Questions and answers

Some questions come up time and again when people find out that they have diabetes – here are the answers to some of the most common ones.
 

• Will I lose my driving licence because I have diabetes?

The short answer to this question is no. However, you do have to let the DVLA (Driver and Vehicle Licensing Agency, see page 147), at Swansea know when your diabetes is first diagnosed, unless your treatment consists of diet alone. You’ll find the address on your licence. The DVLA will issue you with a three-year licence; then, on the anniversary of renewal, you’ll get a questionnaire from them to fill in. Depending on circumstances, you may be asked to see your GP or local diabetes clinic for a brief medical examination before your licence is renewed. You must be fully aware of hypoglycaemia and meet all required visual standards. Patients who have had extensive laser treatment should check at their eye clinic if they meet the requirements.

From January 1998, a European Community Directive on driving regulations came into effect. Motor vehicles are divided into four categories: categories A and B include motorcycles and motor vehicles under 3.5 tonnes in weight. These categories are not affected by the new regulations for patients with diabetes.

However, categories C (motor vehicles over 3.5 tonnes but under 7.5 tonnes) and D (motor vehicles used for carrying passengers with more than eight but fewer than sixteen seats) will require a medical questionnaire to be completed. This has the same standards as the current LGV (large goods vehicle) and PCV (passenger-carrying vehicle) licences and patients needing insulin will normally be excluded from driving vehicles in these classes, unless they were on injections before the rules came into effect.

Diabetes UK has been able to negotiate a concession for category C licence applications for people on insulin. There is an application pack available from the DVLA. A medical examination is required and you would be expected to pay for this (possibly up to £94). If you satisfy the requirements they will send you a further medical questionnaire and you will need a second medical examination from a specialist, which may cost up to a further £100.

If a licence is awarded you will need annual assessments but should not incur any costs for these. Unfortunately no concession has been granted for category D except on a voluntary basis. You can drive a vehicle that weighs less than 3.5 tonnes and has no more than 16 seats, provided that it is strictly on a ‘not for hire or reward basis’, you are aged between 21 and 70 years, and you have had a category B licence for at least 2 years. The law does not bar insulin users from driving taxis with fewer than nine seats, but many local taxi-licensing authorities do impose restrictions.

As well as the DVLA, you need to let your motor insurance company know if your diabetes develops while the policy is in force. Some companies tend to load premiums for drivers with diabetes and, if this happens to you, contact Diabetes UK (address on page 147) for their list of insurers offering preferential rates for drivers with the condition.

The DVLA has just issued advice for drivers on insulin. They require them to test before driving and at least every two hours if on a long trip. They advise that you should not drive if your glucose is below 4 mmol/l (‘four is the floor’). If it is between 4.1 and 5.0 mmol/l they suggest a carbohydrate snack or meal before setting off. If you experience hypoglycaemia when driving, you should pull over, switch off the engine and leave the vehicle, as well as take carbohydrate to raise blood glucose levels.

• Can I still enjoy a normal sex life?

Unless a man with diabetes has impotence problems (see page 117), there is no reason why your sex life should be affected in any way and having diabetes makes no difference to a woman’s fertility (see page 94). It’s worth pointing out, however, that sexual intercourse is a vigorous activity and so could cause your blood glucose level to drop and precipitate a hypoglycaemic reaction in people on insulin, sulphonylureas or glitinides.

• Can diabetes affect my job?

It depends to some extent on what you do. The main factor to consider, if you are on insulin or sulphonylureas, is what the consequences would be for both yourself and your colleagues if you suffered a hypoglycaemic reaction. For this reason, you would have to think carefully about whether to take up a job that involves physical hazards – such as working at heights like a steeplejack or scaffolder – or other dangers, in the police or ambulance services, for example. However, if you were already employed in one of these areas when your condition was first diagnosed, you may be able to carry on if your diabetes is well controlled and you rarely experience hypoglycaemic reactions.

Whatever you do, it is important to tell your employer and your colleagues that you have diabetes, however tempting it might be to keep quiet. It could be very embarrassing and possibly dangerous for you and everyone else if you were to have a hypoglycaemic reaction and no one recognised it or knew what to do.

If you experience difficulties with your job or feel that you might be experiencing discrimination, please contact Diabetes UK for advice. They may be able to put you in contact with individuals or groups who can help. There are new guidelines recently published from professional bodies representing the police and fire services and these are available from Diabetes UK.

• Will my children get diabetes?

For patients with type 1 (insulin-dependent) diabetes, there is a small but increased risk of their children also being affected. For unknown reasons, this is more likely if the father has diabetes. If both parents have diabetes the risk is increased further. At present estimates the risk for a child with one parent with diabetes is around 5 per cent and if both parents have the condition it may be as high as 15 per cent.

For type 2 diabetes (non-insulin dependent), the situation is much less clear. Some families with special types of diabetes have a very high risk of inheritance. These are, however, a very small minority and, for most patients with type 2 diabetes, the risk cannot be determined with any accuracy.

• Will I go blind or have kidney failure with diabetes?

As there is a tendency for diabetes to run in families, many patients have direct experience of relatives or acquaintances who have had severe complications from diabetes. As far as eye and kidney problems are concerned, these affect only a minority of patients and the risks of developing problems can be greatly reduced with careful control of blood glucose.

There are also many new treatments available for both eye and kidney complications that can prevent progression or deterioration, provided that the problem is picked up at an early stage. This is why it is critical that patients with diabetes receive regular check-ups.