I’m coming to the end of my first clinical placement as a trainee paramedic, and have been working full time hours in an irregular shift pattern - I’ve just finished a run of lates and nights this week. Personally, I’ve found it to be no trouble at all, but I’m certain that’s down to the tech I use and the diet I choose to follow.
Like you, I use Omnipod, and am fortunate enough to have a Dexcom CGM, so I get alerts on my watch if my levels are going out of range soon enough that I can deal with any issues before they become a problem. Using those, I’ve put together a DIY artificial pancreas system called “Loop” - in essence it connects the CGM and the pump and adjusts the basal rate every five minutes depending on where the system predicts my levels will be in an hour’s time. I tell it if I’m eating, and enter the carb count, but other than that, it ticks away in the background and I don’t have to think too much about diabetes when I’m working. It also means I can control the Omnipod from my phone and watch, rather than using the PDM. It’s not perfect, but keeps me in range ~95% of the time and able to maintain an HbA1c of under 40 with minimal hypos.
However, the thing I feel that’s helped me most with the demands of ambulance work, is a very low carb diet - with small amounts of carbs and therefore small amounts of insulin on board, I don’t worry about swinging levels, spikes or hypos. There’s a maximum of maybe 2u of insulin in my system at any one time. A diet of high protein and moderate fat means that I can happily go the 8+ hours on a 12-14 hour shift before we get a meal break, as I’m not starving and craving carby food to keep going. I only eat two meals a day anyway, no matter what I’m up to, and don’t tend to graze or snack. If I do start to drift low, I just turn the insulin down a little and take one or two dextrose tablets. there is one other T1 on my course, she’s on MDI and using a Libre, and also eats very low carb. I couldn’t imagine having an 80g carb sandwich and then thinking about the hypo implications of 8u insulin on board, especially if I was to go from a quiet job checking over a Nana in a nursing home and waiting for hours outside A&E, to an RTC and the sheer physicality of a traumatic cardiac arrest, extended periods of CPR and moving people. My work is just too unpredictable, and I’ve gone for the approach of making my food very predictable to counter that. I always carry my meal in my bag on the truck, and dextrose tabs in my pocket.
Nursing is different, I think - utmost respect to you, it’s not a job I could do myself. I imagine you‘ll be on your feet a lot more than I am (we do a fair bit of sitting down on the way to jobs, at a patient’s home, waiting outside A&E) and rushing around. Of course under the Equalities Act 2010 we have the right to “reasonable adjustments” - regular meal breaks if you need them, for example. You’ll also need to contact the Disability Office at your university, as they don’t seem to hook up with Occy Health, at least not at mine! They’ll have a standard T1 “package” of adjustments, such as exams in a separate room (not so much for our benefit but because beeping CGM alarms and pod beeps could disturb others), food breaks etc. There may also be some help with equipment, like a small fridge for insulin if you’re away from home, and a laptop to help you catch up on any uni work you might miss due to hypos/pump failures/groggy brain due to high sugars.
All the very best with your studies!
Thank you so much for all the information, I really appreciate it! Good luck with the rest of your studies!