I’m hoping IOSH members can help me with an issue which I’m sure other contractors will have addressed.

Several of our excavator/dumper/roller/dozer drivers are diabetic. Their condition is controlled through medication (tablets and/or insulin). They declare their condition at site induction so that the site management know what medication they are using, where they keep it and what to do if certain symptoms are observed. However, I understand that Type 2 Diabetes may prevent someone from working as an HGV driver. What do other contractors do? Do they allow workers with Type 2 Diabetes to operate plant? Do they risk assess each case?

Any help or information would be gratefully received.

Thanks,

We must be very careful not to discriminate here.In general Metaformin does not give rise to the potential for Hypos and insulin may if things become unbalanced. It is the hypo attacks that are the significant risk and drivers etc using insulin must check their bloods during relevant hours for driving or work. Hypo attacks during relevant driving hours can lead to suspension of a driving licence. Only emergency service drivers are totally barred from driving such vehicles, not driving in general though.

Generally I would suggest that it is the type of treatment and the level of control that the individual has, rather than the type of diabetes that is more relevant. If you are going to assess, then you need to do this on a case by case basis, talking in account the type of treatment and how good control is. Ideally you might consider (with the appropriate consent) writing to the individuals GP to get an opinion on fitness to operate/drive plant and vehicles.

There is plenty of information out there on this

http://www.diabetes.org....g_with_diabetes/Driving/
http://www.diabetes.co.u...iving-with-diabetes.html
https://www.gov.uk/diabetes-driving

Bob is correct, Metformin is highly unlikely to lead to a hypo, although many/some with T2 are now treated with a combination of drugs, some of which e.g. Byetta used with Glipizide have a significantly increased risk of hypo if proper control is not exercised.

If your diabetes is treated with insulin, you will automatically lose the entitlement to drive vehicles within the C1/C1+E class (including categories C1, C1E, D1, D1E, C, CE, D or DE) but you may apply to be assessed individually for fitness to drive these vehicles if you can meet a number of conditions; see

https://www.gov.uk/gover...251492/INS186_091013.pdf

Discrimination in itself is not illegal and of course ultimately you may quite legally discriminate depending on the circumstances. With regards to diabetes there are some types of work activity that people suffering from diabetes are not allowed to do, off the top of my head, offshore and aircraft cabin crew are but 2; this is ‘discrimination’, but not illegal.

If you treat each person as an individual (because they are!) and base any decisions on that basis, backed up by clear medical opinion, you shouldn’t go too far wrong.

SteveDM

I think they all agreed that Metformin was "unlikely" to cause hypos and you have to own that this is the case. No one ever said it was impossible, but it is not listed as a side effect on the information sheet and the doctor does not warn of hypos so it is, as they say, "unlikely".

You have no way of knowing how many of the people responding take Metformin or have a family member that does ..... perhaps they have first hand knowledge and experience. In fact, if you are on Metformin, even a high daily dose, you are not required to do blood glucose monitoring which indicates that this is a pretty stable drug which does exactly what it is supposed to.

I think the heavy sarcasm was misplaced. Yes, these people are not medical professionals, but if you live with diabetes or with family members who have diabetes, you quickly become very knowledgeable ..... because you have to.

I have just been on a DESMOND course - for people who have been diagnosed with type 2 diabetes - type 1 course is called Daphne.
Anyway, we were told (and booklet given out) says that it is unlikely that someone with type 2 whether on medication or diet control will have hypos or hypers as type 2 diabetes works differently than type 1. they did say that the DVLA require people taking medication for diabetes needs to inform them, insurance companies need to know as well
As stated above there is no need for daily blood checks unless on insulin - its the 3 monthly blood test at GP's that counts as it has amount of sugar wrapped around your red blood cells.
Some peoples type 2 might need insulin as control but apparently this is not the norm as in type 2 the pancreas still produces insulin but in a few cases the amount is too low and insulin is given then.
When 'cleared' by DVLA and insurance rest should be risk assessment as previously stated.
We were advised that there is a website called mydiabetesmyway (might only be in Scotland though) where you register and can then access all your blood tests and retina checks etc. This should be a good indication to the person how well their condition is being managed.

Sorry I have rabbited on a whole day course in a few paragraphs. These courses are free.

SteveDM

As a type 2 diabetic and Metformin user I find your comments deeply offensive. Further, abuse of alcohol and carbohydrates is likely to create hypers - ie HIGH blood sugars NOT Hpos - LOW sugar levels. You really should be checking your facts out before making pronouncements. DVLA concern is primarily insulin users as hypos are a real possibility and it is these that make drivers dangerous. You really need seriously high blood sugars to cause issues, certainly I used to get some over 20mmol/L and I did know about it!!!! but was still coherent in my thinking and responses.

Blood Glucose monitoring according to NICE is not a formal requirement until insulin treatment is undertaken and the NHS stick rigidly to this recomendation so it is to me totally unnecessary to try and introduce a monitoring standard unless of course you are going to take on board all of the costs incurred to the operative. Certainly you would need to be very careful about making any distinctions concerning the people you have as the Equality Act has some sharp teeth if it comes to court/tribunal

I've been watching this thread closely with interest. I am type 2 and take Metformin, my bloods are always around the 4 mark which is in the normal range. I can eat and drink whatever and how much or as little as I wish to without any adverse affects at all. I have been diabetic for about 5 years now.

I have my normal driving license and as far as I know I can drive long goods vehicles if I choose to, I still have my license.

My conclusion is that everyone is different and what fits one does not necessarily fit all.

If an employer is made aware of an employee being type 2, and there is no requirement to inform, then they should take it as individual to that person.

I am more concerned about drivers using their mobile phone while driving, now that is hazardous to others!

Steve, anyone actually reading the posts will be able to see for themselves that neither Bob nor I at ANY point suggested that the BNF was wrong, nor at any point in our original posts did we even refer to the BNF.

I can't speak for Bob, but my comments are based on considerable personal experience and those of 'peers' in support groups. I have yet to suffer a hypo while taking metformin and others in my support group, likewise. And, I haven't stopped drinking alcohol since diagnosis. Neither Bob nor I have said that metformin can't lead to a hypo, but rather that "..in general.." it won't or for me that it is "..highly unlikely..". Although in fairness 'likely' might have been a more accurate term to use. I suggest that the reality is that those taking metformin are much more likely to suffer from hyperglycaemia, whether drinking alcohol or not.

I am FULLY aware of the potential for hypoglycaemia when taking Drugs INCLUDING metformin but as per my original post, the risk of this when taking metformin alone is IMVHO low or very low.

Actually, the language in your subsequent post was unreasonable as is your most recent. Neither of us suggested the BNF was wrong at any point. But don't let the facts get in the way.

When you've dug the hole deep enough.............

Steve DM

Are you a fully qualified doctor or do you have diabetes? My husband is both a fully qualified doctor and a diabetic and many people on this forum have come out as being diabetic and having first hand knowledge of hypos and hypers and yet, you still fail to read their posts correctly that "while it is possible to have a hypo when taking metformin, it is unlikely". No one has ever disputed that it is possible, no one has said that the BNF was wrong, you are just storming in and telling these people who live with this illness day in and day out for years and decades that you know better than they do. I doubt this very much and, frankly, your attitude is markedly offensive now.

Did I say my husband was a doctor? Oh yes, but he is a doctor of philosophy with his specialism in forensic science. You didn't say we had to consult with a medical doctor and I think that this fact adequately sums up this whole stupid and pointless argument.

In answer to the original question, yes, each person should be risk assessed individually as this is a very personal illness and under the Equality Act it is a protected characteristic so you need to be very diligent.

You mean before the injections he felt woof?

He may have an opinion, but I bet he is not allowed to drive heavy goods vehicles....

This one got tied up with a lot of other minutiae and perhaps it is now time to address the issues again.

Unless the operatives are directly employed by you this question is really best resolved by the contract with their employer. However as they are arriving on site it is a bit late for such actions

Unless the persons involved are insulin users there really ought not be a great deal of involvement in dealing with their medications. I would take their openess about their condition as a positive sign that they are aware of their problems and seeking to manage it properly and theus they should not be "punished" for their openess. I am always concerned about those who do not tell until it is too late.

For insulin users then regular meal times are the one area where you can ensure the site adapts to their needs. In general many insulin users have both long time release and short time release insulin. To maintain balanced sugar levels the carbohrdrate intake has to be managed. Unfortunately the NHS tends to work on having a specific Carb intake and a set Insulin bolus. Unfortunately this is extremely suspceptible to upset by delayed or partial or missed meals. A minority work out fromm the carbs they intend to eat an insulin bolus to suit the intake. Such persons can often be more stable but there are no rules.

What you ought not do is start to get involved in a higher level of testing than that required by the NHS or DVLC. If you do then be prepared for the cost to fall to you.

Not yours I trust. H&S is not simply about bare bone facts but about managing risks in such a way as to produce the best possible result without overkill. It is called as far as reasonably practicable>

Bob