Diabetes & Fitness for work
Diabetes
Diabetes is a condition in which the body loses the ability to self-regulate blood sugar levels. High blood sugar levels are associated with long term complications such as blindness, nerve damage, heart disease, kidney disease and vascular disease. Short term complications include blurred vision, frequent toiletting and fatigue. The aim of diabetic medical treatment is to keep the blood sugar levels within the normal range to minimise the risk of complications.
Diabetic treatment - 3 main treatment regimes
- Diet controlled - no risk of hypoglycaemia
- Oral medication - minimal to modest risk of hypoglycaemia
- Insulin - potentially highest risk of hypoglycaemia
Impact of diabetes on work
Diabetes can affect fitness for work in two ways. Firstly, treatment with medication (insulin, hypoglycaemics) may lead to episodes of low blood sugar (hypoglycaemia). When the blood sugar is low, a diabetic person can start to feel hungry, sweaty, agitated and aggressive. As the blood sugar falls further, the person will eventually become confused and lose consciousness. This has obvious safety implications.
Secondly, the long term complications from diabetes itself (blindness, nerve damage, kidney damage, heart disease) can directly affect work ability. For example, diabetes increases the risk of having a heart attack.
Impact of work on diabetes
The nature of the work can affect the management of diabetes. The following are some factors that can increase the difficulty of maintaining good diabetic control:
- Shiftwork
- Very physically demanding work
- Hot work
- Isolation from medical services
- Irregular meals
- Excessive alcohol
Minimising the risk
Diabetes is a common condition. Diabetes is not an automatic bar to employment and many diabetics are employed gainfully in a variety of industries including traditionally 'high risk' industries such as transport, rail and mining.
The risk of problems at work can be minimised by a careful risk assessment at the preplacement stage and regular medical review thereafter. Factors that the doctor takes into consideration are:
- Type of diabetes (insulin dependent, non-insulin dependent)
- Nature of diabetic control, compliance with treatment and self-monitoring of sugar levels
- Risk of episodes of low blood sugar (hypoglycaemia)
- Presence of diabetic complications
- Information from the treating doctor and treating specialist
- Nature of the work (eg. safety critical roles, shiftwork, remote work)
- Arrangements for ongoing medical management
Further reading
Guidance on assessing fitness to work for diabetics in safety critical roles are available in
Assessing fitness to drive - Commercial drivers
Rail guidelines
Dr. Roger Lai
MBBS (Hons)
Occupational Medicine Registrar
OccuMED Consulting
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