Ask D"Mine: Tick Tock, Diabetes

http://type2diabetestreatment.net/diabetes-mellitus/ask-dmine-tick-tock-diabetes/

Happy Saturday, and welcome back to our weekly advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil is watching the clock... on a couple of questions related to the topic of time, that is. He"s exploring how time factors into our never-ending diabetes management routine. If you"ve got a few moments of our own to spare, please read on to hear what Wil has to say.

Got your own questions? Email us at AskDMine@diabetesmine.com

Linda, type 2 from Colorado, writes: I’ve got a question I haven’t found an answer to yet. My work schedule is different—I get up around 10:30 am, immediately do a blood test, and then do my nighttime test right before bed—usually around 2:00 am. Everything I read about D-management: The Dawn Phenomenon, best times to test, “first meal” and “breakfast,” etc., all seems to be based on a pretty traditional schedule—up at 6:30ish, work 8-5, in bed by 10:00 pm. So when I’m reading all this stuff, do I just mentally roll it all forward by about 4 hours? Or does the time difference make a real difference? Thanks in advance for your time.

Wil@Ask D’Mine answers: I always have time for good questions! Now, let me take the time to point out that time doesn’t exist in nature. It’s a cultural concept. And time is only as old as time itself. The oldest clock in the world—a sundial—was found in Egypt and dates from about 1500 BCE. (For what it’s worth, today’s iPhone reports time using a sexagesimal timekeeping system developed by the ancient Sumerians 4,000 years ago.)

So while time has a long role in human history, verging on an obsession from the earliest days, it’s not entrenched in our biology. For that, we need to look to circadian rhythms, a biological “clock” that helps sync your body to your environment. All living things (including fungus!) have circadian rhythms, a complicated internal timing process that in humans drives hormone production, cell regeneration, brain wave activity, body temperature, hunger signals, sleep patterns, and more. This matters to diabetes control primarily because the ebb and flow of hormones can have a big impact on our blood sugar, and secondarily because fatigue and huger patterns drive our food choices throughout the day.

The driver of the circadian rhythms is a biological “clock” called the suprachiasmatic nucleus, which is located waaaaaay down low, low, low in your brain—buried in the primitive hypothalamus.

Whoa, whoa, whoa horsey. How does this clock deep in the brain set itself to the environment, you ask? Through the eyes. Light, or more precisely, exposure to sunlight, gives our body clock the clues it needs to take a licking and keep right on ticking.

Unless you work at night, of course.

Then artificial light ends up replacing sunlight. Eventually. It will take a while, but assuming you consistently work an oddball schedule, your body will adapt, kicking and screaming all the way. Our body clocks are not so easily reset, which is why night workers have such higher accident rates, but given time, your dawn phenomenon will happen at your dawn, before your alarm clock splits the night at 10:30 am, rather than when the sun creeps towards the horizon behind your blackout curtains.

So you do need to “roll it all forward.” If you leave your diabetes management on everyone else’s sexagesimal time while living your life on your personal Linda time, your diabetes control will always be “off.” Your therapy plan won’t meet your body’s needs. As a type 2, the differences are likely to be subtle but they will impact your A1C in a negative way. For us type 1s, the difference can be profound, and has a huge impact on the programing of insulin pumps, especially in the area of basal patterns.

Of course, God forbid you have an ever-changing schedule, your body will never keep up. You’ll have to resort to French Roast coffee to start your clock at the beginning of your shift and Cognac to shut it off at the end of your shift, and your blood sugars will still do the funky chicken dance. Diabetes management on a rotating shift is beyond challenging, so much so that, if you have diabetes and changing shifts, the best thing you can do for your health is to change careers.

Assuming your schedule is pretty well set, and it sounds like it is, you should mentally adjust all the diabetes management tips by four hours. It takes time, but it does make a difference. Luckily for you, you have all the time in the world.

And speaking of time, I think we have time for one more question…

Gerry, type 2 from Florida, writes: I take Novolog at mealtimes and my evening meal is usually very late, at 7-8:30 pm or so. How closely together can Novolog and Toujeo be taken? I usually take the Novolog at between 7 and 8 sometimes later—how long do I need to wait to take the Toujeo after the Novolog to be safe? Thank you for your time!!

Wil@Ask D’Mine answers: Not to worry, I just checked my circadian clock and I have plenty of time to answer your question: And the answer is no time at all.

You can take the Toujeo and the Novolog right at the same time, down to the sexagesimal second, if you want to. The first insulin is a long-acting formulation, and the second is a fast-acting insulin. They don’t interact with each other at all, and they are each off in your body doing their own things. You don’t need to look at a clock at all.

You should, however, look at a map.

Because while the timing of these two very differently functioning insulins doesn’t affect each other in any way, their geographical location to each other can, at least in theory. Back a long time ago, insulins with different jobs were commonly mixed together into single syringes to reduce the burden of taking a zillion shots over the course of the day, but our more modern analog insulins apparently don’t play well in the sand box together, and all the drug makers cautions us not to “mix” them.

I don’t know exactly what happens if you do—I don’t think it would cause an explosion or anything—but apparently mixing them together can cause either or both to not work as designed, and the worry is that if you inject two different types of insulin too closely on your body you could “mix” them under your skin, with the result being that you wouldn’t get the control you are expecting.

Most sources say to keep the two shots at least two inches away from each other, but I err on the safe side and tell my patients to use one half of their bodies for fast insulins and the other half of their bodies for slow insulins. (This approach also comes in handy if someone develops an injection site reaction, as it makes it easy to figure out which insulin is the troublemaker.)

And with that, Dear Readers, I think we are out of time for the day.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn"t adhere to Healthline"s editorial guidelines. For more information about Healthline"s partnership with Diabetes Mine, please click here.

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