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Q: Insulin

I'm an HIV+, insulin-dependent diabetic, 37 years old, and am going back to work but it's on the night shift. What suggestions do you have for switching my diet around?"

A: Charlie Smigelski, RD responds:

You are probably going to have to play with your insulin levels a bit as you become more active at work to begin with. Then your insulin blend, regular versus NPH, and how each reacts in your body may also change.

The hardest part will be what happens on weekends when you try to switch sleep schedules again? Basically, I am guessing that you are going to take an evening nap at some point, then be up all night, then go home, rest a bit and go to sleep all day. When you wake up at 4 or 5, you will be starting your "day" and will inject yourself. But you will likely want "supper", and the insulin you use for this would be different than if you were plotting breakfast and lunch in regular life; you might use more regular insulin in this case. Next you might have "lunch" at 11pm before work, and your old lente insulin dose still applies; then, on a work break, you might have "breakfast", and finally at home and before sleep you'll have some protein and a starch (bedtime snack to prevent bottoming out while you sleep). Maybe your mix will be different. So all in all, I cannot say exactly what new blend of insulin you will use. Maybe you are someone who has the exact same blend of starch and protein calories at all three meals, (like 4 "meats" and 3 "starches" and this will make the move easier). I know this is all very vague, but with out knowing what you will do or have done, I cannot offer more details.

As I said, if on the weekend you hope to switch sleep schedules, ugh.

Remember you need good antioxidant vitamin supplementation for both HIV disease for limiting the sugar damage (HgbA1c) of diabetes. See the recommendations for the HIV+ person who's into rigorous exercise in the Q&A titled Physical Exercise. You may also want to add 50 mg a day of CoEnzyme Q10 to that plan.

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