Diabetes

What is it?

Diabetes is a common condition in which the body is unable to control the level of glucose (sugar) in the blood. Normally insulin, a hormone produced by the pancreas, allows glucose to move from the bloodstream into cells to be burnt as fuel. In diabetes, insulin production is reduced. There are two common types of diabetes. In Type 1 diabetes, insulin production is lost completely. Type 2 diabetes retains some insulin production but insufficient to control glucose adequately. The diabetic state therefore can range from relatively mild to life threatening.

How does it affect people?

Reduced control of blood sugar means that it can fluctuate over a much greater range than normal. High blood glucose is not usually an immediate problem. However, low blood glucose (hypoglycaemia or ‘hypo’) can cause a sudden attack of drowsiness and disorientation and progress to loss of consciousness. This most commonly occurs in people who are taking insulin, but it can also be a problem with specific combinations of tablets.

When a person starts on insulin treatment, they will be given instructions on how to recognise and self treat a hypo. This involves immediate administration of high sugar food / drink. Most diabetics will recognise a hypo early enough to manage this and prevent the attack, and must carry high sugar food at all times. This can be a problem in the longer term however as the ability to recognise a hypo can change and make them more difficult to manage.

Since diabetes is a lifelong condition, complications which develop over many years assume great importance. Given that the condition may start in young adulthood, these complications can become a problem during the working life and are not confined to the elderly. Reduced vision and even blindness, kidney disease and poor circulation affecting the feet are risks for people with diabetes.

How is it treated?

There is no cure for diabetes, but it can be controlled. This can be relatively simple in the mildest cases, by adjusting diet; however the vast majority of people with diabetes will need tablets or insulin replacement.

Tablets, known as oral hypoglycaemic agents, are taken daily and along with diet can allow very good control of blood glucose for some people. If insulin is required it must be administered by injection at least daily and sometimes more than once during the day, or continuously by a pump. Depending on the severity of the condition, the blood glucose may also need to be checked periodically by testing blood from a finger prick; this allows the person to tailor their insulin dose very precisely.

All people with diabetes are advised to maintain a healthy lifestyle and take regular exercise. Other acute illness, such as diarrhoea and vomiting, can upset normally good diabetes control.

How might it affect work?

Most people are able to control their diabetes very effectively and enjoy a normal lifestyle, including working normally. The treatment regime can usually be adjusted for shift work, although rapid rotations can be difficult. Occasionally some adjustments to work or working hours may be required, but most people who have diabetes can perform normal roles.

What do I need to do as the Manager?

If you have an employee who has diabetes you should discuss with them how best this can be managed at work. It may be necessary to make some adjustments to their work to minimise the risk to themselves and others. People taking insulin will require:

A clean, safe place where they can administer insulin / test blood / take breaks for this purpose
Predictable mealtimes to reduce the risk of hypos
Time off for medical appointments

You should also review the risk assessments for their work activities taking their condition into account. If this generates specific queries, contact Occupational Health for advice.

Diabetes & driving

The most significant problem for people with diabetes concerns driving. The Driver and Vehicle Licensing Agency (DVLA) rules are as follows:

People with diabetes treated with insulin must inform the DVLA of their condition. They will normally retain their ordinary driving licence (ODL) but may be required to reapply at least every 3 years (normally a licence lasts until the age of 70). This will depend upon them monitoring blood glucose levels regularly, being able to recognise a hypo and having good vision. In general they are not granted Large Goods Vehicle (LGV) or Passenger Carrying Vehicle (PCV) licences.

Most people with diabetes controlled on tablets or diet alone need not inform the DVLA, can hold an ordinary driving licence and a vocational licence provided that their vision meets the required standard. There are certain exceptions to this if specific tablets are taken in combination, in which case the driver should check with their doctor and/or the DVLA guidance. If the diabetes progresses and insulin becomes necessary, the vocational licence will be revoked.

Points to Remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks.

General guidance

If you require further information, refer to the general advice on managing attendance.