I am 50 years old, I have had diabetes for 38 years (currently on Humalog before meals with Lente at bedtime, and, for the last two years, my annual hemoglobin A1c readings have been 7.6 to 8.4%. However, my daily tests are erratic, without a pattern to easily adjust a dose. My doctor says the mechanism that evens out blood sugars has worn out which often happens in patients who have had diabetes for a long time.

At the moment I am signed off sick from work as I am absolutely fed up with the struggle to get it right. I am a bank teller on the counter alone in a small branch, drive 20 miles in rush hour, etc. How can I put a case to my company for retirement through ill health?

I can empathize with you regarding your struggle. It sounds like you have really tried to battle the blood sugars. I probably can’t give you a satisfactory response to your question. It is more an ideal than a measured response. However, I would sit down with your physician or other primary care giver and describe what you are going through. Either the treatment regimen should change or you will have to change your occupation.

Unfortunately, at least under U.S. law, I do not think you would qualify for disability. If you really cannot work, I would suggest seeing a lawyer or seek council with someone who knows about the UK disability laws. I would anticipate that you have already spoken with your employer about working at a facility with more backup or chance for a break to treat your diabetes or a less stressful position. Even some help with stress management might help.

JTL

[Editor’s comment: Your diabetes control, while not ideal, is reasonable and should not preclude you from working. Smoothing out the blood sugars most likely will require a sophisticated education program about basal/bolus therapy with particular attention to insulin adjustment based on carbohydrate counting and the prevention of highs and lows rather than response to them. Use of Lantus (insulin glargine) as your basal insulin might be helpful. Another option would be an insulin pump. Of course, to work effectively, tight control requires detective work which means monitoring blood sugars before meals, two hours after meals, and a few times during the night initially to establish doses. Subsequent monitoring may or may not decrease depending on response and should always be increased when things look like they’re out of control. In addition, your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System, ask if it is available. Please discuss these options with your diabetes team, and if you are not currently being followed by one, ask for a referral.

While this might sound harsh, I sense that there’s a chance that the diabetes is an “excuse” for some bigger issue causing your sick leave. I strongly suggest, as Dr Lane has already suggested, that you seek help from a mental health professional to help you identify and cope with your stressors.

SS]