Diabetes education booklet

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 of people with diabetes (85% - 90% will have Type 2 diabetes). The remainder will have Type 1 diabetes.
Diabetes Mellitus is a condition in which the amount of sugar in the blood is too high. When we eat a meal the starchy and sugary carbohydrates are changed into sugar (glucose ) during dijestion and this sugar then  passes into the bloodstream. When the pancreas senses that there is a rising level of glucose in the blood it secretes a hormone called insulin. Insulin changes glucose into energy which provides fuel for the body. Insulin is vital for life because without it, the glucose could not be changed into energy and the body could not function without energy. It is often said that insulin acts like a key – unlocking the cell to allow the energy in. Obviously, like a car, we only need a certain amount of energy to provide for the requirements of the body. If we eat more than we need this will be stored as fat.

Signs and symptoms of diabetes
·         Excessive thirst
·         Frequency in  passing of urine
·         Blurred vision
·         Loss of weight
·         Tiredness
·         Mood changes
·         Frequent infections e. boils, thrush etc


Types of diabetes

There are two main types of diabetes:
·         Type 1 ( used to be called insulin dependent ) affecting children and young adults mostly
·         Type 2 diabetes ( used to be called non insulin dependent ) is commoner in the over 40 year olds although children as young as sixteen and obese are alsodeveloping Type2 diabetes

 Main Aim of treatment
The main aim of treatment of both types of diabetes is to normalise blood glucose levels to protect against long term damage to the eyes, kidneys, nerves,
heart and all the blood vessels. Some experts call diabetes “a blood vessel disease”  because preventing narrowing of the blood vessels is key to preventing complications.


Type 1 diabetes

The exact cause of Type 1 diabetes is unknown but thought to be due to a viral infection or environmental factors. In type 1 diabetes there is total destruction of the cells in the pancreas  ( beta cells ) that produce the insulin. The onset of type1 diabetes is acute, because as stated earlier insulin changes glucose into energy but in the absence of insulin, glucose builds up in the blood and is not turned into energy. In an effort to overcome the lack of fuel for the normal functioning of the body, fats and proteins are broken down instead. This is why
patients are often underweight at diagnosis.
Once treatment with insulin is started the patient will begin to feel better quickly and will regain the lost weight.

Treatment for type1 diabetes
People with Type 1 diabetes will need injections of insulin for the rest of their lives. Insulin is destroyed by the gastric juices so cannot be taken in tablet form.
People with Type1 diabetes will need a minimum of two injections daily and often more. They will also need to eat a healthy diet and take regular exercise and do regular self blood glucose testing
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 2 diabetes

Type 2 diabetes occurs when the pancreas secretes less insulin than normal or when the insulin secreted fails to work properly (called insulin resistance). People who are overweight are five times more likely to develop Type 2 diabetes and four out of five people with Type 2 diabetes are overweight. Excess weight increases your body’s own glucose production and thus your body’s need for insulin too. At the same time, this extra insulin increases fatty acids stores and further increases insulin resistance. It becomes a vicious circle.
Type 2 diabetes is particularly associated with central excess weight ( apple shaped rather than pear shaped). Health risks increase when waist circumference is greater than 37inches (94cms) in men and 31.5 inches (80cms ) in women. Reducing calorie intake if you are overweight will help your body use insulin better by reducing insulin resistance.
You will find a whole section of this book devoted to healthy eating, weight control and exercise.

Type 2diabetes has a gradual onset. You may not feel any symptoms beyond a little tiredness which is often mistakenly attributed to age and working hard. As Type2 diabetes progresses  you may become aware of some of the signs already mentioned or you may be diagnosed  whilst being investigated for something else. It is suggested by experts that most people have had Type2 diabetes for at least five years before diagnosis.

The following people are at an increased risk of developing Type2 diabetes:
  • Family history of diabetes
  • Asian or Afro-Caribean origin
  • Women who have had gestational diabetes
  • Obese people
  • People who take little exercise
  • Older age
  • People on certain medications eg steroids, and some anti psychotic medications

Treatment for Type2 diabetes

People with Type2 diabetes will be encouraged to eat a healthy balanced  diet and take regular exercise. They will be treated with diet only for the first three months after diagnosis (unless their blood glucose is very high and they are losing weight). If diet and exercise alone does not control your blood glucose levels you may also need to take tablets.

Diabetes and Driving in UK

Having diabetes does not mean that you cannot drive as long as you doctor says you are safe to do so – this is usually when your diabetes becomes stable and controlled. You will however have to plan in advance before getting behind the wheel of your car if you are on certain tablets for your diabetes and/or taking insulin.

You must by law inform the Driver and Vehicle Licensing Agency (DVLA) if
  • Your diabetes is treated with tablets or insulin
  • If your treatment changes from tablets to insulin or if insulin is added to the tablets
  • If there are changes in your health or condition that may affect your ability to drive safely
  • If you are applying for a licence for the first time, you must answer YES to the question about diabetes.

People Treated with Insulin
After you have written to the DVLA informing them of your insulin treatment, you will be sent a form (called “Diabetic 1”), asking for more information and for the name and address of your GP/ Hospital Doctor. You will be asked to sign a consent form allowing the DVLA to contact the doctor directly for more specific information on your diabetes control, eyesight and general fitness to drive.
This does not mean that you will be refused a licence – it just ensures safety for you and other drivers. Please answer all questions fully and honestly.


People Treated with Tablets

After you have informed the DVLA that you have diabetes, they will send you a letter explaining your responsibility to re-notify them if you start having insulin or have “hypos” (low blood sugar), or if you develop any of the complications of diabetes which could affect your ability to drive.
They will not normally ask you any other questions at this stage and you will normally expect to keep your “till to” licence.

Diet alone Treated patients

No restrictions on driving and do not need to inform DVLA.

Restricted Licences
Insulin treated – a driving licence will be issued to you for one, two or three years if you are treated with insulin. Just before expiry date, you will receive a reminder to renew your licence and you will be asked to return your current licence. You will be sent another “Diabetic1” form to confirm your medical condition. Renewals of restricted licences are free.
Tablets or diet treated – usually issued with a “till to” licence. When you reach 70 years of age, you will be expected (like everyone else in UK) to renew it every one to three years. There is a charge for this renewal.

Provisional licences – applies to insulin treated only – need to be renewed every one, two or three years.

When renewing licences, it is always sensible to keep a copy of the old licence or to make a note of the driver number, before sending to the DVLA. The process takes between six – eight weeks unless there are complications.

If you drive a motorcycle the rules for informing the DVLA are the same as for a car.
Eyesight Problems
Obviously it is important to have good distance vision and good field of vision (what you can see side to side when looking straight ahead). There are various tests that an ophthalmologist can do to carry out to test these factors. Your licence may be revoked if you fail a field of vision test, but you can appeal against it. There are different types of field of vision tests, some people do better on one type versus another. The DVLA will accept the results of any approved type of test.

Large Goods Vehicles (LGV) and Passenger Carrying Vehicles (PCV)
In 1991 the titles of HGV (heavy goods vehicle) changed to LGV
                    And PSV (public services vehicles) changed to PCV.
People treated with diet alone or diet and tablets are normally allowed to hold LGV and PCV licences, provided they are otherwise in good health.

People treated on insulin are not allowed to hold these licences. If you currently hold such a licence and start using insulin you must inform the DVLA and stop driving the vehicle immediately.
In 1996, the regulation on larger vehicles was extended to include medium sized vehicles. Anyone passing their driving test after 31st December 1996 will only be given a licence to drive vehicles up to 3.5 tonnes.

Vehicles weighing 3.5 tonnes – 7.5 tonnes (Category CI ) and mini buses (DI) are now treated as Group 2 vehicles – normally there is a complete ban on insulin users obtaining a group 2  licence. However some CI licence holders can now apply for a medical assessment and can regain ability to drive these vehicles whilst on insulin. Please write to the DVLA for more information.

Taxis
The law does not bar insulin users from driving taxis, provided they are less than nine seats. As local councils issue licences the policy may vary in different parts of the UK. Some taxi authorities issue blanket restrictions. Please contact Diabetes UK and DVLC for more information.

Diabetes in Pregnancy (Gestational Diabetes)
If you need to commence insulin in pregnancy, you should notify DVLA immediately.
You will normally be allowed to continue driving but are recommended to stop if your control becomes unstable or if you do not have good warning signs of hypoglycaemia. You should re notify the DVLA six weeks after delivery if you are still on insulin, as your licence will need to be reassessed.
If you have problems relating to your driving licence, please discuss it with your diabetes team, who will be able to advise you. DVLA wish to issue licences, not to take them away – you can help by giving as much information as possible.

DO NOT DRIVE IF
·         You have difficulty recognising early signs of hypoglycaemia  (Section   )
·         You have started on insulin and your diabetes is not yet controlled.
·         You have problems with eyesight not corrected by glasses
·         You have numbness or weakness in your feet caused by nerve damage or circulation (neuropathy or ischaemia)
·         You have been drinking alcohol.

Precautions before Driving
  • Long journeys need careful planning, allowing for regular stops if you are on specific tablets for diabetes and insulin.
Normally it is wise to have something to eat every two to three and half hours if you are on insulin and not to miss meals and not to delay meals if you are on tablets and insulin.
  •  Test your blood sugar before driving and regularly during a long drive or if at work before you drive home at the end of the day or shift.
  • ·Always carry quick acting glucose and slow release carbohydrate in the car at all times if you are on insulin or specific diabetes tablets.
  • Always carry identification on your person and in the car stating your name, how your diabetes is treated and the name of your GP.

At the first sign of Hypoglycaemia
·         Stop driving as soon as it is safe to do so
·         Remove ignition key and move into passenger seat.
·         Immediately take glucose tablets or sugary drink (both may be required)
·         Follow this with slow release carbohydrate i.e sandwich, crisps, biscuits etc.
·         Wait for at least 15 – 20 minutes until you feel better, recheck blood if possible, if you do not feel better, take more glucose and biscuits and wait a further 15 minutes.
·       If you continue to feel unwell – call for help and do not drive – if considering using motorway emergency assistance, please remember you may be unsteady on your feet, so take extra glucose before walking.

Car Insurance
 The main potential danger of diabetes and driving is the possibility of having a hypoglycaemic episode which could impair your judgement and lead to an accident.
Since the Disability Discrimination Act came into effect at the end of 1996, insurers can only refuse cover if they have evidence of increased risk.
It is virtually important to inform your motor insurance that you have diabetes.
Your motor insurance may become invalid if
·         You fail to update them on changes to your treatment or physical condition
·         You fail to notify the DVLA as mentioned previously
·         You fail to comply with DVLA restrictions or recommendations
Diabetes UK Services   has an exclusive service that will search through a panel of insurers for the best quote,  - freephone 0800 731 7431.

Life Assurance / Insurance
Some people experience difficulty getting life cover. It is important that you declare your diabetes when applying for a new policy. Any life policy you hold at the time of diagnosis is unaffected.
Any difficulties ring Diabetes UK Careline 0845  120 2960
Or write to Diabetes UK Careline, 10, Parkway, London, NW1 7AA (operates a translation service also)

Travel Insurance
Many travel insurance policies exclude pre-existing medical conditions such as diabetes, you must check carefully if your policy includes or excludes diabetes.
Some insurance companies charge an extra £10 - £15 to include diabetes. It is worth having a letter to this effect from the insurers
Diabetes UK are continually expanding the service they offer. Please see relevant telephone lists at the back of this booklet.

Diabetes and Employment
An employer cannot by law refuse to employ you or dismiss you purely because you have diabetes, according to the Disability Discrimination Act (DDA1995).
Although most people with diabetes do not consider themselves to have a disability, diabetes is covered by the Act.
Certain professions are exempt from the DDA and can refuse to employ someone with diabetes, especially if they are treated with insulin, these include
·         Air line crew
·         Armed services
·         Off shore workers
·         Train drivers
·         Any work requiring LGV and PCV
·         Police force
However, if diabetes is diagnosed whilst in this employment, it may be possible to continue with some negotiable changes in your duties. 

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