Other considerations in diabetes management

Driving
  • Diabetes with insulin treatment or any complications should be declared to DVLA.
    • Driving licenses are then period-restricted – have to be renewed every 3 years
  • The key  risk to driving is hypoglycaemia which causes CNS problems- although visual impairment is also a problem
    • If patient has had a hypose he cannot drive for a year
    • Advice given:
      • Check BM before journeys  – should be 5mmol
      • Stop driving at first signs of hypoglycaemia –  i.e. hunger, autonomic hyperactivity
      • Keep fast-acting carbs in the car – e.g. Lucozade
      • Take regular snacks during driving.

 

Referral criteria
  • Refer the following cases to specialist (i.e. a diabetologist in hospital setting):
    • All children and pregnant women
    • Complex cases – e.g. can’t diagnose the type and needs antibodies
    • Developing complications – either long-term or short-term
      • Short-term – urgent referral if DKA and then also refer neuropathy, nephropathy, HTN
      • Long -term – would usually be managed by the podiatrist/opthalmologists already
        • Must refer persistent proteinuria to renal diabetic team
    • Refractory to treatment – i.e. failing to improve glycaemic control