and my CGM has saved it. I just love the fact that if I don’t want to eat or can’t, I don’t have to. If I want to sleep in, I can without having to worry about injections one peaking insulins. Pumps are still a lot of work and it takes awhile to get the basals set and than of course they change again. But I do love being on a pump and do I love my CGM. It could really help you with scheduling issues. Good luck!
for me, my pump do make a difference, i’m busy a lot of the time, at my work,.
my pump have made, my life so much better & easy, & the cgm have saved me, i can sleep in, if i want to, & i don’t have to get up do, a injection,. good luck.
Stop being un-optimistic. Be realistic! There really is no need to wonder or think what will insurance cover/not cover. Call them. I spent years thinking that a CGM and pump were out of my reach. Then I got fed up with my numbers (involved throwing and breaking my meter after a very unexpected high). I called my insurance company directly and got the information I had been thinking about for years…in a matter of minutes. Come to find out, a pump is more affordable to me now than taking two types of insulin.
Anyhoo, I was a nursing assistant in long term care facilities for about 5 years. My CGM enabled me to see that I was falling and eat a quick treat while working. I would get to 70 and be trending down, throw some glucose tabs/smarties/fruit snacks in my mouth and continue on my way. Rarely did I have to take an extra break to treat anything after I got the CGM. A pump made things even easier, as I didn’t have to go anywhere to take a quick “shot” of insulin. I will warn you, however, depending on where you end up working, you will want things hidden. I dealt with many combative and confused patients and I was always afraid that my tubing would get ripped out or my pump would be grabbed and thrown, or used to beat myself or a co-worker.
P.S. Just got the actual image of being hit with my pump…lol.
Thanks for the push, haha. I just hesitate because I called Aetna in January asking if they had a preferred insulin, etc so that I’d be prepared before my upcoming endo appt…in case I needed a new prescription. They said no, there was no preferred or discounted insulin and that Novolog would be fine. I even spoke with 3 different people. A month later, I get a letter stating that they prefer Humalog, and that they “paid for Novolog this one time” but after that, they wouldn’t (and by “paid for” I mean a 10% discount off the retail price. Oh joy.) So much for trying to be proactive.
I’ll definitely try to get in touch with someone and see what they can tell me about Dexcom coverage…this whole discussion has pretty much convinced me that I should go for that, at least. And the pump does seem more appealing to me than it did before…but I’d love to see what I can do with just the CGM first. The idea of seeing where I’m trending is just too good to pass up!
And I appreciate the advice about grabby patients, haha! I’d love to work with dementia/Alzheimer’s patients and uhhh…that could get dicey.
I just imagined an elderly patient grabbing an insulin pump by the tubing and lasso-ing it above his head like a cowboy
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