10. Living with diabetes

Advice and guidance on a variety of topics to help you live with diabetes.

Concessions

• If you are taking medication for diabetes you are entitled to free prescriptions, ask your pharmacist or GP for an exemption certificate
• You are entitled to a free eye check every year

Dental care

Remember to tell your dentist that you have diabetes. Regular check-ups and early treatment are important as dental infections may affect your diabetes control.  There are no concessions for people with diabetes for dental care.

Pregnancy and diabetes

It is important to plan your pregnancy.

Having diabetes increases the risk of problems during pregnancy. Preconception care and good blood glucose control before and during pregnancy can reduce these risks. Poor blood glucose control at the time of becoming pregnant increases the risk of developmental problems for the foetus.

Your HbA1c should be less than 48 mmol/mol, if  it is safe for you to aim below this target level. Any reduction in HbA1c may reduce the risks. If the HbA1c is above 86 mmol/mol pregnancy should be avoided. It is important to avoid an unplanned pregnancy.

• Diabetic eye and kidney complications can become worse in pregnancy.
• Some medications used in diabetes care are not recommended in pregnancy e.g. Metformin is the only diabetes tablet used in pregnancy.
• Some medications for blood pressure control are not used in pregnancy.
• Statins must not be used.
• It is important to start taking the vitamin Folic Acid before pregnancy. When you have diabetes you need a higher dose of Folic Acid 5 mg which needs to be prescribed by your GP.

Care before pregnancy should include a review of your diabetes management. It is especially important to have good blood glucose control before you stop using contraception. Any method of contraception can be used unless you have been advised otherwise by your GP. Methods that are effective and reliable reduce the chance of unplanned pregnancy. Plan your pregnancy.

Operations and diabetes

If you are having an operation your blood glucose needs to be well controlled. Your HbA1c should be checked when you are referred to the surgeon and then every three months until you have had your operation.

Diabetes and employment

Diabetes does not have to make a difference to your work. To prove this to your employer, your diabetes will need to be well controlled and you must be able to adjust your treatment to suit your working life. You may find you need specific advice in relation to your particular job.

Points to consider in relation to work:

• When applying for a job, if there is a health section on the application form you should state that you have diabetes. If your diabetes is well controlled you may wish to add this on the form. It is important to be honest.
• Following the diagnosis of diabetes let your manager and human resources department know.
• You should consider telling your colleagues about your diabetes as you may need their assistance if you are unwell at work such as if you go ‘’hypo’’ (see section 5).
• For people using insulin there are restrictions in place for some occupations. For up to date advice contact Diabetes UK Careline (see section 12) or diabetes.org.uk.
• Discuss any employment concerns you have with your healthcare professional.

Discrimination at work

Lack of understanding about diabetes can still lead to discrimination in the workplace based on prejudice and lack of information.  The Disability Discrimination Act 1995 makes it illegal for employers to treat people with disabilities differently from other employees. Although most people with diabetes do not consider themselves as disabled, diabetes is covered by the Act. If you consider you are being discriminated against you can contact your union, Citizens Advice Bureau or Diabetes UK Careline (see section 12 – Appendices).

Driving

Having diabetes does not mean that you have to stop driving unless you have diabetes complications which could affect your ability to drive safely. Such problems could be due to loss of vision, nerve damage in the feet or ‘’hypo’’ problems.

Notifying the Driver and Vehicle Licensing Agency (DVLA)

• You do not need to inform DVLA if your diabetes is treated with diet and exercise alone.
• If you are taking non- insulin medication for your diabetes management you may need to inform DVLA according to the type of licence you hold.
• If you are on insulin you are required by law to inform the DVLA. There are specific restrictions if you are a Group 2 Driver (Bus or Lorry) or have a C1 licence.

For more information please contact the Driver and Vehicle Licensing Agency (DVLA) or the Diabetes UK Careline (see section 11).

DVLA guidance as of 2012 recommends that drivers check blood glucose levels within 2 hours of commencing driving. Please contact your healthcare professional for advice about blood glucose monitoring and appropriate treatment of hypoglycaemia whilst driving.

Insurance

Motor insurance

When applying for motor insurance you must declare that you have diabetes even if you are not asked about this. You should inform your insurance company of any changes to your treatment or your condition. Not doing this could mean you are not covered. Insurers can only charge you more or refuse you cover if they can prove you have increased risk.

Life insurance

You must declare your diabetes when applying for a new insurance policy. Any life insurance policy you hold at the time of diagnosis is unaffected.

Travel insurance

You must inform your travel insurance company that you have diabetes and what medications you are taking.  You are likely to have to pay a higher premium as most insurance policies do not cover pre-existing conditions.  Ensure the policy you chose covers your medical conditions.

Diabetes and travel

When travelling you need to consider:

Medication

Carry medication in your hand luggage to ensure it is not lost

• Make sure that you have enough medication and blood glucose/ketone monitoring equipment to cover the time away and to allow for a delayed return.
• Remember to pack your usual travel sickness and diarrhoea treatments
• If you are on insulin:
  • You will need a letter from your GP verifying that you have diabetes so that you can explain at customs why you are carrying insulin, delivery devices and needles.
  • Check with the manufacturer what insulin will be available in the country you are visiting. The names and strengths of insulin can be different from in the UK
  • Insulin should be kept cool (below 25 degrees centigrade) and out of direct sunlight. Cool bags can be bought for use when travelling. Any insulin kept out of the fridge must be used within 28 days. Insulin should not be allowed to freeze, and so should not go in the hold of the plane.
  • Insulin can be absorbed quicker in hotter countries so regular blood glucose testing is important to avoid hypos. Remember to keep hypo treatment to hand at all times
  • It is a good idea to check with your accommodation where you can store your medication before you travel.
  • The BD Safe-clip device available on prescription can be used to clip and store used needles/ small travel sharps box

Diet

• Have some healthy snacks with you in your hand luggage and in your suitcase and hand luggage for long flights.
• It is usually better to avoid “diabetic meals” on planes as they are often low in carbohydrate rather than providing a balanced meal.

Feet

• Make sure that you have comfortable, well-fitting shoes in case your feet swell in hot weather.
• Avoid going barefoot, particularly on the hot sand and in the sea. Make sure you do not get sand in your shoes.

 General

• Arrange to have any necessary vaccinations or malaria tablets before you go. Your practice nurse can advise you about this. Vaccinations may upset your diabetes control in the short term.
• Check what to do if you are travelling across time zones. You can discuss this with your GP or diabetes specialist nurse once you have booked your travel.
• Get travel insurance, make sure it is going to cover your needs
• If travelling in European Union Countries take your European Health Insurance Card. This does not replace travel insurance. To apply for a card go to ehic.org.uk or call 0300 330 1350.
• Carry plenty of bottled water to make sure you drink safe water regularly.
• Look up how to say “I have diabetes” in the language of the country you are visiting and carry your diabetes ID card/insulin passport/insulin ID card with you. If taken ill on holiday never stop taking your insulin or tablets even if you cannot take solid foods.

Discuss any concerns you have about travelling with your GP or specialist nurse.

Social life

Your social life should not change much as long as you plan ahead and have a contingency for emergencies. This means making sure you are well organised and prepared. It is not always easy to be spontaneous, however gradually you will get to know what you can and cannot do without planning in advance. If you have a car, ensure you keep an emergency box in the car with some glucose tablets, packet of biscuits or crackers, bottle of water, Lucozade etc. Whenever you are out and about remember to carry your hypo treatment with you.

Make sure you tell your friends and family about your diabetes and what your needs are. This will help then to help you and be considerate if you say “I need to stop for something to eat” or “I think I’m having a hypo”.

Eating with friends

Friends and family can sometimes worry about what they should serve you. Reassure them that you do not need a special diet, you just need to be a bit more careful about the sugar content of the food. To reassure them you could discuss the menu and you may be able to suggest any changes that suit your needs.

If on insulin or a Sulphonylurea see section 5 – Monitoring your blood glucose and:

• Make sure you know when you are going to eat so that you can plan your other meals around it.
• If the meal is late, ask for/have with you something starchy to keep you going.
• If eating out try to look at the menu before going, most are available online.