Personal Problems
Smoking
Smoking reduces glucose tolerance and sensitivity to insulin and increases the risk of developing type 2 diabetes. Like diabetes, smoking is an important risk factor of disease of arteries and enhances blood clotting. It disturbs control of blood glucose and is related to diabetic kidney and retinal disease. It is strongly associated with many other health hazards and increased morbidity and mortality.
By suppressing appetite and increasing energy requirement, smoking reduces weight. Many diabetics fear that they will gain weight if they stop smoking. Though, such a weight gain often occurs after cessation of smoking, it can be anticipated and treated with dietary advice. Benefits of cessation of smoking are far more than the harmful effect of weight gain.
Employment
Problems of employment arise mainly in a young diabetic, seeking a new job. Many employers are concerned that diabetics may have more absenteeism, disability or may retire prematurely and hence are reluctant to employ them. Well controlled diabetics have a good work record and some well motivated diabetics can actually have a better work record than their non diabetic peers. People with mild diabetes or well controlled diabetes should not be put in the same category as that of severe and grossly uncontrolled diabetes. But prejudices die hard. Despite laws, discrimination against diabetics, seeking employment, has been reported from many countries.
An employed diabetic should not have any difficulty in holding a job barring disability due to serious complications of diabetes. Many diabetics have achieved eminence in commerce, industry, education, administration, medicine, politics, judiciary etc. IN general, steady jobs with regular hours of work, meal and rest are suitable for persons with diabetes. Irregular hours of work, frequent changes of shifts and especially night shifts, and frequent touring can pose problems for diabetics, especially if they are on insulin. Even these problems are not insuperable if the diabetic has understood the principles of diet, the actions of different insulin preparations and prevention of hypoglycaemia. Diabetics controlled by diet alone or by oral drugs should not have difficulty in carrying out most jobs. In Israel, even insulin taking diabetics have not been rejected from serving in the armed forces.
A diabetic taking insulin is not allowed to drive a public vehicle, operate cranes, work at heights or with heavy and unprotected and moving machinery, oil rigs, with incinerators and in coal mines. He/she will not be selected in the police, fire brigade or armed forces.
A diabetic should not conceal the disease if asked whether he/she has any health problem. The chances of being rejected on medical grounds are less if diabetes is well controlled. A young diabetic should have good education and develop some skill, so that he/she is not forced into manual labour.
Life Insurance
Diabetes should be disclosed to the insurer. Failure to do so will lead to nullification of the contract and the liability of the insurer, in case of any claim. As a result of an increase m the life expectancy of diabetics, the policy of insurance companies as regards underwriting of diabetics has become more liberal in recent years. The Life Insurance Corporation of India and other insurance companies consider certain diabetics for the issue of endowment insurance policies for the insurance, the extra premium charged, depending on the merits of the individual case. A diabetic should approach different insurance companies for a suitable insurance plan. A diabetic likely to be accepted for life insurance is the one who has fulfilled the following requirements.
Age up to 65 years.
Well controlled diabetes. Serum cholesterol and triglycerides within normal limits.
Absence of damage to target organs.
The insurers consider overweight persons or person with an impaired glucose tolerance. The insurance companies may suggest alternate plans in individual cases.
Driving
A high blood glucose level can give rise to a temporary blurring of vision. Eye complications arising from diabetes and laser treatment of retinal disease may impair vision and preclude driving. The involvement of the nerves of the lower limbs can result in defective sensations and reflexes. A defective circulation in legs may occur in diabetes. Hypoglycaemia can give rise to confusion, changes in mood and behaviour and impaired judgment, blurring of vision and even fainting. All these diabetes related problems can make motor driving hazardous for a diabetic as well as for others using the road.
A newly diagnosed diabetic, especially one treated with insulin, should not drive until blood glucose is stable. A diabetic should not drive a car or a motor cycle unless he/she is able to recognise the symptoms of hypoglycaemia and knows its prevention and management. A long motor car journey should be well planned. During a long journey, a diabetic may omit or postpone meals and develop hypoglycaemia. Physical exertion involved in repairing the vehicle may also produce hypoglycaemia. A diabetic driving a vehicle should have some glucose or sugar in the car or on his/her person and diabetes identity card. A diabetic on insulin or tablets should have a meal containing carbohydrates within two hours before starting the journey and should take 20 g carbohydrates every two hours while driving. He should not drink alcohol before and during travel. Blood glucose should be monitored during long travel. If a diabetic develops warning signals of hypoglycaemia, he/she should stop driving, switch off the engine, come out of the vehicle and should not drive again for one hour after the reaction has subsided.
A diabetic with an impaired vision or weak or unsteady legs should not drive a vehicle. Since hot pedals may injure the insensitive feet, diabetics should not drive barefoot.
There are great differences in licensing regulations in various countries.