Hypoglycaemia in Clinical Diabetes

324 LIVING WITH HYPOGLYCAEMIAestablished by individual industries or firms, rather than by legislation. Although medicaladvice has usually been sought, this has not always been well informed, and may not haveinvolved physicians with expertise in diabetes or of occupational health. Some restrictionshave been challenged successfully, with one example in the UK being the reinstatement ofseveral active firefighters, based on individual medical assessment.People with insulin-treated diabetes are not usually permitted to work alone in isolated ordangerous areas or at unprotected heights. They are also debarred from serving in the armedforces. This is based on the grounds that all service personnel (including noncombatants)could be involved in a conflict at short notice, and maintaining provision of insulin andappropriate dietary requirements could present difficulties in a wartime situation. Employmentis not usually permitted in emergency teams, civil aviation, work in the offshoreoil industry, and in many forms of commercial driving (Waclawski, 1989). A list of jobsin which the employment of people with insulin-treated diabetes (both types 1 and 2) isrestricted is shown in Table 14.2.The civil aviation authority in the UK does not permit diabetic individuals who are treatedwith insulin or sulphonylureas to fly commercial aircraft, or to work as air traffic controllers,although in the USA an air traffic controller appealed successfully against dismissal ongrounds of discrimination. In the European Community, discussions are proceeding toproduce common airworthiness regulations for pilots with medical disorders, includingdiabetes.Table 14.2 Employment restrictions placed on diabetic workers treated with insulin in UK (adaptedfrom Waclawski, 1989)VocationaldrivingCivil aviationNational andemergencyservicesDangerousareas forworkWork atheightsLarge goods vehicles (LGV licences)Passenger carrying vehicles (PCV licences)Locomotives and underground trainsProfessional drivers (chauffeurs)Taxi drivers (variable: depends on local authority)Commercial pilots; flight engineersAircrewAir traffic controllersArmed forces (Army, Navy, Air Force)Police forceFire brigade or Rescue servicesPrison and Security servicesOffshore oil-rig workMoving machineryIncinerator loadingHot-metal areasWork on railway tracksCoal miningOverhead linesmenCrane drivingScaffolding/high ladders or platforms