Restrictions for patients with diabetes. What complicates the choice of profession in diabetes? Workplace for people with diabetes

Prof. Ilya Nikberg
Sydney, Australia

The daily life of a patient with diabetes mellitus (on average, from 3 to 5% of the population is affected, in old age this figure rises to 10-15%) should be subject to a certain treatment, preventive and hygienic regimen. Only its careful observance can allow people suffering from this serious illness to be socially active, to lead a life as close to normal as possible.

One of the most important components of such a life is labor activity. Fascinating and compatible with the requirements of an individual treatment and prophylactic regimen, activity is a powerful factor in maintaining the patient's vital activity, his social usefulness and satisfaction.

However, the specific features of many types of such activities negatively affect the course of the disease, make it difficult to compensate, increase the risk of severe complications, lead to early disability, and in some cases are simply contraindicated for a diabetic patient.

Therefore, the problem of combining this activity with restrictions due to the nature of the disease often arises from childhood, when choosing a profession, during study and work, and even at retirement age.

In the era of the modern scientific and technological revolution, along with long-known ones, many new professions have appeared that have expanded and diversified the types of labor activity person. But, unfortunately, not all professions are acceptable for a patient with diabetes. Some are clearly contraindicated, access to many others has severe restrictions.

From the point of view of the suitability of a particular profession for a patient with diabetes mellitus to work in it, the initial requirement is as follows: the nature and characteristics of labor activity should allow the patient to fully combine it with compliance (without prejudice to work and danger to others) of the treatment and prophylactic regimen necessary for this patient (the time of taking medications with allowed food, self-monitoring of blood glucose levels, prevention of hypoglycemic conditions and emergency care for them, normal rest and sleep, etc.).

Based on this general requirement the following specific advice and recommendations follow (primarily, and mainly, they are addressed to patients suffering from type 1 diabetes, although they also apply to patients of type 2 to a greater or lesser extent):

• Exclusion of works with shift schedule, in the evening and at night.
• Refusal or restriction of work associated with increased physical activity and harmful working conditions (unfavorable microclimate of working premises, dangerous physical, chemical and biological effects, strong psycho-emotional stress)
• Exclusion of work in extreme conditions (underwater, underground, in emergency situations, in isolated rooms, etc.).
• Exclusion (limitation) of work on the management of ground, air, underground and other public transport and construction mechanisms.
• Limiting the time of work that requires prolonged eye strain.

In addressing the issue of professional orientation and work activity of a diabetic patient, not a formal (presence of the disease) but an individual approach is needed. It should take into account not only (and in some cases not so much) the very fact of the presence of the disease, but also its very important personal characteristics: the form, severity and nature of the course of the disease, the means and regimen of treatment, the presence and severity of complications, the "diabetological" literacy of the patient , possession of means of self-control and emergency self-help, understanding and level of self-discipline and responsibility for oneself and others, age and work experience (professional experience) of the patient, the moral and psychological significance of labor activity in the life of this patient, etc.

During the professional orientation of a child with diabetes mellitus, parents and teachers should tactfully, gradually, with the least damage to the child's psyche, without contributing to the formation of an inferiority complex, explain to him personal and

social expediency of the preferable choice of one or another “suitable” profession, to give arguments for its attractiveness and prospects, etc. Similar arguments should be used in communication with young people who got sick with diabetes during their studies, or who still have little work experience in their specialty, etc., who still have many years of work and a full-fledged “life with diabetes” ahead of them, for which compatibility with the relevant profession.

When a person becomes ill with diabetes at a more mature age, who has a solid professional record and experience (most often at this age, the disease proceeds according to type 2, which in most cases does not require insulin injections), the question of further professional activity decided on an individual basis. If the nature of this activity allows it to be combined with the observance of the necessary therapeutic and preventive recommendations, then the patient can continue to work in the specialty, limiting himself only to an easy correction of its schedule and duration, diet, etc. In such situations, it is often advisable to change the profession to a profession close in its profile (for example, the transfer of a sick bus driver to the position of a repairman in a car fleet).

From the point of view of acceptability for a diabetic patient, all types of professions can be divided into three main groups.

Contraindicated. Drivers public transport(buses, trams, trolleybuses, taxis, etc.), pilots, astronauts, submariners, divers, miners working in caissons, high-altitude builders and installers, drivers and operators of moving construction and other mechanisms, repairmen of external electrical networks, mine rescuers, work on enterprises with a high level of physical, chemical or biological hazards, work in places remote from the possibility of providing emergency medical care and other professions with a high risk of extreme situations, at night, requiring special attention and responsibility, excluding the possibility of complying with the treatment and prophylactic regimen required by the patient .

Relatively contraindicated. Works and professions associated with frequent business trips, work associated with the impact of industrial pollution environment(physical, chemical, biological), prolonged eye strain, actors, cooks, guides, confectioners, professional sports, work in isolated rooms without partners, with irregular working hours, high psycho-emotional stress, and the like.

Featured. Middle and high school, researchers and laboratory assistants (with the exclusion of exposure harmful factors environment and the need for frequent business trips), doctors (except for surgical specialties, infectious disease specialists, emergency medical care), pharmacists, nutritionists, storekeepers, financial workers, economists, programmers, builders and repairmen of internal premises, librarians, various types of administrative and economic and managerial work and a number of other professions that do not interfere with the observance of the treatment and prophylactic regimen required for this patient.

As for any other person, for a diabetic, work should not be a burden, but a joy.

Concluding the story about the professional orientation and activities of a patient with diabetes mellitus, let us briefly dwell on the issue of using personal vehicles indirectly related to this problem.

The number of private car owners is steadily increasing all over the world and among them there are many people with diabetes. The desire of a diabetic patient to “live like everyone else” is understandable and largely feasible. Therefore, for those patients who do not have medical contraindications associated with the severity and nature of the course of the disease, there is no reason to restrict the right to drive a personal car. In most cases, patients with type 2 diabetes can use cars. It is more difficult to resolve this issue in relation to patients of the first type, who take insulin injections. As an exception, and provided that the disease is well compensated, the patient is not prone to frequent hypoglycemic reactions and the fogging and loss of consciousness caused by them, such patients may also be allowed to drive a personal car. But only on "quiet" highways, where there is no heavy traffic and pedestrians.

In any case, a diabetic driver must:

* Do not violate the prescribed diet and medication (including injections of insulin).

* Get behind the wheel and drive a car after the prescribed meal and no later than one hour before its next meal.

* Carry with you (in the car) an individual glucometer, used hypoglycemic agents, devices for administering insulin, the drug "glucagon", a sandwich, some sweets, glucose tablets, plain and sweet (on sugar) water.

* At the slightest sign beginning hypoglycemia or other manifestations of poor health, confusion and orientation, etc. immediately stop the car and check the blood sugar level, if necessary, take glucose tablets, drink sweet water, etc.

* It is desirable that the patient has a medallion (bracelet) indicating that he has diabetes, or another similar certificate with a record of information about the addresses and telephone numbers of persons who must be notified if necessary (applying for an ambulance) medical care, accident, etc.)

* During a long trip, make stops for rest at least every 1.5-2.0 hours.

Travel companions accompanying the patient on a trip should be aware of his illness and the measures to be taken in case of a sudden onset of a hypoglycemic state. Some patients do the right thing, in whose cars there is a clearly visible sign containing the appropriate instructions in a conspicuous place.

After a patient is diagnosed with diabetes mellitus, the doctor prescribes a strict therapeutic diet. The choice of food primarily depends on the type of diabetes.

Type 1 diabetes

Since the blood sugar level in type 1 diabetes is normalized by the introduction of insulin into the body, the diet of diabetics is not much different from the diet healthy person. Meanwhile, patients need to control the amount of easily digestible carbohydrates they eat in order to accurately calculate the required amount of hormone to be administered.

With the help of proper nutrition, you can achieve a uniform intake of carbohydrates in the body, which is necessary for type 1 diabetes. Diabetic patients with malnutrition can have serious complications.

To carefully monitor the indicators, you need to keep a diary, where all the dishes and foods that the patient ate are recorded. Based on the records, you can calculate the calorie content and the total amount eaten per day.

In general, the treatment is individual for each person and is usually compiled with the help of the attending physician. It is important to take into account the age, gender, weight of the patient, the presence of physical activity. Based on the data obtained, a diet is compiled, which takes into account the energy value of all products.

For good nutrition per day, a diabetic should eat 20-25 percent of proteins, the same amount of fat and 50 percent of carbohydrates. If we translate into weight parameters, in daily ration should include 400 grams of carbohydrate-rich foods, 110 grams of meat dishes and 80 grams of fat.

The main feature of the therapeutic diet for type 1 diabetes is the limited intake of fast carbohydrates. The patient is forbidden to eat sweets, chocolate, confectionery, ice cream, cooking.

The diet must include dairy products and low-fat milk dishes. It is also important to get the right amount of vitamins and minerals from food.

At the same time, a diabetic with type 1 diabetes must follow certain rules that will help get rid of complications.

• You need to eat often, four to six times a day. You can eat no more than 8 bread units per day, which are distributed over the total number of meals. The amount and time of the meal depends on which insulin is used for type 1 diabetes.
• In particular, it is important to focus on the scheme of insulin administration. The main part of carbohydrates should be eaten in the morning and lunchtime.
• Since insulin levels and needs can change each time, the insulin dosage for type 1 diabetes should be calculated at each meal.
• If you have a workout or an active walk, you need to increase the amount of carbohydrates in the diet, since people need more carbohydrates during increased physical exertion.
• In type 1 diabetes, it is forbidden to skip meals or, conversely, overeat. A single serving can contain no more than 600 calories.

In type 1 diabetes, the doctor may prescribe contraindications for fatty, smoked, spicy and salty foods. Not suitable for diabetics, including alcoholic drinks any fortress. Dishes are recommended to be steamed in the oven. Meat and fish dishes should be stewed, not fried.

If you are overweight, you should be careful when eating foods that contain sweeteners. The fact is that some substitutes can have a much higher calorie content than regular refined sugar.

Type 2 diabetes

The therapeutic diet for type 2 diabetes is aimed at reducing the excess load from the pancreas and weight loss in a diabetic.

1. When compiling a diet, it is important to observe a balanced content of proteins, fats and carbohydrates - 16, 24 and 60 percent, respectively.
2. The calorie content of products is compiled based on the weight, age and energy consumption of the patient.
3. The doctor prescribes contraindications for refined carbohydrates, which must be replaced with high-quality sweeteners.
4. The daily diet should include the required amount of vitamins, minerals and dietary fiber.
5. It is recommended to reduce the consumption of animal fats.
6. It is necessary to eat at least five times a day at the same time, while the diet must be based on physical activity and the intake of hypoglycemic drugs.

With type 2 diabetes, it is necessary to completely exclude dishes in which there is an increased amount of fast carbohydrates. These dishes include:

• ice cream,
• cakes,
• chocolate,
• cakes,
• sweet flour products,
• candies,
• bananas,
• grape,
• raisin.

Including there are contraindications for eating fried, smoked, salty, spicy and spicy foods. These include:

1. Fatty meat broths
2. Sausage, sausages, wieners,
3. Salted or smoked fish
4. Fatty types of poultry, meat or fish,
5. Margarine, butter, cooking and meat fat,
6. Salted or pickled vegetables
7. High-fat sour cream, cheese, cottage cheese curds.

Also, porridge from semolina, rice cereal, pasta is contraindicated for diabetics and is also completely excluded.

It is necessary that in the diet of diabetics there must be dishes containing fiber. This substance lowers the level of sugar and lipids in the blood, helps to reduce weight.

It inhibits the absorption of glucose and fats in the intestines, reduces patients' need for insulin, and creates a feeling of satiety.

As for carbohydrates, you need not to reduce the quantity of their consumption, but to replace their quality. The fact is that a sharp decrease in carbohydrates can lead to loss of efficiency and rapid fatigue. For this reason, it is important to swap high glycemic index carbs for lower glycemic carbs.

Diet plan for diabetes

To get complete information on foods with a high and low glycemic index, you should use a special table that every diabetic should have. It is advisable to find it on the Internet, print it out on a printer and hang it on the refrigerator in order to control your diet.

At first, you will have to strictly monitor each dish introduced into the diet, counting carbohydrates. However, when the blood glucose level returns to normal, the patient can expand the therapeutic diet and introduce previously unused foods.

It is important to enter only one dish, after which it is necessary to conduct a blood test for sugar. The study is best done two hours after the product is absorbed.

If blood sugar remains normal, the experiment should be repeated several times to ensure the safety of the administered product.

You can do the same with other dishes. Meanwhile, you can not introduce new dishes in large quantities and often. If blood glucose levels begin to increase, you need to return to the previous diet. Meals can be supplemented with physical activity to pick up best option daily diet.

The main thing is to change your diet consistently and slowly, following a clear plan.

sometimes doctors say completely incomprehensible things (to put it mildly). with diabetes, some professions are really not recommended, for example, a public transport driver, since here the driver is responsible for people's lives .. and you never know what kind of hypoglycemia will come up, or what kind of daily shift work with which no regimen of insulin therapy will work. and in general, diabetes does not carry any special restrictions on the profession. you just think about how your profession will be dangerous for you and for others and decide whether it suits you or not. I think the profession of a cook is not catastrophic in diabetes, the main thing is not to eat a lot at work))) to hide - not to hide this is a personal matter for everyone, the main thing is to follow the insulin therapy regimen, eat and measure sugar on time and not risk your health. I do not hide and I officially do not have any restrictions on working capacity, this is with an experience of 17 years.

Kostya Jan 19, 2013

Getting settled with the group (officially) in general is a super problem! I, with my 3 "diabetic", while I took shape, rummaged around for 2 years! Nulyak is at zero and “would you go to ..” drives) One salvation was found - “Moscow program for the employment of disabled people”)) They pay ridiculous pennies, but at least I earn them myself, but I don’t beg from someone.

Elena Liskovskaya Kyiv 19 Jan, 2013

I think that you can and can work as a cook, the main thing is not to lift weights. And you also can’t stand directly above the steam so that hot air doesn’t directly hit the retina of the eyes, and so what’s wrong with this work, if there is also earnings.

Igor Klimenko 21 Jan, 2013

About work for a diabetic

Chef - great job! And as for the dia-ka, I will share information.

Officially, medicine (traditional) does not recommend diabetics to work in the kitchen, because. at the same time, the cook has many systems involved, including the exchange of v-v, which leaves much to be desired. This leads to overeating against the background of uncontrolled nutrition - then it is clear what will happen to sugars.

But there are ways to SELF-TUNING (need to learn) when the cook is preparing and not tasting the food.
In this case, the cooking process is a spiritual process, and the finished food always has perfect taste and other parameters.
I am familiar with such technologies and have been using them for more than 30 years. When I "work in the kitchen", the result is dishes from which everyone who eats, including me, is delighted, while my health is in order.

According to the legislation of Ukraine, enterprises are required to have a certain number of able-bodied disabled people. Having spread the network through acquaintances-acquaintances-acquaintances, you can always find such an enterprise and get a job (also my tested example).

And for the most extraordinary.
Anyone who is looking for a JOB is ready to sell his time to someone. But it is always reasonable for people who have knowledge, experience, skills and abilities to take responsibility for themselves and organize their activities. At the same time, the regime of labor is in the hands of these people. And I have mastered this path

Oksana Malysheva 30 Jan, 2013

Katerina, I want to advise you! Of course, according to all the rules and legislation, you have the right to preferential work, but alas, in our country (I live in Ukraine, Kamenetz-Podolsky, Khmelnitsky region), this is almost unrealistic. Try to contact the Employment Center at the place of residence, or look for work in the office from 8:00 to 17:00. After-school groups are supposed to work (at the end of the day) until 18:00, so problems should not arise at school. I believe that problems can arise with food at school, of course, but if you ask the teacher to make sure that the child is not given compote, tea, etc., cookies and buns, then everything else there is "dietary, so to speak" (I myself suffer from diabetes with 2 years old, while going to Kindergarten, and a simple secondary school). Be brave and don't despair, good luck.

A diabetic, like any other person, has to work. Choosing a profession is a difficult and important decision. Can a diabetic do shift work? Let's talk about it today.

The Labor Code contains a definition of shift work. It follows from this that it is based on the performance of work according to a predetermined schedule, which provides for a change in the time that individuals are present at work. A characteristic feature of shift work is the change of workers at the same workplaces.

Shift work can be associated with both an increased risk of diabetes and poor diabetes management. It requires the need for periodic administration of antiglycemic drugs or insulin.

Read articles on this topic, which I have compiled specifically for diabetic shift workers.

The long-term, chronic course of diabetes mellitus leaves a significant imprint on the social problems of the patient, primarily employment. The attending endocrinologist plays an important role in determining the professional employment of the patient, especially the young one who chooses his specialty. At the same time, the forms of the disease, the presence and severity of diabetic angiopathy, complications and concomitant diseases are of great importance.

Exist general provisions for any form of diabetes. Almost all patients are contraindicated hard work associated with emotional and physical stress. Patients with diabetes are contraindicated to work in hot shops, in conditions of extreme cold, as well as sharply changing temperatures, work associated with chemical or mechanical, irritating effects on the skin and mucous membranes.

For patients with diabetes, professions associated with an increased risk to life or the need to constantly maintain their own safety (pilot, border guard, roofer, fireman, climber, etc.) are unsuitable.

Patients receiving insulin cannot be drivers of public or heavy trucks, work at moving, cutting mechanisms, at height. The right to drive private cars for patients with well-compensated stable diabetes without a tendency to hypoglycemia can be granted on an individual basis, subject to sufficient understanding by patients of the importance of treating their disease (WHO Expert Committee on Diabetes Mellitus, 1981).

In addition to these restrictions, professions associated with irregular working hours and business trips are contraindicated for people in need of insulin therapy. Young patients should not choose professions that interfere with a strict diet (cook, confectioner).

The optimal profession is one that allows for a regular alternation of work and rest and is not associated with fluctuations in the expenditure of physical and mental strength.

Particularly carefully and individually should be assessed the possibility of changing the profession in persons who fell ill in adulthood with an already formed professional position. In these cases, first of all, the state of health of the patient and the conditions that allow him to maintain satisfactory compensation for diabetes for many years should be taken into account.

There is another moral aspect professional problem. Some patients, especially younger ones, want to keep their illness a secret. Sparing the psyche of patients, the doctor is obliged to observe medical secrecy. At the same time, he must try to convince the patient of the uselessness and even the harm of such an idea about his illness.

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 on the basic rules for emergency care for such a disease.

When deciding on the ability to work, the form of diabetes, the presence of diabetic angioneuropathies and concomitant diseases are taken into account. Mild diabetes usually does not cause permanent disability.

The patient can be engaged in mental as well as physical labor, not associated with great stress. Some restrictions in labor activity in the form of the establishment of a normalized working day, the exclusion of night shifts, temporary transfer for other work can be carried out VKK.

In patients with moderate diabetes mellitus, especially with the addition of angiopathy, the ability to work is often reduced. Therefore, they should be advised to work with moderate physical and emotional stress, without night shifts, business trips, or additional workloads.

Attention!

Restrictions apply to all types of work that require constant attention, especially in patients receiving insulin (possibility of developing hypoglycemia). It is necessary to ensure the possibility of insulin injections and compliance with the dietary regimen in the production environment.

When transferring to a job with a lower qualification or with a significant reduction in the volume production activities patients are diagnosed with disability Group III. The working capacity of persons with mental and light physical labor is preserved, the necessary restrictions can be implemented by decision of the VKK of the medical institution.

With decompensation of diabetes, the patient is given sick leave ok disability. Such conditions, which often occur and are difficult to treat, can cause permanent disability of patients and the need to establish disability group II.

Significant disability, characteristic of patients with severe diabetes, is due not only to the violation of all types of metabolism, but also to the addition and rapid progression of angio-neuropathies and concomitant diseases. With rare exceptions, when it comes to highly skilled, mainly intellectual work, patients are not capable of regular performance of duties in a normal production environment.

Some individuals may work in specially created conditions or at home. Limitation of working capacity and, in connection with this, a decrease in qualifications and the amount of work serve as a reason for the establishment of VTEK disability of group III. If regular professional activity is impossible due to severe disorders of microcirculation and metabolism, group II disability is determined.

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 a dense and persistent disability and to the transfer to disability II and I groups. Evaluation of working capacity in patients with visual impairment due to diabetic retinopathy or diabetic cataracts is carried out after consultation with an expert ophthalmologist.

Source: https://www.rostmaster.ru/

Shift work and type 2 diabetes

A large international study suggests that type 2 diabetes is most common in people with shift work (day-night).

The findings, published in Occupational and Environmental Medicine, point to people who work in shifts. They are the ones at risk. It is believed that a violation of the schedule affects the state of the body, hormonal levels and sleep - this causes an increase in risks.

The UK Diabetes Campaign advises such employees to eat a balanced diet and eat only healthy foods.

The disease can lead to blindness, increase the risk of heart attacks and strokes, and damage nerves and blood vessels, which increases the risk of leg amputation (in very severe cases).

Research in the sleep lab has shown that napping at the wrong time of day leads to the early stages of type 2 diabetes developing within a few weeks.

An analysis of data from 226,652 people strengthened the association with type 2 diabetes. In the UK, 45 out of every 1,000 adults have some form of diabetes, the vast majority of whom are type 2.

A study by researchers at the Huazhong University of Science and Technology in China found that 9% of people who worked in shifts were more likely to develop type 2 diabetes.

But for men, this figure was 35%. For people torn between night and day shifts, the risk increased by 42%. The researchers say: "The results showed that male shift workers should pay more attention to diabetes prevention."

"Given the increasing prevalence of shift work around the world and the heavy burden of diabetes, the results of our study provide practical and valuable clues for diabetes prevention."

Possible explanations include disturbed sleep and eating patterns during shift work. One idea is that eating late at night makes the body more prone to storing fat, which increases obesity and, in turn, type 2 diabetes. The study suggests that the increased risk can be avoided by changing the level of male hormones.

In addition, do not forget about other factors that affect the risk of type 2 diabetes, because you can not pay attention only to a person's work schedule - this is just one of the factors. It's just more likely that it is shift work that is causing the disruption in sleep and nutrition, leading to an increased risk of developing the disease.

Source: http://www.ecolife.ru

Choosing a Career for a Diabetic Patient

When choosing a profession, a diabetic should avoid two extremes: one should not underestimate the seriousness of one's disease and dashingly rush to storm unbearable heights, but one should not absolutize the exclusivity of one's position, running away from everything that requires you to spend your mind and energy.

Thousands of people with diabetes mellitus left a mark in science, art, contributed to their work technical progress society. French artist Paul Cezanne, English writer Herbert Wells, medical academics A. Nesterov and V. Baranov - the list goes on and on.

Yes, and you yourself could name dozens of names of people who successfully do what they love, despite the disease. It is only a pity that those around are not always attentive to those who work nearby, and do not realize why their colleague is “ridiculously punctual” in eating or by hook or by crook fights off business trips and agricultural work. And he, it turns out, is sick, but once again he does not want to remind about it.

When talking with a diabetic about choosing a profession, doctors advise choosing one that does not require a sharp change in physical and mental stress. It, of course, should be safe for the health of the patient himself and not threaten with unexpected "state of emergency" for others.

It is not difficult to imagine what is fraught, for example, for bus passengers with hypoglycemia or a driver's coma. And is it possible, without fear for the life of a diabetic, to “bless” him on the path of a climber-fitter or a policeman?

Anyway, about systems approach in choosing a profession, one can speak in the absence of severe complications and compensation for carbohydrate metabolism, regardless of the type of treatment used.

Attention!

The head of the enterprise or institution where you are employed or where you worked before the disease must be informed of your diagnosis. This will save you from possible misunderstandings, help you properly organize the regime of work and rest. You should be able to inject insulin or take pills, and not just “grab on the go” what you have to, but strictly on time to eat the food you need.

Why do people with diabetes need to give up shift work? In this case, the regimen of insulin administration is violated and timely correction of previously used doses of drugs is required. Your manager must know in advance that any overtime, even if you seem to be indispensable, is not for you, and if he appreciates you as a specialist, he must come to terms with this.

By the way, there is another very curious and extremely useful recommendation: in order to be appreciated at work, and you yourself do not get stuck when you discover that your illness and your profession interfere with each other, try to master them as much as possible from the very beginning. If your child is sick, take this as a guideline in order to ensure his future with his own head and his own hands.

What exactly should be the professional orientation of a patient with diabetes mellitus?

Young people are encouraged to master such professions as a teacher, a librarian, an agronomist, a trade worker, a physician (but not a surgeon), an economist, a painter, a parquet floor worker, a television and radio master, a clerk, an assistant secretary. But even in the case of choosing these seemingly calm professions, one should take into account the severity of diabetes, complications, concomitant diseases.

• With a mild form of diabetes, in addition to the conditions mentioned above (exemption from night shifts, business trips, loads that require high energy costs), work in hot shops and underground is excluded.
• With an average degree, a ban on work where attention is required (conveyor line), the movement of mechanisms, and transport is added to this.
• For severe diabetes professional labor becomes practically impossible and, as a rule, comes down to work at home.

What specific professions can be considered compatible with diabetes, if it is compensated and not burdened with serious complications?

• doctor, preferably a general practitioner and dentist,
• pharmacist,
• laboratory assistant
• nurse,
• nutritionist and dietitian,
• hospital administrative staff,
• school and university teacher
• mechanic,
• technician,
• economist,
• accountant,
• gardener,
• decorator,
• tailor and others.

Contraindicated professions associated with extreme situations:

• enlisted men and non-commissioned officers of the military service,
• police officers,
• mine rescuers,
• athletes and artists whose performances involve risk,
• roofers,
• firemen,
• installers.

There can be no question of working in infectious diseases hospitals, bacteriological and chemical laboratories, in general, wherever there is heat or cold, dampness, harm to the eyes, mucous membranes and skin. Someone may be surprised by the undesirability of working in canteens, bakeries, confectioneries, buffets, but this immediately becomes clear, given that one cannot do without sample tastings.

Where this prohibition is ignored by force or unknowingly, breakdowns and complications are inevitable. As statistics show, the most “generous” for diabetes in women is the food industry, where, compared with other, traditionally female industries, the incidence of diabetes is three times higher.

It can be difficult, if not impossible, to part with the profession that determines your vital status established system of values. But after all, firstly, it is not always necessary to part if the disease has caught you already at the top or decline life path- here, even with a severe form, adjustments to the regimen, mitigation of the requirements are possible. And secondly, the same driver (and leaving the steering wheel or remote control in this case is mandatory) can become a dispatcher or auto mechanic, a policeman can become an inspector of the personnel department, etc.

When talking about choosing a profession or mastering it in conditions of illness, one cannot avoid mentioning the need to create a favorable moral and psychological climate in work collective. Alas, not every manager easily puts up with the fact that the decrease in the working capacity of patients, even with uncomplicated diabetes mellitus, compensated only by diet, averages 20 percent.

If the boss knows about the essence of the disease (and both the shop doctor and the patient himself should help him in this), it seems that the working life of a diabetic will not be overshadowed by the indifference of others.

But life is life. And bosses are different. It is no coincidence that the World Health Organization in its latest report on diabetes mellitus (Geneva, 1990) declares the inadmissibility of discrimination against diabetic patients in obtaining a profession, work. This means that there are facts of discrimination - and how they manifest themselves, how to deal with them, apparently, should become a permanent topic for our magazine. In some countries education and employment opportunities for people with diabetes are protected by law.

Stand up to protect their rights and guarantees public formations diabetics, which are created all over the world, uniting patients on a scale of cities, towns - and up to a national scale. Among other problems, they manage to solve issues related to career guidance, vocational training for young people, and retraining of people with diabetes in adulthood. And although this experience is only beginning to be adopted in our republic, this fact gives reason for hope ...

Source: http://www.happydoctor.ru

Shift work significantly increases the risk of diabetes and obesity

Working in shifts, a person usually devotes too little time to sleep, and very often not at night, which in turn can significantly increase the risk of developing diabetes and obesity, a group of British scientists came to this conclusion as a result of another study.

We analyzed the condition of 21 people who worked in an unusual mode, which did not include the ability to go to bed or eat at the same time. Based on an analysis published in Science magazine Translational Medicine, it has been found that with this lifestyle, the body is faced with some metabolic problems that the body tries to regulate. As a result, in some patients, the first symptoms of diabetes developed within just a few weeks.

The researchers arranged for the test group conditions as close as possible to shift work. The length of their day was extended to 28 hours, and most of the time they spent in dimly lit space so that the influence of sunlight could not properly set the biological clock to the desired rhythm.

They averaged 6.5 hours of sleep during their extended day, which is equivalent to about 5.6 hours on a normal day. Researchers have calculated that from such a lifestyle in the body, the production of hormones that suppress the production of insulin jumps several times over. In three participants in the experiment, the level of sugar in the blood was kept at this high level that their condition was close to developing diabetes, as a result of which they had to be withdrawn from the trial.

All participants experienced an average of an 8% drop in metabolic rate, which was immediately reflected in the rates of fat gain.

On average, over the three weeks of the test, each of the participants added 2-3 kg of adipose tissue. Thus, the researchers concluded that shift work, especially at night, is extremely dangerous in terms of increasing the likelihood of developing diabetes and obesity.

In this case, the circadian rhythm goes astray, which causes a hormonal imbalance in the body, significantly weakens the immune system, and can lead to a number of the most adverse consequences.

Fear of being denied a job or being fired often leads a person to hide from an employer that they are sick. This happens not only with diabetes, but it is with this disease that this should not be done. If diabetes is controlled only by diet, the only inconvenience in the workplace will be the need to eat on time, but this may go unnoticed by other employees and superiors.

If the treatment is associated with the risk of hypoglycemia, then, firstly, it is quite dangerous for the patient himself, and possibly for those around him, and, secondly, sooner or later it will still show up. Then explanations with the employer cannot be avoided. It is likely that layoffs, too. This means that you must immediately tell about your illness and explain what inconveniences it is fraught with for the work process.

Many employers have a very remote idea of ​​diabetes, knowing only that this condition requires frequent insulin injections. They refuse to hire or fire them just like that, just in case.

Choice of profession

Choosing a profession for a person with diabetes can be difficult.

If parents take care of the correct career guidance of their son or daughter, then, as adults, children will be able to find application for their knowledge and abilities, regardless of whether they are sick or healthy. To do this, raising a child (this also applies to healthy children), you can not concentrate his attention only on any one profession.

Diabetes, unfortunately, is not the only reason why a person may be considered unfit to perform a particular job. How many hard experiences are experienced by the boys who dreamed of a military career when the medical board does not let them through because of some kind of flat feet! And young people who have devoted all their childhood to the sport of high achievements, who have achieved considerable success, who suddenly fall out of the cage due to an absurd injury ...

But if a teenager at the same time has computer skills, or he owns foreign language, or knows how to make something with his hands, or is well versed in music, or ... This list is endless, then he will be able to overcome life's obstacle and get out of a difficult situation with dignity and profit for himself. But if a young man knows nothing more than how to run around the stadium with the ball, then this will turn out to be a real tragedy. We have already talked about this before, but everything said equally applies to young people who have not yet had time to get a specialty.

When choosing a profession, one must very meticulously assess one's own condition and one's physical capabilities. Diabetes is already a serious health challenge. You should not test yourself for strength, also choosing a job with harmful conditions.

Permanent work on outdoors entails the risk of frequent colds, which adversely affects the course of diabetes. If it is also associated with physical activity, the risk of episodes of hypoglycemia increases dramatically. Working in an excessively dusty, damp room or where the temperature is elevated is also not the best choice.

The options for chemical and pharmaceutical production are also not suitable (work in a pharmacy is not contraindicated), infectious diseases departments of hospitals, everything associated with increased vibration (it also causes a healthy person over time specific disorders- vibration disease, and in diabetes mellitus, its destructive effect will manifest itself much faster and to a more severe degree).

Contraindicated

Types of work associated with an immediate danger to a person with diabetes and others are absolutely contraindicated. In our country, people with diabetes are not allowed to work as drivers - hypoglycemia that occurs while driving a car can lead to a serious traffic accident.

For the same reason, the driving of locomotives and aircraft is excluded. The possibility of sudden disturbances in coordination and consciousness due to hypoglycemia does not allow diabetics to work with cutting machines, under water, at height, at the conveyor, in hot shops of metallurgical plants, etc.

A person can become disoriented when they need to make a quick, informed decision, so a diabetic person will not be hired as an air traffic controller and a railroad traffic controller. Avoid working in factories Food Industry: practice shows that the incidence of diabetes in such workplaces is several times higher than the average in other industries (frequent tasting of manufactured products necessitates additional insulin injections and entails weight gain).

Service in the army and police, associated with extreme physical and psychological stress, is also not shown, and pass medical commission that selects candidates for these positions will fail. If the disease began when a person had already served for some time, they can choose a job option in the same military units and departments of the Ministry of Internal Affairs: clerks, personnel officers, analysts are needed everywhere. Especially valued workers who know the service from the inside.

Well-compensated diabetes mellitus without serious complications is not an obstacle to maintaining a position in most patients, but changes will have to be made to the working day.

The need for multiple meals is unlikely to please the authorities if they do not know what it is connected with. If there is a need to transfer to insulin therapy, you need to tell your colleagues that it is insulin that is being injected, otherwise it can be regarded as a manifestation of drug addiction.

If injections have to be done at work, store insulin and everything that comes with it should be in a lockable box, and preferably in a safe. This is due to the fact that vials can be dropped and broken, and the drug can be used for other purposes, including for criminal purposes. Many people prefer to carry insulin with them every day from home, but in winter this can cause it to spoil. In the summer heat, the drug may also deteriorate during transportation.

One of the colleagues (preferably two or three) needs to be told how hypoglycemia manifests itself and how first aid should be provided. The room must have a cooler or kettle, water and sugar. Some patients refuse work time check blood glucose levels - they are embarrassed or they have no time. This is wrong, as valuable information is lost, without which it is difficult to regulate glycemia.

If everything is done openly, without hiding, although not defiantly for show, no one will resent the desire of a colleague with diabetes not to participate in overtime work and don't go on business trips. If this is a prerequisite for the work performed, you need to think about moving to another department or to another position. Additional training may be required, but in order to keep the job, you must agree to it. And by the way, this can be very interesting.

If a person is busy with hard physical labor, he needs to eat a lot. A diabetic patient is afraid to "go over" the bread units and therefore often undernourished, which leads to episodes of hypoglycemia provoked by active physical exertion, and to general malnutrition, which further undermines health.

Difficulties with insulin injections

When working in shifts, there are difficulties with the regimen of insulin injections. Regular meals should be taken while awake, including the last snack before bed. It is better for such patients to use "ultra-short" insulins, the action of which is short-lived: periods of wakefulness and sleep follow at irregular intervals, and it can be extremely difficult to adjust to them.

The scheme of insulin administration remains, as it were, the same: for example, what was administered before bedtime in the late evening is also administered before bedtime, only at 10 am, when the patient returns home from his shift. Of course, it will still not be possible to achieve a good, rhythmic alternation of insulin doses, because the rhythm of sleep and wakefulness will be disturbed. This means that such work is a temporary option until a person finds something more suitable for himself.

Travel work requires patients on insulin to take food with them and make occasional stops along the way to eat.

If a person is flying on a business trip by plane, he should be aware that during the pre-flight inspection at the airport, he may be required to lay out all the food that he took with him for timely snacks. And he will also have to explain the purpose of syringes. In this case, it is very useful to have a certificate from a doctor with you indicating the diagnosis, a recommendation to inject insulin and eat regularly.

If it so happens that a person suffering from diabetes is already on the plane, it's time to eat, and the passengers have not yet begun to feed, there is no need to be shy - you should tell the flight attendant about the problem. Even if she does not like the request to give out an additional portion of in-flight meals, she will in any case prefer to feed such a passenger than to provide him with emergency assistance in flight.

Sometimes employers are interested in retaining a valuable employee and do not mind that he, having diabetes, remains at his workplace, but they do not make concessions: overtime, business trips, night shifts - everything continues as before.

No matter how difficult the financial situation is, it is impossible to follow the lead of such leaders: the disease will progress extremely quickly, and very soon the person will no longer be able to do any work. That's when financial position will really be deplorable.

So even from a material point of view, it is better to part with such work in time and find something else. At the same time, it will be possible to maintain overall working capacity for a longer time without becoming disabled. However, in this case, you should be aware that there are quite a few enterprises that specifically create jobs for the disabled, as this gives them tax benefits.

Interestingly, according to some studies, people with diabetes are less likely to take sick leave than their healthy counterparts. This is partly due to more strict control of their own health - they try to dress for the weather, many quit smoking, and regular meals help to minimize the number of stomach upsets.

But basically, in my opinion, this is the result of a fear of showing the leader his weakness. The objective reality is that the authorities do not put up with frequent absences due to illness and are looking for replacements for such workers. A person with diabetes needs to be doubly vigilant: the temptation to take a walk in March without a hat can result in the loss of a job.

Chronic diabetic complications

Significantly complicate the situation of chronic diabetic complications. Retinopathy and cataracts significantly reduce vision, and if the load on the eyes continues, it deteriorates catastrophically.

One of my patients, in order to continue working as an accountant, had to use the help of another person: he dictated the initial data to her, she analyzed them, and the assistant entered the results into a computer. Removal of the cataract and replacement of the lens did not bring relief, because as a result of poorly controlled diabetes and constant eye strain, retinopathy continued to progress.

Nephropathy, combined with frequent exacerbations of chronic pyelonephritis, leads to a long absence from work due to illness. The formation of a diabetic foot limits the ability to move independently. Complications from the heart and blood vessels reduce overall performance.

Some patients, as they say, go to work to the last. The fear of being left without a source of existence prevents them from stopping in time and stopping self-torture. It ends naturally - a deep disability sets in with absolute disability.

This means that if serious diabetic complications develop, you need to find the strength in yourself to move to another job in time, even if it is much worse paid. An early disability retirement can hit a family budget more than a partial loss of income.

Your own employer

If a person has his own business and is his own employer and leader, the situation changes. Of course, the daily routine of entrepreneurs leaves much to be desired: endless trips to meetings with potential and established partners, business dinners with alcohol and rich fatty snacks, smoking, constant tension in anticipation of any financial troubles, responsibility for hired workers - all this is not at all greenhouse conditions for a patient with diabetes mellitus.

In this case, it is very important to find a good, reliable assistant who will take on part of the load. Even if at the same time the income of the enterprise will decrease somewhat, the saved health is worth it.

It is gratifying that many businessmen note that the tradition is to drink and eat a lot during business meetings is gradually fading away. Increasingly, low-calorie dietary dishes appear on the table: grilled meat and fish, salads without mayonnaise, vegetables and fruits. In addition, a person's behavior during business feasts is increasingly dependent on his own attitudes and less and less on the opinions of others.

Smoking

Fortunately, it is becoming fashionable not to smoke. Of course, not everyone can give up a bad habit, but the more respect is given to those who succeeded. And what can we say about self-respect! Usually the words “I smoked for twenty years, but quit and have not smoked at all for two years” are said with such pride that you understand how difficult it was to do this.

Situations where a businessman, because he has diabetes, closes his business and goes to state pensions, are quite rare. Generally people are fine knowledgeable features own body, adapt well to new conditions and continue to work actively.