Living with Diabetes
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Smoking & Diabetes
How Is Smoking Related to Diabetes?
We now know that smoking causes type 2 diabetes. In fact, smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers. And people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease.3 The more cigarettes you smoke, the higher your risk for type 2 diabetes.3 No matter what type of diabetes you have, smoking makes your diabetes harder to control. If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes. Smokers with diabetes have higher risks for serious complications, including:
- Heart and kidney disease
- Poor blood flow in the legs and feet that can lead to – infections, ulcers, and possible amputation (removal of a body part by surgery, such as toes or feet)
- Retinopathy (an eye disease that can cause blindness)
- Peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor condition
Sex and Diabetes
I am a diabetic man, what kind of problems could diabetes cause to my sex life?
For men, diabetes can cause damage to the nervous system over a sustained period of time, also known as diabetic neuropathy. One aspect of this is the potential for diabetes to damage the erectile tissue leaving it impossible for a man to achieve or maintain an erection.
Almost 1 in 3 men with diabetes suffer from erectile dysfunction.
I am a diabetic woman, what kind of problems could diabetes cause to my sex life?
For some women with diabetes, vaginitis (inflammation of the vagina) can be recurrent.
Vaginitis can be brought on by a number of different ways including bacterial inbalance of the vagina (bacterial vaginitis) yeast infections (thrush) or from chemical irritation, such as from soaps or fabric conditioners.
This can make sex painful, and is heralded by itching or burning sensations.
Cystitis can also be a recurrent problem for women with diabetes.
Furthermore, some evidence indicates that, in a similar way to men being unable to maintain an erection, the woman’s clitoris may fail to respond to stimulation.
Getting behind the wheel with diabetes
If you drive, having diabetes doesn’t automatically mean you can’t anymore.
There are many myths about driving and diabetes. Do you automatically lose your licence when you’re diagnosed? Do you have to jump through hoops to keep hold of your licence?
Yes, restrictions on people with diabetes may be higher than with people who don’t have diabetes, but the situation may not be as bad as you think.
Only people who use insulin have to tell the DVLA that they have diabetes, with a few exceptions. And out of those people, around 97 per cent of applications are successful and they can carry on driving on a restricted licence. This usually has to be renewed every three years.
We’ve got lots of clear information to help you work out all the laws on driving.
But some people do lose their driving licence, and the most common reason is because of severe hypos.
Driving and preventing hypos
The most common reason for people with diabetes to lose their licence is hypos – and, in particular, severe ones.
Hypos (or hypoglycaemia) can happen when your blood glucose level (also called blood sugar) is too low, usually below 4mmol/l. This can happen if the balance of the medicine you take, the food you eat and the physical activity you do sometimes isn’t right, amongst other things.
Hypos can make your eyes go blurry, make you feel tired and you can lose concentration. All of which can affect your ability to drive.
But not everyone with diabetes is at risk of having hypos. It can affect people who take certain medication to manage their diabetes, including insulin and sulphonylureas. Speak to your healthcare team if you’re not sure whether you’re at risk of having them and what you can do to prevent them. Here are some tips:
- Don’t delay or miss meals and snacks
- Take breaks on long journeys
- If your blood sugar level is 5mmol/l or less, eat some carbs before driving
- If your blood sugars are less than 4mmol/l – don’t drive until you have treated the hypo and your blood sugar is under control
- Keep hypo treatments to hand in the car
- Check your blood sugar levels before driving and every two hours on long journeys.
If you have a hypo when you’re driving
If you have a hypo while driving, the law says you have to stop the vehicle. You have to:
- Switch off the engine, remove keys from the ignition and move from the driver’s seat.
- Take fast-acting carbs, like glucose tablets or sweets, and some form of longer-acting carbohydrate.
- Don’t start driving until 45 minutes after your blood sugar level has gone back to your ideal range as you need to give yourself time to regain focus.
If you’re struggling to control your hypos, talk to your healthcare team about whether you should be driving. And check out our information on the DVLA’s driving laws for people with diabetes. If you’ve lost awareness of your hypos, then you shouldn’t drive at all.
Checking your sugar levels before driving
If you usually check your own blood sugar levels, you must check them before driving and every two hours during a long journey. At the moment, the law says that you’re not allowed to use flash glucose monitoring to check your sugar levels before you drive.
Like you, we don’t think this is fair. So we’re campaigning for the government to change this.
Driving and eye problems (called retinopathy)
Retinopathy is when there’s damage to the retina (the ‘seeing’ part at the back of the eye) and can cause sight loss. People with diabetes are more likely to get eye problems as a complication, because it’s linked to high blood sugars.
If you start to develop eye problems, you should let the DVLA know. This doesn’t mean you’ll automatically get your licence taken away. It will depend on the stage your eye problems are at. You may need to attend a special eye test to assess your range of vision. This will be done at an opticians near you that the DVLA will recommend. The DVLA will also fund this, so you don’t have to worry about cost.
Some eye problems are reversible, so if you do need to stop driving for a bit, you may have the chance to reapply for your licence if your condition gets better. Talk to your healthcare team if you’re unsure.
Driving and other diabetes complications
Neuropathy affects your nerves and can cause you to lose feeling in your hands and feet, as well as other parts of your body. In severe cases of neuropathy, you should ask your healthcare professional or the DVLA for more advice.
Heart complications caused by diabetes can affect your licence, but your specialist heart team will advise you on this. The British Heart Foundation have more information about how heart conditions can affect your licence.
What if I lose my licence?
Having your licence taken away can be very stressful. It can cause a great amount of inconvenience and upheaval. However, in most cases you will be able to reapply after a certain period of time providing your condition has improved.
The date that you can reapply will be on your notice of refusal and you will be able to apply up to eight weeks before this date.
Most car insurance suppliers will not penalise people with diabetes by charging them higher premiums. Be sure to complain if they do, and if you’re still not satisfied then try another company.
You will have to declare your diabetes as a ‘material fact’ when applying for the insurance. We’ve got lots more information about insurance and diabetes to help you.
The emotional journey with diabetes
What Causes Depression?
So does depression cause diabetes, or does diabetes cause depression? The reality is deeper than that. In my book, Diabetes: Sugar-coated Crisis, I argue that Type 2 diabetes and depression are best considered different symptoms of the same disease. This disease may go by the names insulin resistance, metabolic syndrome, or powerlessness.
In his book, Overcoming Depression, British psychologist Paul Gilbert writes that depression is a natural response to having a lack of power in your life. (Gilbert called another book Depression: The Evolution of Powerlessness.) Gilbert asks and answers the question, “Where does depression come from? What good does it do?” It must do some good, because it causes a lot of harm, and yet we still have it. Depression genes would be long gone from our gene pool if they didn’t help us in some way.
Gilbert’s answer is that “Depression keeps us out of battles that we know we cannot win.” Consider how a depressed chimpanzee or monkey acts: “downcast, nonthreatening, withdrawn.” This behavior may feel terrible, and it may keep the chimp from getting much food or any mates. But it will keep him or her from getting beaten up by more powerful chimps. When you lack power, depression can save your life. And if depression keeps you out of losing battles, what about being sick? That will keep you on the sidelines, depressed and frustrated, perhaps, but safe.
So the less power you have, the more likely you are to be depressed and to have Type 2 diabetes. As I explain in my book, power can come from resources (like money, education, living in a good neighborhood), from support (the help of friends, family, professionals, congregation, others), or from self-concept (self-confidence, self-esteem, having positive goals and reasons to live). The best way to treat depression is through empowerment.
Diabetes in the Sun
- High body temperatures can lower blood sugar. Mayo Clinic writers Nancy Klobassa Davidson, RN, and Peggy Moreland, RN, CDE, say you should check your sugars more often in the hot weather.2. Sunburn can raise blood sugar. The Mayo Clinic advises wearing a good sunscreen, sunglasses, and a hat while out in the sun.3. Warm skin absorbs insulin faster, while dehydrated skin absorbs insulin more slowly. The closer you can keep your injection site to normal temperature and hydration, the better.4. Dehydration from sweating can raise blood sugar and can lead to heat exhaustion. According to the Cleveland Clinic, people with diabetes are more likely than others to be admitted to hospitals for dehydration and heat exhaustion, and to die from it.High glucose levels lead to urinating more, which increases risk for dehydration. This may be especially true if you’re on an SGLT-2 inhibitor drug. Keep drinking water with a bit of salt if you are blessed to live in an area where water is available. Have a bottle with you and don’t wait until you’re thirsty to drink.
Learn to check yourself for dehydration by pinching up some skin on your arm and letting it go. It should snap right back into place. If it goes more slowly, you are getting dehydrated. Don’t drink alcohol or caffeine in super-hot weather, as they are dehydrating.
5. Heat can damage insulin, other medications, and test strips. The Joslin Clinic advises people to keep their insulin cool, but not on ice. If you take medicines with you while you’re away from home, get a cooler bag to keep your medicines and test strips in. Extreme heat or cold can affect test results and degrade diabetes drugs.
6. Insulin pumps and continuous glucose monitors should do OK in hot weather if they are not exposed to direct sun for long. Joslin suggests covering them with a white towel.
7. Perspiration can loosen adhesives on continuous glucose monitors and insulin pumps. Your sensor or infusion set might become loose. Insulin-pumpers.org suggests tapes and dressings such as Compeed and others you can see here that will stay tight when damp.
8. It becomes harder to exercise in the heat. Movement is important, but it’s more important to keep cool. Mayo Clinic says, “Exercise and do more strenuous activities in the early or later hours of the day when the temperatures are cooler and the sun is not at its peak.” At night may be even better. The same is true of physical work — best not to do it in midday.
Other sites go farther, saying to only exercise indoors in an air-conditioned space.
9. Summer shoes can affect feet. Everyday Health makes the point that summer footwear such as sandals, flip-flops, or going barefoot expose feet to injury, including burns from hot sidewalk. To be safe, always wear shoes, and check your feet carefully at the end of each day.
10. Know the signs of heat exhaustion. With diabetes, your risk for heat exhaustion is greater, because diabetes can affect the ability to sweat. If you don’t sweat, you can’t stay cool.
Symptoms of heat exhaustion are similar to hypoglycemia (low blood glucose): dizziness, fainting, confusion, and for some people, excessive sweating. “You may think it’s the heat and not recognize that your blood sugar levels have fallen to dangerous lows,” says Dr. Lori Raust of Mayo Clinic in Arizona. Check your blood sugar and get medical help for any of these symptoms.
11. Keep as cool as possible. Wear light-colored, lightweight clothes, and stay out of direct sun. Go to air-conditioned places. Try to set up a cool space for yourself and family. North sides of buildings are normally cooler than the south side. Basements are often several degrees cooler than higher floors.
You can cool your own space more affordably and ecologically by setting up a single air-conditioned room instead of putting the whole house on AC. Keep the cool-room door closed. Don’t run the AC if you’re not there.
Swamp coolers or fans also use less electricity than AC. Close your blinds in the day; open blinds and windows at night; don’t use the oven, according to this Huffington Post article.
12. For the future, take keeping cool seriously, because coming years are only going to get hotter. A house and roof painted white will be cooler. White color reflects heat instead of absorbing it, so white clothes keep you cool and a white house is one way to slow global warming.