There are certain types of jobs that diabetes patients are not allowed to do, especially if they are on insulin. Dr Louise Johnson explains the jobs that fall in this category and further discusses other concerns that diabetes patients could have while in the workplace.
Pilot
A Type 1 diabetes patient can’t be a pilot, however, a Type 2 diabetes patient, only treated with metformin tablets, can. The reasoning behind this is other oral medications and especially insulin could cause a sudden drop in blood glucose. This is dangerous for not only the pilot but passengers and public on the ground.
Mining industry
As soon as diabetes patients who work in the mining industry go on insulin, it becomes dangerous to go underground due to the risk of hypoglycaemia.
Public transport drivers
Since the driver controls the vehicle (taxi, bus, train) that carries passengers from point A to point B, it can be risky if the driver experiences hypoglycaemia. It can also be dangerous, if the driver has high blood sugar as it may lead to drowsiness and possible accidents.
Other concerns
Safety shoes
Diabetes patients working in industries where safety shoes are a requirement, need to ask their doctor to write a motivation to wear special safety shoes, suitable for diabetic patients. This is of importance to prevent their feet from injuries, such as scratches, pressure points and ulcers. Since injuries on the foot of a diabetes patient can lead to deeper ulcers and infection.
If it is not treated correctly and the patient has impaired sensation (peripheral neuropathy), it can contribute to the development of an amputation should the wounds not heal. Diabetes patients with impaired sensation often complain of burning feet, especially at night. They are the high-risk group for feet problems.
Writing exams
Diabetes patients that are on the go with studies should discuss their condition with the lecturers or invigilators. They need to inform them that their blood glucose can go incredibly high due to stress, and can cause severe drowsiness and a diabetic ketoacidosis (high sugar coma).
Diabetic ketoacidosis is a condition where the sugar rises exceptionally high due to insufficient insulin in the body. The body’s metabolism changes from using glucose as substrate for energy to using muscle breakdown products, called free fatty acids. The result is difficulty breathing, abdominal pain, nausea, vomiting, and confusion. This is a medical emergency, and can lead to death if not treated urgently.
Hence, why the lecturer/invigilator should also allow the diabetic student to take a sugar snack, glucose test machine, and insulin into the examination room. This is necessary to correct low or high blood sugar immediately to prevent any acute complications. Additional time should also be allocated to the student during exams, should the student have a low blood sugar event as it takes up to 30 minutes for the brain function to return to normal.
Driving
For many South Africans, driving forms part of their work – either by driving long distances to get to work or driving being one of their duties. Diabetes can affect driving due to hypoglycaemia. The low blood sugar may result in transient cognitive dysfunction or even loss of consciousness.
In a simulator, it was shown that cognitive functions critical to driving, such as reaction times and hand-eye coordination are impaired during hypoglycaemia. People experiencing hypoglycaemia ignored road signs and did not keep to lanes3.
Diabetes can also affect driving due to chronic complications associated with diabetes. The bleeding diabetic eye with decreased vision and the patient with an amputated limb has more difficulty to drive. The same can be said of the diabetic patient that had a stroke.
Type 2 diabetes is often associated with sleep apnea (stop breathing intermittently). This is a condition where a person has excessive daytime sleepiness due to snoring and a severe interrupted sleep pattern at night, which can be dangerous if the person is driving. Sleep apnea can be associated with obesity. It is effectively managed with a continuous positive airway pressure (CPAP) machine that increases the pressures in the airways at night and prevents the sleep apnea.
Any diabetic that had a severe hypoglycaemic event should not drive for at least six weeks thereafter. A severe low blood sugar event is where a person needs the help of a third party or is hospitalised due to hypoglycaemia. They can start driving again after six weeks or only after their awareness of hypoglycaemia has returned4.
Type 2 diabetes
People with Type 2 diabetes can do most occupations, if they follow a rigorous healthy lifestyle and diet to prevent going onto insulin.
Insulin is currently still needed after about 10 years of Type 2 diabetes but there are a variety of new drugs on the horizon that may help stretch this period even longer. Always take your HbA1c (average blood glucose value) into consideration to prevent complications and stay on target.
Managing your diabetes and workday
In the normal course of a workday, diabetes should be taken into consideration. Midday meals should not be skipped. If a person works at a company with a canteen, it would be reasonable to expect the company to cater for people with diabetes. Scholars and students attending academic institutions have the same requirements for special low-glycaemic index (GI) meals. Ideally, these institutions should cater for these scholars and students and their special needs.
The 2015 International Diabetes Federation (IDF) stats show that one in eleven people have diabetes, while the number of people suffering from diabetes in Africa was 14,2 million. This means that there are many diabetes patients at any company or academic institution.
One should take into consideration that obesity has epidemic proportions and healthy food consumption can help curb the diabetes epidemic. The South African National Health and Nutrition Examination Survey (SAHANES) data show that one third of men and two thirds of women are currently obese in South Africa1.
The data shows accordingly in Type 2 diabetes – an unhealthy lifestyle plays a major role in developing Type 2 diabetes and 80-90% of Type 2 diabetes patients are overweight. Data also showed that if obese people loose 5% to 10% of their weight, diabetes could be prevented2.
Any company should screen employees for diabetes at least once a year, since early detection of Type 2 diabetes can be excellently managed with lifestyle management such as moderate exercise and weight loss.
References:
- Shisana O, Labadarios D, Rehle T et. al. (2014) ‘The South African National Health and Nutrition Examination Survey. ( SANHANES-1)
- Wing RR, Lang W, Wadden TA et. al. (2011) ‘ Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.’ Diabetes Care, 34(7) p1481-1486
- Cox DJ, Gonder-Frederick L, Kovatchev B et. al. (1993) ‘Driving decrements in type 1 diabetes during moderate hypoglycaemia.’ Diabetes, 42 p239-43
- SEMDSA Type 2 diabetes guideline expert committee. (2017) ‘The 2017 SEMDSA Guideline for the management of type 2 Diabetes.’ JEMDSA,22 (1)Supplement 1 (S1-S196)
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