Shift workers have it tough. I used to work in the ER — I remember it well. If I worked 3 to 11, I never got to see my friends. If I worked 11 to 7, I was just wiped out all day. I knew that lifestyle was not for me.

But if you’re a nurse in a hospital, you don’t have a choice. People get sick 24/7. They need your help.

Working the night shift often means not eating right, with fewer selections at the hospital cafeteria, and less exercise. When your circadian rhythm is disturbed, everything goes out the window.

A mammoth health study focusing on nurses also indicates something else — that shift work might be a factor in the diabetes epidemic we face in this country.

The Nurses’ Health Study started in 1976, enrolling 140,000 female nurses who didn’t have diabetes, heart disease or cancer. These nurses diligently filled out questionnaires about their lifestyle, including what they ate, how much they exercised, whether they smoked, etc. Shift work was defined as working three night shifts per month.

Over approximately a 25-year period, nearly 11,000 nurses out of the 140,000 in the study developed diabetes. As you would expect, nurses who didn’t exercise regularly, who were overweight, who smoked, who ate a poor diet with few fruits and veggies were more likely to be diabetic.

But what surprised researchers was that shift work was another independent factor in the development of diabetes. When they did the math, they figured out that 80 percent of the risk for diabetes was from poor lifestyle and 20 percent was from doing shift work.

Why is this? When we change our sleep and wake times, we change our circadian rhythms. Among other things, these circadian rhythms affect our hormones, other metabolic pathways, the balance of bacteria in the gut. This is all speculative, but that could be a factor in health issues.

My spin: If you do shift work, you have to be even more diligent about living a healthy lifestyle. Hospitals should provide better working conditions and better food for those on the night shift. I am sure all shift workers — from those in convenience stores to over-the-road truckers — have the same risks.

Now, this brings me to another problem — massive drug costs for diabetics.

A recent article in the Journal of the American Medical Association showed that up to one in four patients reported skimping on prescribed insulin because of cost. Many gave themselves smaller doses, while others temporarily stopped their insulin hoping they would not get sick until they could buy the next dose. Still others stopped taking insulin altogether or never even started because it was too expensive.

When I prescribe insulin do you think I know the cost? Absolutely not. If I try to get the cost from the pharmacy, they tell me they can’t give me that information unless they run the prescription for that particular patient. Every insurance is different.

Going to my go-to site for drug costs,, it shows a typical out-of-pocket cost for a month of Lantus insulin is $421, with others jumping up to $500 per month. I learned at a Mayo Clinic conference last year to go back to an old-fashioned insulin called Novolin 70/30, which comes in at $170 per month.

There is a bottom line here: These essential life-saving drugs are much too costly for many who have inadequate medical insurance, can’t come up with the co-pay or don’t have any insurance at all. And this study showed many of these people just don’t take their life-saving medications.

My spin: There is a problem here that we, as a society, have not solved. We need transparency in drug costs. Practitioners need to know which drugs cost more so they can prescribe the lower-cost ones that often work as well. And we, as a society, have to step up and help those who need help. We are, in fact, the missing link. Stay well.

This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.