SOME QUESTIONS AND ANSWERS

Is a hypo dangerous?

If the warning signs of hypoglycaemia are recognised and promptly acted on, a hypo should not cause lasting harm. Death from a hypo is very rare.

In response to low blood sugar levels, the body automatically releases hormones that counteract them (most importantly, glucagon and adrenaline). These inhibit insulin secretion from the pancreas and stimulate the liver to increase glucose output, bringing a recovery. It is the release of adrenaline that causes the sweating, pounding heart and tremor that are recognised warning signs of a hypo.

In some people, this self-correcting response may occur at such a low blood glucose level that warning signs do not appear before brain function is affected. In this case, the individual may become confused and eventually unconscious, without recognising other warning signs. The inability to recognise the onset of a hypo is known as “hypoglycaemia unawareness” and is more common in people who have had type 1 diabetes for some time.

When a developing hypo is recognised in time, corrective action can be as simple as taking a small oral dose of glucose (20-30g) or sucrose (a sugar lump). This is quickly absorbed and recovery is usually swift. It should be followed by taking a longer-acting snack containing complex carbohydrates.

If the onset of a hypo is not recognised and the person has become unconscious, medical attention may be needed. Glucagon (1mg) should be given by subcutaneous or intramuscular injection, or glucose (30-50ml of a 50 per cent solution) given intravenously by a doctor or paramedic. Glucagon is not suitable where the hypo is related to the use of a sulphonylurea.

How does diabetes affect daily life, and what kind of support is available?

Diabetes has a significant impact on lifestyle, butdoes not generally prevent people from living a normal life (unless they develop a complication such as blindness). However, the individual concerned (and close family) will need to devote time and energy to self-management, and learning about the condition and its treatment is very important.

Much support is available from healthcare professionals, including doctors, nurses, dietitians, podiatrists, ophthalmologists, pharmacists and others, as well as from family and friends. Organisations such as Diabetes UK produce a wide range of information materials on specific topics and offer other types of support, such as telephone, mail or email access to advisors and/or local support groups.

Some typical lifestyle questions:

Is it safe to drive with diabetes?
Many people with well-controlled diabetes are able to continue driving. Research shows that they are no less safe than other road users. The DVLA must be notified if you have diabetes that is treated with insulin or (in some cases) tablets. Certain restrictions may apply, e.g. to driving heavy vehicles or those designed to carry more than eight passengers. Diabetes UK has a leaflet with detailed information on driving.

Does diabetes affect playing sports?
The success of a number of world-class athletes with diabetes shows that it does not. However, strenuous exercise may potentially precipitate a hypo. Insulin doses may need to be reduced (or carbohydrate intake modestly increased) to compensate for such exercise and should be discussed with the care team beforehand.

Is diabetes a barrier to certain job?
Those who treat their diabetes with insulin are currently excluded from some jobs, including:

• the armed forces
• being an airline pilot
• driving a vehicle over 7.5 tonnes, or that carries large passenger numbers
• driving a train, or working trackside
• driving a taxi (in some areas)