The long, chronic course of diabetes mellitus leaves a significant imprint on the social life of the patient, especially employment. The attending endocrinologist plays a large role in determining the professional employment of the patient, especially a young person choosing a profession. Moreover, the forms of the disease, the presence and severity of diabetic angiopathies, complications and concomitant diseases are essential. There are general guidelines for all forms of diabetes. Hard labor associated with emotional and physical stress is contraindicated for almost all patients. Diabetes patients are contraindicated in working in conditions of severe cold or heat, as well as sharply changing temperatures, work involving chemical or mechanical, irritating effects on the skin and mucous membranes. Professions associated with an increased risk to life or the need to constantly observe their own safety (pilot, border guard, roofer, fireman, climber, etc.) are not suitable for patients with diabetes mellitus.
Patients receiving insulin cannot operate public transportation or heavy machinery. The right to drive private cars to patients with persistently compensated stable diabetes without a tendency to hypoglycemia can be granted individually, provided that patients have a sufficient understanding of the importance of treating their disease (WHO Expert Committee on Diabetes, 1981). In addition to these restrictions, persons in need of insulin therapy are contraindicated in professions related to irregular working hours, business trips. Young patients should not choose professions that interfere with a strict diet (cook, pastry chef).
The optimal profession is one that allows for the regular alternation of work and rest and is not associated with differences in the expenditure of physical and mental power.
Particularly carefully and individually, one should evaluate the possibilities of changing the profession for people who have become ill in adulthood with an already established professional position. In these cases, first of all, the patient’s state of health and the conditions that allow him to maintain satisfactory diabetes compensation for many years should be taken into account.
There is another moral aspect of the professional problem. Some patients, especially young ones, want to keep their disease secret. Sparing the psyche of patients, the doctor must observe medical confidentiality. At the same time, he should try to convince the patient of the uselessness and even harm of such an idea. This is especially important for patients with labile diabetes, who may need outside help at work, and therefore, on the contrary, it would be necessary to instruct colleagues in the basic rules of emergency care for such a disease.
Staff must be instructed on the basic rules for emergency diabetes care.
When deciding on the disability, the form of diabetes, the presence of complications and associated diseases are taken into account. Mild diabetes is usually not the cause of permanent disability. The patient may be engaged in mental as well as physical labor, not associated with high stress. Some restrictions on work in the form of establishing a normalized working day, excluding night shifts, temporary transfer to another job can be implemented by the CWC.
In patients with moderate diabetes mellitus, especially with the addition of angiopathies, working capacity is often reduced. Therefore, they should be working with moderate physical and emotional stress, without night shifts, business trips, and additional workloads. The restrictions apply to all types of work requiring constant attention, especially in patients receiving insulin (the possibility of hypoglycemia). It is necessary to ensure the possibility of insulin injections and dietary compliance in an industrial setting.
Mild diabetes is usually not the cause of permanent disability.
A significant limitation of the ability to work, characteristic of patients with severe diabetes, is caused not only by a violation of all types of metabolism, but also by the rapid progression of angio-neuropathies and associated diseases. With rare exceptions, when it comes to highly qualified, mainly intellectual work, patients are not able to regularly perform duties in a normal work environment. Some individuals may work in specially designed environments or at home.
It is necessary to ensure the possibility of insulin injections and dietary compliance in an industrial setting.
The rapid progression of microangiopathies (nephropathy, retinopathy), atherosclerosis can lead to progressive loss of vision, severe renal failure, heart attack, stroke, gangrene, that is, to dense and permanent disability. Disability assessment in patients with visual impairment due to diabetic retinopathy or diabetic cataract is carried out after consulting an expert optometrist.