Living with diabetes

Diabetes mellitus, like any chronic medical condition, impacts on quality of life. In one study, at the time of diagnosis of type 1 diabetes, 36% of children exhibited significant psychologic distress. Remarkably, however, in 93% this had completely abated 9 months after diagnosis. Not surprisingly, the parents of newly diagnosed children also experience psychologic upset of a temporary nature, more prominent in mothers. Although not established, adults with new-onset type 1 diabetes probably have similar temporary psychologic responses; however, there is apparently little psychologic morbidity in adults associated with the diagnosis of type 2 diabetes.

Depression is twice as common in adults with type 1 and type 2 diabetes than in a control population and, interestingly, depression commonly precedes the diagnosis in type 2 patients. The course of depression in diabetes may be particularly chronic and severe.

The diagnosis of diabetes has effects on other aspects of the diabetic patient's life. In most developed countries, drivers with diabetes have a statutory requirement to declare their diabetes to the national licensing authority. Furthermore, failure to do so may invalidate motor insurance policies. Following declaration of the diagnosis of diabetes, a driving license is issued for a maximum of 3 years in the UK, but is renewable at no cost following completion of a medical questionnaire. If a patient reports a medical problem that may affect safe driving then the licensing authority will solicit more detailed medical reports. Most countries impose limitations on the issue of vocational licenses (heavy goods vehicles, passenger carrying vehicles) to insulin-treated diabetic drivers.

Diabetic individuals treated with insulin or sulfonyl-ureas are not permitted to fly commercial aircraft or to work as air-traffic controllers.

Diabetic patients may experience difficulties with employment. Statutory or company policy may disbar them from certain occupations and these include train drivers, the armed forces, off-shore oil-rig work, etc. Furthermore, even when there is no risk due to possible hypoglycemia, discrimination by employers may affect hiring practices leading to loss of self-esteem and earning ability, and impacting on the patient's ability to support a family and their future quality of life.

Insurance may also prove to pose problems for individuals with diabetes. Insurance companies may refuse to accept diabetic applicants for life insurance or impose restrictions or inflated premiums. More favorable insurance terms may be provided by approved brokers recommended by national diabetes associations.

There are many other areas in life where having diabetes may cause difficulties and they include travel overseas, insurance and medical care abroad, exposure to unusual foods and drinks in different countries and the effect of intercurrent illness and sport on day-today blood glucose control.

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