Introduction to diabetes

Approximately 1.4 million people in the UK have diabetes and it is suggested by

Diabetes UK that there could be another one million people with diabetes and are
unaware they have it. The majority o people with diabetes !"#$ % &'$ will have
Type ( diabetes). The remainder will have Type 1 diabetes.
Diabetes *ellitus is a condition in which the amount o sugar in the blood is too
high. +hen we eat a meal the starchy and sugary carbohydrates are changed
into sugar !glucose ) during dijestion and this sugar then passes into the
bloodstream. +hen the pancreas senses that there is a rising level o glucose in
the blood it secretes a hormone called insulin. ,nsulin changes glucose into
energy which provides uel or the body. ,nsulin is vital or lie because without it-
the glucose could not be changed into energy and the body could not unction
without energy. ,t is oten said that insulin acts li.e a .ey / unloc.ing the cell to
allow the energy in. 0bviously- li.e a car- we only need a certain amount o
energy to provide or the re1uirements o the body. , we eat more than we need
this will be stored as at.
Signs and symptoms of diabetes
2xcessive thirst
3re1uency in passing o urine
4lurred vision
5oss o weight
Tiredness
*ood changes
3re1uent inections e. boils- thrush etc
Types of diabetes
There are two main types o diabetes6
Type 1 ! used to be called insulin dependent ) aecting children and
young adults mostly
1
Type ( diabetes ! used to be called non insulin dependent ) is
commoner in the over 4' year olds although children as young as
sixteen and obese are also developing Type( diabetes
Main Aim of treatment
The main aim o treatment o both types o diabetes is to normalise blood
glucose levels to protect against long term damage to the eyes- .idneys- nerves-
heart and all the blood vessels. 7ome experts call diabetes 8a blood vessel
disease9 because preventing narrowing o the blood vessels is .ey to preventing
complications.
Type 1 diabetes
The exact cause o Type 1 diabetes is un.nown but thought to be due to a viral
inection or environmental actors. ,n type 1 diabetes there is total destruction o
the cells in the pancreas ! beta cells ) that produce the insulin. The onset o
type1 diabetes is acute- because as stated earlier insulin changes glucose into
energy but in the absence o insulin- glucose builds up in the blood and is not
turned into energy. ,n an eort to overcome the lac. o uel or the normal
unctioning o the body- ats and proteins are bro.en down instead. This is why
patients are oten underweight at diagnosis.
0nce treatment with insulin is started the patient will begin to eel better 1uic.ly
and will regain the lost weight.
Treatment for type1 diabetes
:eople with Type 1 diabetes will need injections o insulin or the rest o their
lives. ,nsulin is destroyed by the gastric juices so cannot be ta.en in tablet orm.
:eople with Type1 diabetes will need a minimum o two injections daily and oten
more. They will also need to eat a healthy diet and ta.e regular exercise and do
regular sel blood glucose testing
2
If you have been diagnosed with Type 1 diabetes please ask your health
professional for the special section on Insulin Ttreatment which will
give you much more specific and detailed information
Type ! diabetes
Type ( diabetes occurs when the pancreas secretes less insulin than normal or
when the insulin secreted ails to wor. properly !called insulin resistance). :eople
who are overweight are ive times more li.ely to develop Type ( diabetes and
our out o ive people with Type ( diabetes are overweight. 2xcess weight
increases your body;s own glucose production and thus your body;s need or
insulin too. At the same time- this extra insulin increases atty acids stores and
urther increases insulin resistance. ,t becomes a vicious circle.
Type ( diabetes is particularly associated with central excess weight ! apple
shaped rather than pear shaped). <ealth ris.s increase when waist
circumerence is greater than =>inches !&4cms) in men and =1.# inches !"'cms )
in women. ?educing calorie inta.e i you are overweight will help your body use
insulin better by reducing insulin resistance.
"ou will find a whole section of this book devoted to healthy eating# weight
control and e$ercise
Type (diabetes has a gradual onset. @ou may not eel any symptoms beyond a
little tiredness which is oten mista.enly attributed to age and wor.ing hard. As
Type( diabetes progresses you may become aware o some o the signs already
mentioned or you may be diagnosed whilst being investigated or something
else. ,t is suggested by experts that most people have had Type( diabetes or at
least ive years beore diagnosis.
The ollowing people are at an increased ris. o developing Type( diabetes6
3amily history o diabetes
Asian or Aro%Aaribean origin
3
+omen who have had gestational diabetes
0bese people
:eople who ta.e little exercise
0lder age
:eople on certain medications eg steroids- and some anti psychotic
medications
Treatment for Type! diabetes
:eople with Type( diabetes will be encouraged to eat a healthy balanced diet
and ta.e regular exercise. They will be treated with diet only or the irst three
months ater diagnosis !unless their blood glucose is very high and they are
losing weight). , diet and exercise alone does not control your blood glucose
levels you may also need to ta.e tablets.
4
Diabetes and Driving
<aving diabetes does not mean that you cannot drive as long as you doctor says
you are sae to do so / this is usually when your diabetes becomes stable and
controlled. @ou will however have to plan in advance beore getting behind the
wheel o your car i you are on certain tablets or your diabetes andBor ta.ing
insulin.
@ou must by law inorm the Driver and Cehicle 5icensing Agency !DC5A) i
@our diabetes is treated with tablets or insulin
, your treatment changes rom tablets to insulin or i insulin is added to the
tablets
, there are changes in your health or condition that may aect your ability
to drive saely
, you are applying or a licence or the irst time- you must answer "%S to
the 1uestion about diabetes.
:eople Treated with ,nsulin
Ater you have written to the DC5A inorming them o your insulin treatment- you
will be sent a orm !called 8Diabetic 19)- as.ing or more inormation and or the
name and address o your D:B <ospital Doctor. @ou will be as.ed to sign a
consent orm allowing the DC5A to contact the doctor directly or more speciic
inormation on your diabetes control- eyesight and general itness to drive.
This does not mean that you will be reused a licence / it just ensures saety or
you and other drivers. :lease answer all 1uestions ully and honestly.
5
:eople Treated with Tablets
Ater you have inormed the DC5A that you have diabetes- they will send you a
letter explaining your responsibility to re&notify them i you start having insulin
or have 8hypos9 !low blood sugar)- or i you develop any o the complications o
diabetes which could aect your ability to drive.
They will not normally as. you any other 1uestions at this stage and you will
normally expect to .eep your 8till to9 licence.
Diet alone Treated patients
Eo restrictions on driving and do not need to inorm DC5A.
?estricted 5icences
,nsulin treated / a driving licence will be issued to you or one- two or three years
i you are treated with insulin. Fust beore expiry date- you will receive a reminder
to renew your licence and you will be as.ed to return your current licence. @ou
will be sent another 8Diabetic19 orm to conirm your medical condition. ?enewals
o restricted licences are ree.
Tablets or diet treated / usually issued with a 8till to9 licence. +hen you reach >'
years o age- you will be expected !li.e everyone else in UK) to renew it every
one to three years. There is a charge or this renewal.
:rovisional licences / applies to insulin treated only / need to be renewed every
one- two or three years.
+hen renewing licences- it is always sensible to .eep a copy o the old licence or
to ma.e a note o the driver number- beore sending to the DC5A. The process
ta.es between six / eight wee.s unless there are complications.
, you drive a motorcycle the rules or inorming the DC5A are the same as or a
car.
6
2yesight :roblems
0bviously it is important to have good distance vision and good ield o vision
!what you can see side to side when loo.ing straight ahead). There are various
tests that an ophthalmologist can do to carry out to test these actors. @our
licence may be revo.ed i you ail a ield o vision test- but you can appeal
against it. There are dierent types o ield o vision tests- some people do better
on one type versus another. The DC5A will accept the results o any approved
type o test.
5arge Doods Cehicles !5DC) and :assenger Aarrying Cehicles !:AC)
,n 1&&1 the titles o <DC !heavy goods vehicle) changed to 5DC
And :7C !public services vehicles) changed to :AC.
:eople treated with diet alone or diet and tablets are normally allowed to hold
5DC and :AC licences- provided they are otherwise in good health.
:eople treated on insulin are not allowed to hold these licences. , you currently
hold such a licence and start using insulin you must inorm the DC5A and stop
driving the vehicle immediately.
,n 1&&G- the regulation on larger vehicles was extended to include medium siHed
vehicles. Anyone passing their driving test ater =1
st
December 1&&G will only be
given a licence to drive vehicles up to =.# tonnes.
Cehicles weighing =.# tonnes / >.# tonnes !Aategory A, ) and mini buses !D,) are
now treated as Droup ( vehicles / normally there is a complete ban on insulin
users obtaining a group ( licence. <owever some A, licence holders can now
apply or a medical assessment and can regain ability to drive these vehicles
whilst on insulin. :lease write to the DC5A or more inormation.
7
Taxis
The law does not bar insulin users rom driving taxis- provided they are less than
nine seats. As local councils issue licences the policy may vary in dierent parts
o the UK. 7ome taxi authorities issue blan.et restrictions. :lease contact
Diabetes UK and DC5A or more inormation.
Diabetes in :regnancy !Destational Diabetes)
, you need to commence insulin in pregnancy- you should notiy DC5A
immediately.
@ou will normally be allowed to continue driving but are recommended to stop i
your control becomes unstable or i you do not have good warning signs o
hypoglycaemia. @ou should re notiy the DC5A six wee.s ater delivery i you are
still on insulin- as your licence will need to be reassessed.
, you have problems relating to your driving licence- please discuss it with your
diabetes team- who will be able to advise you. DC5A wish to issue licences- not
to ta.e them away / you can help by giving as much inormation as possible.
'( )(T '*I+% I,
@ou have diiculty recognising early signs o hypoglycaemia !7ection )
@ou have started on insulin and your diabetes is not yet controlled.
@ou have problems with eyesight not corrected by glasses
@ou have numbness or wea.ness in your eet caused by nerve damage or
circulation !neuropathy or ischaemia)
@ou have been drin.ing alcohol.
:recautions beore Driving
5ong journeys need careul planning- allowing or regular stops i you are
on speciic tablets or diabetes and insulin.
8
Eormally it is wise to have something to eat every two to three and hal hours
i you are on insulin and not to miss meals and not to delay meals i you are
on tablets and insulin.
Test your blood sugar beore driving and regularly during a long drive or i
at wor. beore you drive home at the end o the day or shit.
Always carry 1uic. acting glucose and slow release carbohydrate in the
car at all times i you are on insulin or speciic diabetes tablets.
Always carry identiication on your person and in the car stating your
name- how your diabetes is treated and the name o your D:.
At the irst sign o <ypoglycaemia
Stop driving as soon as it is sae to do so
*emove ignition .ey and move into passenger seat.
,mmediately ta.e glucose tablets or sugary drin. !both may be re1uired)
3ollow this with slow release carbohydrate i.e sandwich- crisps- biscuits
etc.
+ait or at least 1# / (' minutes until you eel better- rechec. blood i
possible- i you do not eel better- ta.e more glucose and biscuits and wait
a urther 1# minutes.
, you continue to eel unwell / call or help and do not drive / i
considering using motorway emergency assistance- please remember you
may be unsteady on your eet- so ta.e extra glucose beore wal.ing.
Aar ,nsurance
The main potential danger o diabetes and driving is the possibility o having a
hypoglycaemic episode which could impair your judgement and lead to an
accident.
7ince the Disability Discrimination Act came into eect at the end o 1&&G-
insurers can only reuse cover i they have evidence o increased ris..
,t is virtually important to inorm your motor insurance that you have diabetes.
@our motor insurance may become invalid i
9
@ou ail to update them on changes to your treatment or physical condition
@ou ail to notiy the DC5A as mentioned previously
@ou ail to comply with DC5A restrictions or recommendations
Diabetes UK 7ervices has an exclusive service that will search through a panel
o insurers or the best 1uote- % reephone '"'' >=1 >4=1.
5ie Assurance B ,nsurance
7ome people experience diiculty getting lie cover. ,t is important that you
declare your diabetes when applying or a new policy. Any lie policy you hold at
the time o diagnosis is unaected.
Any diiculties ring Diabetes UK Aareline '"4# 1(' (&G'
0r write to Diabetes UK Aareline- 1'- :ar.way- 5ondon- E+1 >AA !operates a
translation service also)
Travel ,nsurance
*any travel insurance policies exclude pre%existing medical conditions such as
diabetes- you must chec. careully i your policy includes or excludes diabetes.
7ome insurance companies charge an extra I1' % I1# to include diabetes. ,t is
worth having a letter to this eect rom the insurers
Diabetes UK are continually expanding the service they oer. :lease see
relevant telephone lists at the bac. o this boo.let.
Diabetes and 2mployment
An employer cannot by law reuse to employ you or dismiss you purely because
you have diabetes- according to the Disability Discrimination Act !DDA1&&#).
Although most people with diabetes do not consider themselves to have a
disability- diabetes is covered by the Act.
Aertain proessions are exempt rom the DDA and can reuse to employ
someone with diabetes- especially i they are treated with insulin- these include
Air line crew
Armed services
10
0 shore wor.ers
Train drivers
Any wor. re1uiring 5DC and :AC
:olice orce
<owever- i diabetes is diagnosed whilst in this employment- it may be possible to
continue with some negotiable changes in your duties.
11