1. Diabetes, risk and driving!
Lorna Bingham NP

2. Overview Risk & workplace risk Diabetes T1 vs T2
Diabetes related issues
Depression
Acute, Chronic complications
Occupations
Driving, cranes, fork lifts ,operating machinery, ladders etc
Hobbies
Kite boarding, diving, caving
Human factors

4. Considerations of work place risk
Health & Safety at work ACT 2015
Control Measures
Hazards Identified
Good Practice
Managed
Plan &
Education
Teamwork
Occupational Health risk reduction
Evidence based Practice
Assessment

5. Risk Management Principles and guidelines AS/NZS ISO 31000:2009
Risk- Context
Accountability
Communication
Define risk criteria
Risk assessment
Identify
Analysis
Evaluate
Treat

6. Worksafe - manage risk
Provides an extensive range of industry-specific guidance about how to manage workplace risks for:
manufacturing
agriculture
forestry (there is a separate Safe Tree industry website)
construction and building
adventure activities
the extractives, geothermal, petroleum and energy sectors
asbestos
mining
major hazard facilities
work-related health (eg noise, silica, solvents).

7. Diabetes comparison Type 2 – make insulin but not working effectively
Type 1 – make no insulin
Type 2 – make insulin but not working effectively
Acute onset
3 P’s- Polyuria, polydipsia, polyphagia, infections, blurred vision
Any age
Ketones
Treatment
Need insulin injections from diagnosis
Gestational Diabetes Mellitus (GDM)
Other
Insidious onset
Family Hx of T2DM or CVD
Obese BMI > 30
Antipsychotic medications
Ethnicity
Treatment
LIFESTYLE
Monitoring and follow up
Metformin, glipizide, gliclazide Anti HTNs , statins
Many will need insulin eventually

8. Context Occupation & hobbies=concern
Heights
Water
Other
Working
alone
Equipment & machinery
Chemicals
Electricity

9. A comprehensive assessment framework reduces risk in diabetes
Family history
Psychosocial inc occupation & hobbies
Medication
CVD & HbA1c
Diagnosis
Good communication lowers risk
Role and responsibility,
Health literacy

10. Diabetes risk – how do we manage it?
Diagnosis /misdiagnosis
Medication – insulin top 6 medications for errors
Acute complications & Management
Hypoglycaemia
Hyperglycaemia, HHS or DKA
Chronic complications result in hospitalization

11. Psychosocial Aspects of Diabetes
Clinical significant psychopathology is more common in those with diabetes
Depression – screen annually, women higher rate than men
Anxiety lifetime prevalence of 19.5% in T1 & T2
Disordered Eating – screen if unexplained hyperglycaemia and weight loss
T1 insulin omission
T2 binge eating
Diabetes Distress & Fear of Hypos in T1

12. Diabetes Distress
“Refers to significant negative psychological reactions related to emotional burdens and worries specific to an individuals experience in having to manage a severe, complicated and demanding chronic disease such as diabetes” Prevalence 18-45% Constant behavioural demands of medication dosing, testing, food intake (S45)

13. Driving Medical aspects of fitness to drive 2014 classes P135-137

14. Diabetes & Driving concerns
Hypoglycaemia - sudden onset
Test if not eaten, date and time correct on the meter & have Rx at hand
Hypoglycaemia unawareness – sudden cognitive impairment
? Should they be driving – run bgls higher 6-12
MUST test before drive and have Rx at hand
Hyperglycaemia - ?safe to drive
Blurred vision, neuropathy, CVD health, retinopathy

15. Hypoglycaemia

16. Diabetes Prevention
There is strong and consistent evidence that modest persistent weight loss can delay the progression from prediabetes to T2 Diabetes
See Diabetes Prevention Program 43% reduction in diabetes at 20 years
Benefit of weight loss of >5%, > 7% is optimal in lipids, BP and glycaemic control
150 mins of moderate – vigorous exercise per week over 3 days and no more than 2 days with out activity

17. To Err is Human Report Institute of Medicine 1999
1:10 suffer unintentional harm in coming into hospitals
Due to “Human factors”
Be vigilant
Tell people with diabetes they are the experts and to question decisions if they do not seem right
Insulin is top 6 medications for errors
Knowledge is vital for reducing risk for people with diabetes (& health professionals!)
National Diabetes Nursing Knowledge & Skills Framework 2018

20. References
American Diabetes Association Standards of Medical Care in Diabetes 2018
National Diabetes Nursing Knowledge & Skills Framework 2018