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Diabetes - Daily Living Activities

Diabetes and Lifestyle Considerations

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Identification

All people with diabetes should be advised to carry some form of identification indicating the nature of their treatment in case of emergency.

Those on insulin should be issued with an insulin passport and carry the appropriate insulin card(s) at all times.

In addition bracelets and necklaces can be obtained from:

Medic-Alert Foundation

Medi-Tag

12 Bridge Wharf

Medi-Tag Department

156 Caledonian Road

Hoopers, 37 Northampton Street

London

Birmingham

N1 9UU

B18 6DU

Tel 071 833 3034 

 

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Alcohol and Diabetes

Alcohol can be consumed safely in moderation however certain special considerations need to be observed. These are:

Effect of alcohol on glucose control both hypoglycaemia & hyperglycaemia.

Impaired perception of hypoglycaemic symptoms

Effect on weight

Other effects

 
   
 

Consider advising the following

 
 

Your judgement may be affected when you drink. You may not recognise that your blood glucose levels are low. Make sure that your friends know about hypos.

 
 

Hypoglycaemia and drunken behavior can be confused with each other. Always wear or carry diabetes information (a bracelet, necklace or ID card).

 
 

Keep to sensible drinking levels.

 
 

You could alternate an alcoholic drink with a low calorie mixer.

 
 

Don't drink on an empty stomach - enjoy a meal before or with your drink.

 
 

You may need to eat a bigger, starchier meal and adjust your insulin before you drink.

 
 

Don't skip meals or substitute alcohol for meals.

 
 

Eat little and often if you are drinking.

 
 

Always carry glucose tablets or sweets with you.

 
 

Remember hypos can happen some hours after a drinking session. Check your blood sugar level and always have a snack before you go to sleep.

 
 

Check your blood glucose level in the morning too.

 
  

 

Hypoglycaemia

When blood glucose levels drop, the liver usually begins to produce glucose from stored carbohydrates to compensate. But drinking alcohol blocks the liver's ability to produce glucose.

Therefore for those at risk i.e. people with diabetes treated with insulin or sulphonylureas, alcohol can exacerbate the dangers of hypoglycaemia.

Symptoms of hypoglycaemia and drunkenness can be confused with each other. Third party intervention for the treatment of hypoglycaemia may be delayed. It is advisable that some form of ID be carried indicating that they have diabetes.

See - Hypoglycaemia

Hyperglycemia

Certain alcoholic beverages and mixers contain high levels of sugars such as Alco pops, cider, some beer, liqueurs, fortified wines etc.

Impaired Perception of Hypoglycaemia

Higher brain function such as judgment and co ordination is affected. Patients therefore become less aware of their hypoglycemic symptoms and the ability to self treat can be affected.

Effect on Weight

Alcohol is high in calories (see calorie table) e.g. a pint of ordinary beer contains 180 calories. The misconception that beer is a safer alcoholic beverage because of its relatively low alcohol content, may lead to the consumption of large quantities without realizing its effect on total calorie intake. Heavy drinkers can become overweight.

Other Effects

Alcohol in excess can lead to raised triglycerides as can poorly controlled diabetes. The combination therefore can cause dangerously high levels predisposing to acute metabolic crisis such as acute pancreatitis. People with diabetes who have high triglycerides should avoid alcohol.

Alcohol can damage nerve cells. Therefore accelerating diabetic neuropathy, causing pain, numbness, tingling or burning sensation and erectile dysfunction.

Other Information about Alcohol

Extra strength lagers contain much more alcohol than ordinary lagers.

Low alcohol beers, lagers and ciders vary enormously in their alcohol content. They can be virtually alcohol free (0.05%) or contain 1/3 the amount of alcohol as similar drinks of ordinary strength. Low alcohol drinks tend to be higher in sugar than ordinary strength drinks.

Low sugar beers and lagers are higher in alcohol content and are not recommended (e.g. Diet Pils), especially for those on insulin

Choose ordinary varieties of beer or lager.

Keep to sensible drinking limits - see chart.

  
What are Sensible Drinking Limits?
     
 One unit of alcohol equals:CaloriesABV 
 Half a pint of beer, lager or cider903-3.5% 
 1 pub measure of spirit (rum, gin, whisky, vodka)5038% 
  (In Scotland a pub measure is 1½ units!)   
 1 small glass of sherry5516% 
  1  medium glass of wine

130

11-14%

 
 1 pub measure of aperitif or liqueurvariesvaries 
     
 

 

 

 

 

 

A sensible drinking limit for people with (& without) diabetes is

 

 

For Men:

No more than 3 units per day = 21 units per week

 

 

For Women:

No more than 2 units per day = 14 units per week

 
   

 

Binge drinking even within the weekly limit can cause gross acute instability in glucose levels and this should be discouraged.

 
    
 

General Advice

Alcohol is not advised during pregnancy. It could harm the baby.

One or two alcohol-free days a week are a good habit for everyone.

Do not drink and drive

  

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Smoking and Diabetes

Smoking increases the risk of developing both macro and microvascular complications. It particularly accelerates cardiovascular complications. It is also an independent risk factor for diabetes.

Therefore:

People with diabetes should be advised not to smoke.

Discussions of the dangers of smoking should be explained in consultations and educational programmes.

Smoking cessation should be included in all diabetes management and educational programmes. For Information Leaflets - click here

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Employment and Diabetes

People with diabetes can undertake most employment opportunities however there are aspects to be considered

Hypoglycaemia risks and restrictions of employment

Effects of employment on self management

Co existing complications

Although there is no legal requirement to inform their employer, people with diabetes should be encouraged to do so.

Hypoglycaemia risks and restrictions of employment

Since 2004, it is against the law for any employer (apart from the armed forces) of any size to discriminate against a person with diabetes because of their condition. Everyone should be assessed on their own merits and should not be subjected to blanket bans.

However there are still restrictions in place for ambulance drivers, and for jobs involving driving Large Goods Vehicles or Passenger Carrying Vehicles (see driving regulations (DVLA Guidance).

Certain jobs which are hazardous should be considered carefully particularly in those prone to hypoglycaemia or hypoglycemic unawareness.

Effects of employment on self management

Jobs with irregular schedules can make effective self management very difficult. For example it may be helpful to enquire about the following:

Shift work

Meal breaks

Driving

Unpredictable physical activity

Work environment  limiting self management  regarding insulin injections, self monitoring and hypoglycaemia treatment

Patients some time need specialist support or advocacy to manage these situations.

Co existing complications

In the presence of certain diabetes complications it may be necessary to advise against certain jobs or review existing jobs if complications arise.

Steel capped footwear places neuropathic patients at very high risk of ulceration unless made to measure.

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Driving and Diabetes

These guidelines were correct as at May 2013; driving regulations may change; you are advised to check the DVLA website for up to date information.

Legal responsibility

Only those patients treated with insulin or hypoglycaemic agents (OHA’s) need to inform the Driver and Vehicle Licensing (DVLA) that they have diabetes.

The DVLA need not be informed if treatment is with ‘diet and exercise’ alone but DVLA must be informed if treatment is started with OHA’s or if there is a change from oral agents to insulin. The DVLA must also be informed if any new medical problems or diabetic complications develop which may affect the safety of driving

Those treated with insulin will be sent a Diabetic 1 form which will ask for further details including the name of their GP or hospital physician and for consent to approach that doctor directly for information if necessary. (See patient information leaflet at end of guideline).

As the regulations for driving are subject to change we recommend that you consult the DVLA or diabetes UK websites for up to date information,

UK Government Website on Diabetes & Driving

Diabetes UK Guide to Driving Website
PDF File Diabetes UK / Profession Information Sheet / Driving & Diabetes
PDF File Diabetes UK / Patient Information Sheet / Driving & Diabetes
PDF File Trend Driving Leaflet for Patients

Taxi Driving

This is at the discretion of the Local Authority; at present both Luton and Bedford allow patients with diabetes to work as taxi drivers including those on insulin. 

Hypoglycaemia

The main potential danger of diabetes and driving is the risk of hypoglycaemia for those treated with insulin, sulphonylureas (or prandial glucose regulators / glinides).

In order to avoid hypoglycaemia patients at risk should be advised:

Do not drive if blood glucose is less than 5mmol/l or have symptoms of hypoglycaemia.

Always to carry fast-acting carbohydrate in the car e.g. glucose tablets or sugary drink and some slow-absorbing carbohydrate e.g. fruit or cereal bars.

Not to drive for more than two hours without eating a snack.

To check blood glucose levels before and during a long journey (always carry blood testing equipment).

To carry medical identification.

If symptoms of hypoglycaemia do occur patients should be advised to:

Stop driving as soon as it is safe to do so.

Immediately take a glucose drink or tablets.

Remove the ignition key and move into the passenger seat to avoid any suggestion that you are in charge of the car.

Not to drive again until 45 minutes after blood glucose has returned to normal.

Drivers with diabetes should know that if they have an accident attributable to hypoglycaemia they render themselves liable to the charge of driving under the influence of drugs.

See - Hypoglycaemia

Visual Standards

Visual standards relating to driving are those applied generally.

Car Insurance

Diabetes must be disclosed either at a start of a new policy or at the time of diagnosis. Changing treatment or the development of new complications should be disclosed; check with individual insurers for exact requirements.

Failure to notify the insurer and the DVLA will invalidate cover in the event of a claim.

Link to
Diabetes UK :Tel: 08451202960
DVLA:Tel: 08702400009  

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Travel and Diabetes

Those with diabetes can travel anywhere in the world but with extra preparation and some special considerations are required including:

Taking adequate supplies of medication and testing equipment especially if travelling to more exotic destinations as replacements may be unavailable or expensive

Obtaining adequate health insurance. Care should be taken to ensure that 'pre-existing' conditions are covered by the policy. In EEC countries basic medical care can be obtained on a reciprocal basis if an EHIC is obtained prior to travel.  This does not remove the need for private insurance.

Avoiding exposure of insulin to extremes of heat (>25OC) or cold (<4OC) as this can damage the insulin

Wearing medical ID

Normal vaccination and malarial prophylaxis precautions should be taken.

Changes in activity pattern, food and temperature may alter blood glucose control: testing is essential!

Additional considerations when travelling by air

Carry a letter from their GP or Diabetes Centre confirming the need to carry insulin delivery devices, needles, blood glucose testing equipment and hypo treatment at all times. This should be presented to the airport security. This is now a security requirement.

Keep all insulin, testing equipment, hypo treatment in hand luggage. Checked luggage can be left outside in hot temperatures and will be exposed to very cold temperatures in the cargo hold of the aircraft. Additionally problems might arise if there is a flight delay or the baggage is lost. Ideally two sets should be carried in two pieces of hand luggage to avoid loss or theft.

It may be advisable to contact the diabetes specialist team for advice and guidance if patients are going on long-haul flights (crossing time zones). In general extra insulin injections may be necessary on westerly flights and dose reductions on easterly ones. Individual advice will vary according to the time of take-off, landing etc and with the length of the flight.

Diabetes UK have series of travel guides and information.

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Benefits and Diabetes

(From NHS Choices website)

People with diabetes that is controlled by medication are entitled to free prescriptions and eye examinations. Some people with diabetes may be eligible for disability benefits and incapacity benefits, depending on the impact of the condition on their lives.

The main groups likely to qualify for welfare benefits are children, the elderly, those with learning disabilities or mental health problems, and those with diabetic complications.

People over 65, who are severely disabled, may qualify for a type of disability benefit called Attendance Allowance.

Carers may also be entitled to some benefit too, depending on their involvement in caring for the person with diabetes.

Your local Citizens Advice Bureau can check whether you're getting all the benefits you're entitled to. They, as well as your diabetes specialist nurse, should also be able to provide advice on filling in the forms.

Want to know more?

Find out more about benefits for people with diabetes from Diabetes UK.

Understand disability benefits with DirectGov.

Understand the Attendance Allowance with DirectGov.

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Useful External Resources and Links

View

Claiming Benefits - Diabetes UK Guidance

General overview to the benefits available for patients with Diabetes.

View

DirectGov

View

NHS Choices - Living with Diabetes

View

Diabetes UK section on driving

View

DVLA guidance on diabetes and driving

PDF File

Trend Driving Leaflet for Patients

PDF File

Diabetes UK / Profession Information Sheet / Driving & Diabetes

PDF File

Diabetes UK / Patient Information Sheet / Driving & Diabetes

View

Smokefree Bedfordshire

View

 Luton Stop Smoking

PDF File

Bedford Smoke Free Leaflet
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