Feeling Cheated

[Mark72]

Hi All,

Up until today i have been a Train Driver, I was always on Metformin as my main control but about 6 months ago my consultant said that for my long term health and perfect control i would be better using a Nova Rapid Flex pen when required along side my Metformin. This i was told would keep my Hb1a readings stable and at the required standards to ensure my long term health. This i have been doing and have in my consultants own words fantasic control and a very good understanding and great attitude to keeping fit and managing my diabetes. However my work has now today at my Periodical medical and review health decided that I'm of too much of a risk to be allowed to carry on driving trains on the main line. They have permently restricted me and are now i find myself with the option of either becomming a manager or finding myself unemployed after 18 years of service to the company.

Basically what im asking is have any of you out there had anything like this done to you within your workplace once you were made a Type 1 and given Insulin. The Disability Act protects me a little but im not sure if it protects me enough really. There are others who refuse to take the doctors advice and carry on with tablets alone and are unwell and very overweight but because they are not using Insulin they are allowed to carry on driving trains. Its very hard to take i'm 37 years old with a beautiful family and its seems that even though i have never had a hypo or been in need of hospital help im deemed dangerous because i use an Insulin pen.

 

[cugila]

Hi Mark72.

Welcome to the forum. We have some confusion here. Are you a T2 on Insulin or a T1 ?

Ken

 

[Mark72]

Well i have always been told i was T2 however my consultant has said he now considers me T1 as i need Insulin to have the perfect control. However my GP still says im a T2 with Insulin support. But either way I'm not allowed to drive trains anymore wether i am T1 or T2 if i am using Insulin. Because they say the risk is too high for them.

To answer some other peoples questions, I have a good healthy diet and im not over weight, My bmi is also good and within the standards required. I attend a Gym 5 times a week to stay fit and assist my blood sugar levels.

Also i still take Metformin 3 times a day 1 tablet each meal 500g, then assist with Insulin depending on my meal and the type of food im eating. I was always in the mindset that T1 was when you had to always take your insulin regardless of what you ate but adjusted accordingly, Am i wrong there?

 

[cugila]

I think I would go along with your Gp and class you as a T2 on Insulin.

You say you are on Metformin as well. Did you get the option to have any additional medication before you were put on Insulin ? Did your Consultant know that you ran the risk of losing your job before putting you on Insulin ? I would have certainly asked for other options before going on to Insulin in your position.

I know you say you eat a healthy diet but we do find that people can reduce Bg levels quite dramatically by a reduction in the carbohydrates that they eat. Do you know what your Bg levels are throughout the day ?

Sorry for all the questions but we are trying to help.

Ken.

 

[LittleSue]

Well i have always been told i was T2 however my consultant has said he now considers me T1 as i need Insulin to have the perfect control. However my GP still says im a T2 with Insulin support.

Your GP is correct. A T2 who starts insulin has not become a T1. The types develop in different ways and this (the aetiology) decides the type, not whether you use insulin or how old you are. In fact both types can start at any age. But because T1 typically starts at a young age and T2 typically starts in adulthod, many GPs assume your type based on your age at diagnosis. So quite a few adult T1s are misdiagnosed as T2 at the start, then reclassified when they end up in hospital with DKA, but they haven't "become T1", they always were T1. To add to the confusion, T1 used to be called 'insulin dependent' or 'juvenile' diabetes and T2 was 'non-insulin-dependent' or 'maturity onset' diabetes, and some doctors still use these terms.

Your consultant has a point in that because you now need insulin to control your condition, in practical terms you have a lot in common with a T1, but I wouldn't call you a T1. Are you on a basal insulin too? A T1 would need a longeracting (basal) insulin such as Lantus or Levemir, not just Novorapid with meals.

 

[Mark72]

I monitor my bloods all day long before and after my meals, Depending on my BGL and what im eating depends wether or not i use any Insulin. Normally in the morning i will have BGL of 5-6 and i will have a protien shake for my breakfast and my metformin tablet. i will then normally test again at lunch and my BGL will again still be aroung the same 5-6 level and i will have some fruit and a small salad and my metformin tablet and also then attend my gym where i work out on the weights and the cardo machines then finishing off with a sauna. i then will again test my bloods which i would normally be around 4-6. i will then eat my dinner where i mainly eat either Fish.Chicken,Pork or a red meat with salad and either potatoes or chips as my carb intake, i Take my tablet and and depending on how many chips or potatoes i have had etc and mayonaise my BGL will be around 8 if i have had a small portion then a little lower. My main problem is if i eat out or have a treat then thats when i really need my Insulin, Or if i eat Bread as i have found that the high levels of sugar in todays bread is a cause of concern and effects my BGL. However im very aware of what foods effect me and those that don't have as much of an effect.

My consultant has given me Levemir to take overnight but haas also suggested i run my BSL to as high as 10 before i go to bed and then take my Levemir dosage? This i am challenging presently. I personally agree with my GP that i am a Type 2 diabetic who uses Insulin to control my BGL when i need to along with my Metformin.

I was told by my consultant that i could pump myself full of tablets and use upto 6 metformins a day and Glimprid and some others but all that would do is eventually kill off my pancreas quicker and that my best and healthiest option was to use the Flexpen system. He originally gave me an all in 1 pen of fast and slow reacting together. Of which he then said that i didn't need that all the time and switched me to nova rapid and levemir like i have stated which im not totally sure with.

I am today in the process of taking my train company through the legal process of discrimination againt me as a Type 1 or type 2 diabetic due to the fact they have said i cannot carry out my role safely enough because i use Insulin, This is a contradiction of the Disability Act where it states i should be given the oppurtunity to prove my individual case as being capable of driving under the control of my condition. The safety systems in place now on my trains are so stringent the likelyhood of me having a hypo and it causing a accident is no higher than that of a driver who is overweight and using tablets or medicine for a heart problem having an attack. Every 6 seconds we have to have carried out an action withing the driving cab or an alarm sound which needs us to do a certain action or all our brake systems intervene and stop the train. Its these said saftey systems which should enable not only diabetics the right to carry on in thier roles as drivers but also open the doors to those who have diabetes to join the industry as a driver.
I fully support all the extra medical care u must prove and the regular assessments from the doctors and levels being checked etc to obtain this freedom. The world has moved on and so should the industry and the UK.

 

[hanadr]

I think you'd be very valuable as a manager, if they won't let you drive. You could work on this discrimination from the inside.
jhhowever, it's a pity your consultant didn't introduce you to low carb control. You might have avoided the insulin. It's true that sulphonylureas, flog your pancreas to death and pobably lead to needing insulin eventually anyway, but What you don't eat, you don't have to control.
Were you offered Byetta?
Could you talk to your consultant about the risk to your job?

 

[Mark72]

Yes i have now been in contact with my Doctor and Consultant and they have now arranged for me to bring my 6 monthly appointment forward so they can assess whether Byetta and a low carb diet will be enough to control my Diabetes. This is mainly down to myself really cutting down on my Carb content and virtually taking no Insulin. However with the Diet plans i have been given from the Doctors and consultants i end up needing Insulin due to the carb content within them. Also after reading Berstien's i relise the fruits that they tell me i must eat are just as bad for my BGL's as Carbs. This has answered alot for me. I had wondered sometimes how my BGL had risen when all i had eaten for lunch was a small amount of fruit. Now i relise it was like taking sugar as the frutose is just as bad even though its natural it still has that effect on my BGL.

Thanks for all the advice here its fantastic to have so much knowledge out there. Its a crying shame that that knowledge isn't in industries where the level of understanding is so poor.

 

[Andyjjones]

Hi Mark72

Hope your still out there, I was wondering what was the out come? I'm type 2 diabetic that has to inject myself once a day with (Lantus) insulin glargine pen at night. Only started doing this 2 weeks ago now.

I take Metformin 1000 mg and Glicazide 80 mg twice a day, after breakfast and dinner.

Only ask as I've started working at a steam railway (volunteer) this year and really would love to work my way up to a driver. Hence why I ask.