Welcome to Let's Talk Fleet Risk, a podcast for those who manage drivers and vehicles, and want to reduce road risk in their organisation. In this episode, I'm talking to Kate Walker, Managing Director of the Diabetes Safety Organisation. We'll be discussing: Why Driver Safety Managers need to understand the hidden epidemic that is diabetes. When is diabetes a DVLA notifiable condition? The potential consequences of a typical on-the-road diet, enabling conversations with employees around driving with diabetes. Good practice for managing diabetes risk, and some resources to help. Hello everyone and welcome to this edition of Let's Talk Fleet Risk. This quarter we're looking at various aspects of fitness to drive, and my guest today is Kate Walker, who is Managing Director of the Diabetes Safety Organisation. Welcome to the podcast Kate. Kate: Thanks for having me today, Simon. Simon: Kate your website says that diabetes is a hidden epidemic leaving all companies exposed to increased absenteeism, increased risk of accidents, and therefore increased risk of company liability, so, why is that? And why does somebody who manages the safety of people who drive for work need to listen to this podcast? Kate: I think it’s really important to address this epidemic of diabetes. I think it's hidden in several ways, so I don't think people necessarily living with it understand the complexity of it. And also, I think it's hidden in the workplace. There's actually one in 12 in the working population living with diabetes and we've just hit 5 million people in the UK. And we can touch on some of the stats in a minute but in terms of your question around why, why is this important for a manager… I think we need to understand that diabetes is a known foreseeable risk in the workplace. And there is legislation that needs to be followed, which again, is often not understood – people think diabetes and they think medical, GPs. And I think there’s a lot of work that needs to be done around bringing this to light and removing the stigma, and also understanding the implications in the workplace. We know that there are 5 million people with the condition. A further 12.6 million in the UK have pre-diabetes. So, these numbers are significant. And if people are unmanaged, time off of work increases, there is an increased risk of accidents from those who are undiagnosed, or those who are not necessarily managing it as well – we know it’s not always easy to get GP appointments, or the time and support that may be needed for people living with diabetes. And there's also the experience we have when we're going to companies – it's hard for people to come forward and share, because of the unknown. Are they going to lose their job? Is their job still safe? What are the requirements? You know, it’s either let's not get diagnosed and we never have to address it, or let's hide away from it – and that poses a risk in so many different ways. As an employer as well – and I think for any safety managers –there's a real need to understand the difference between the two types of diabetes, which we’ll come on to. The right conversation needs to be had, also to understand that the Health and Safety at Work Act does come in here, and people, need to make sure they are managing this risk. People living with diabetes have to also comply with DVLA regulations, and they fit under the Equality Act because, more often than not, diabetes would be a disability. So, for all of those reasons, I think we really need to start a conversation around diabetes across the industry to make our roads safer and to help anyone who is living with it to feel safe to come forward, and really be able to share and understand that it's okay and safe to do so. Simon: Before we started this discussion, I went on the DVLA's website just to see what they had to say about diabetes and notifiable conditions. And it said that if you have diabetes and you manage it with diet, it's not notifiable. But if you do need insulin, it is notifiable. So am I right in thinking that if you're treating with insulin, it's type one, if you're treating with diet, it's type two. And if so, what's the difference? And I guess, how do you come to have diabetes? Kate: So no, it's not only type one on insulin. And again, this question alone, I think really raises a good question of how can we have the right conversation in the workplace if we don't understand diabetes and the two variations here? So, type one people living with diabetes often are frustrated. So, type one diabetes is an autoimmune disease – at some point, their body had a reaction and now their pancreas, which produces insulin, no longer works. And of the 5 million, only 4% - about 400,000 – are living with type one diabetes. Predominantly everybody else is living with type two. In my experience, when we work with people with type one diabetes, they find it frustrating that they are bundled into the same category, and they’re not understood. You’ll often see them now with sensors on their arms, and they have to manage their diabetes throughout the day – so any time they eat, they have to put the right insulin in. They’re effectively self-regulating their own blood sugar levels, which we – myself, as someone not living with diabetes – take for granted; my blood sugars are managed for me. They’re having to deal with it – it’s effectively like another job. Even temperature can cause insulin to do something. As a condition, it’s a lot of work for someone living with it. On the other side, we've got people living with type 2 – so that's 95 % of the 5 million – and 600 ,000 people with type 2 diabetes are also on insulin. Now, the condition is different. So, for type 2 diabetes, it's often progressive. The easiest analogy – if we use vehicles – is if I was driving down to London from Birmingham in first gear, we wouldn’t be surprised if my car engine was smoking. I hadn’t changed gears. If I turn around, come back, change gears, hopefully I’m in no further trouble. If I keep driving at first, at some point the engine will smoke and it will breakdown. The pancreas, from the perspective of living with type two diabetes is very similar. So, if we look after our body, it will work effectively. Over time, if we keep driving in first or pushing too much in – and that could be stress, it could be other medical conditions, it could be the choices of foods, lifestyle… there's many factors that contribute to type two. But if it all pushes on that organ too often, at some point we get the smoke, the warning signs of diabetes, pre-diabetes. And if we ignore that, it turns into type two diabetes. Sadly, it’s a progressive disease – caught early it can be managed on food and lifestyle choices. But left, or not well-managed, it can need medication from different strengths of tablets – some of them strong, and reportable to the DVLA – right up to insulin. So, people living with type two diabetes who are on insulin, they don’t become type one – they are type two on insulin. As I said, there are 600,000 in the UK. So, when we look at insulin, often people with type one diabetes have had it since they were young, and they get a lot of support. Often people with type two diabetes on insulin are not as well educated because there’s not as much support for them. So, I think it’s another place, in the workplace, to help educate and support people living with both types of diabetes on insulin. And under DVLA regulations, they have to test every 2 hours whilst driving on insulin to ensure the blood levels are correct – safely – for the prevention of any accidents happening due to their blood sugar levels dropping too quickly and having a hype. So, if we can have managers and people inside companies understanding the difference, understanding the requirements of people, and the differences that they're living with, it really allows it to become safer – and there are no blanket bans in the UK. So again, anyone can drive as long as their blood sugars are well managed and they're looking after themselves. Simon: Well, what would be typical symptoms of someone who is pre-diabetic? Kate: Classic symptoms of pre-diabetes is over-thirsty. Changing sexual excitement. Going to the toilet regularly. Getting too hot. The difficulty – which is why we say that it’s hidden – is they’re very subtle symptoms. Over-fatigued, can feel more stressed than normal… they’re all symptoms we could put down to a busy day, or work, or drinking too much. Diabetes UK have a Know Your Risk Score – you can do some questions and check it out and I absolutely recommend it. The sooner we catch the pre-diabetes, or the edge of diabetes, it’s reversable for many – not all – and actually, it prevents the complications and the damage that occurs, which are really the major problems that come with diabetes down the line. So, there are some good solutions to it but caught early it can make a massive difference. Simon: You said previously that diet was one of the possible contributory factors, and a lot of the drivers that are managed by the audience on the call today… a lot of those drivers are on the road all day and they rely on cafes petrol stations, motorway service stations, etcetera for their daily nutrition, which obviously isn't great. What are the likely consequences of that? Kate: Yeah, I think this is an industry that is faced with some additional challenges. We've got to look at what impacts diabetes. Stress does, as we've said, nutrition does, movement does. So, can we move a little bit more? Well, that's let’s have a little walk around whilst we're in those cafes and petrol stations just a little bit longer. The food choices are interesting. We all know what it's like to stop at a cafe, but are there better choices? I think we live