Patients treated with insulin

There are more limitations here because of the greater risk of hypoglycaemia. People with insulin-treated diabetes are not permitted to join the armed services, police, or fire service, become professional divers, work on an offshore oil rig, become merchant seamen, drive large goods vehicles or passenger-carrying vehicles, or control trains or aeroplanes. They may also be barred from working in some high-risk areas alone (e.g. supervising an electricity generating station or substation, signalman). Jobs in which hypoglycaemia could be fatal, such as steeplejack or scaffolder, or in which a hypoglycaemic person could be injured or cause injury by machinery are also inappropriate. However, people who develop the need for insulin-treatment whilst employed in some of these areas may be allowed to stay. Several fire-fighters on insulin have regained fully-operational status in Britain recently. The patient will have to prove that he is in full control of his condition, that there is no risk of hypoglycaemia, and that he has no tissue damage that limits relevant function. Such patients (and those on tablets) should be referred to a consultant diabetologist for assessment.

Sometimes patients face the dilemma of health or work:

Bill was a bus driver. He was treated with oral hypoglycaemics but it was apparent that these were not sufficient to control his blood glucose. He was advised to start insulin treatment. He refused because he would lose his job. Over the next two years his hyper-glycaemia increased. Diabetic retinopathy was detected. He steadfastly refused to consider insulin despite warnings that his health might be permanently damaged.

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