How does insulin work in the body?
Work
Can I undertake employment involving shift work?
Yes, certainly. Many people combine shift work with good control of their blood glucose. Shift work does, however, need a little extra care as most insulin regimens are designed round a 24-hour day. Shift workers usually complain that they are just settling into one routine when everything changes and they have to start again. It is hard to generalize about shift work as there are so many different patterns but, if you follow these rules, things should work out all right:
• Aim at an injection of short- and intermediate-acting insulin every 12-16 hours, or use a basal + bolus regimen. This way of giving insulin makes it much simpler to plan for shift work.
• Try to eat a good meal after each injection.
• Eat your normal snacks between meals every 3 hours or so, unless you are asleep.
• If there is a gap of 6 to 8 hours when you are changing from one shift to another, have some short-acting insulin on its own followed by a meal.
• Because your pattern of insulin and food is constantly changing, you will have to do more blood glucose measurements than normal, as you cannot assume that one day is very much like another.
• If your blood glucose results are not good, be prepared to make changes in your dose of insulin.
You will soon know more about your diabetes than anyone else! How can I cope with my diabetes if I work irregular hours as a sales rep?
Just as in shift work many people manage to combine an irregular lifestyle with good diabetes control. People who lead an erratic lifestyle usually find that the basal + bolus regimen gives them the freedom they require.
If you have had an injection of insulin in the morning and normally have fairly low blood glucose before lunch, then you will go hypo unless you eat at the right time. So a well-controlled person cannot afford the luxury of missing meals completely.
However, it is always possible for you to have a few biscuits or even a sweet drink if you are getting past your normal eating time.
The occupational hazard of all sales reps, with diabetes or otherwise, is the mileage that they clock up each year on the roads. The dangers of hypoglycaemia while driving cannot be overemphasized and there is really no excuse for this now that instant blood glucose measurement is available.
Remember:
• If driving before a meal, check your blood glucose.
• If it is low, eat before driving.
• Always carry food in your car and have some immediately if you feel warning of a hypo.
Should I warn fellow employees that I might be subject to hypos?
Definitely. Hypos unfortunately can happen, especially when a person first starts using insulin. Warn your workmates that, if they find you acting in a peculiar way, they must get you to take some sugar. Warn them also that you may not be very cooperative at the time and may even resist their attempts to help you.
Some people find it difficult to admit to their colleagues that they have diabetes but, if you keep it a secret, you run the risk of causing a scare by having a bad hypo and being taken to hospital byambulance for treatment. A needless trip to hospital should be avoided.
My husband’s hours of work can be very erratic. Sometimes he only gets 3 or 4 hours sleep instead of his normal 8 hours. Can you tell me what effect lack of sleep has on diabetes?
Lack of sleep in itself will not affect diabetes although, if your husband is under great pressure, his blood glucose may be affected. The real problem with working under a strain is the tendency to ignore diabetes completely and assume that it will look after itself. Unfortunately a few minutes of each day has to be spent checking blood glucose, eating a snack or giving insulin. These minutes are well spent.
I developed diabetes 5 months ago, 1 week after I had started a new job. I am coming to the end of my 6-month probation period and have been given two weeks’ notice because of my diabetes. They said I could not do shift work because of my diabetes. Could you help?
This is a sad story and a good example of ignorant prejudice against people with diabetes. Of course there are many people on shift work who maintain good control – although it does require a bit of extra thought. You may well have a case under the Disability Discrimination Act and you should seek advice from your local Citizen’s Advice Bureau.
I am a pub manager and have had diabetes for the past 19 years but my employers are now making me redundant. Apparently, their insurers cannot accept me for a permanent position owing to my diabetes. Who can help strengthen my case?
We know of several publicans with diabetes who run good pubs and still keep their diabetes under good control. However, people who work in licensed premises are at greater risk of drinkingmore alcohol than average and heavy drinkers are in danger from hypos (see the section on Alcohol later in this chapter). We wonder if you have been having frequent hypos, which has made it difficult to continue in your present occupation. Ask your clinic doctor and Diabetes
I have been refused a job with a large company because of my diabetes. Have I sufficient grounds to take proceedings against them for discrimination?
The Disability Discrimination Act covers people with diabetes but it can be difficult taking a company to court. We know this sort of discrimination does sometimes happen, especially in large organizations, although, of course, it is very difficult to prove. It may be possible for your case to go to an industrial tribunal to see if there are grounds for unfair dismissal but, as it sounds as if you have been refused a new job rather than dismissed from an existing job, then this could be difficult. The support of your own diabetes team will be important if you wish to take proceedings under the Disability Discrimination Act.
Diabetes
