On the Line

The Diabetes WA Helpline provides free comprehensive access to personalised diabetes management advice and support from a credentialed diabetes educator. Meet our educators as they share some of the common concerns they hear from our members.

Christine Carne

Christy is a credentialed diabetes nurse educator who has worked in the diabetes field for more than 20 years in various roles including diabetes research, children’s diabetes and community diabetes education. For the past seven years she has been employed at Diabetes WA in clinical, telehealth and community education roles. Being a country girl at heart, Christy’s passion is to assist people living in regional and remote WA. After spending two years establishing the Diabetes Telehealth Service for regional WA, she is now focussed on providing her expertise on the Diabetes WA Helpline. She says empowering people with diabetes, their family, and carers to troubleshoot and self-manage their health via the helpline is especially rewarding. Why do I need to report my diabetes to the Government of Western Australia Department of Transport (DoT) for my driver’s licence?

Driving is a complex skill, both physically and mentally, and if you have diabetes, you may need to take extra precautions to ensure road safety for yourself and others. By law all drivers in WA are required to notify the DoT of any permanent or long-term mental or physical health conditions or treatments that may impair their ability to drive a motor vehicle. These are referred to as reportable medical conditions. Reporting any medical condition to DoT means you are helping to keep our roads safer, as well as avoiding potential fines and insurance implications! The DoT also needs to be updated if or when there is a change in the previously notified condition or treatment. Diabetes is one such reportable long-term condition that may affect your ability to drive, either due to having: • hypoglycaemia (low blood glucose levels less than 4 mmol/L) or hypo-unawareness (not experiencing symptoms of low blood glucose levels) • diabetes complications involving the eyes (changes in vision), feet (nerve damage) or heart (changes to heart rate, blood pressure etc.) Reporting a medical condition only takes a few moments and can be done online by visiting the DoT website and completing the ‘Report a Medical Condition’ form (‘Notification of Driving Impairment’ forms are also available at licensing centres or authorised agents). Once the DoT has received your notification they will inform you on what action, if any, is required next. If your diabetes is managed by diet and exercise alone, you may be able to drive without any licence restrictions. However, you are still required to have regular reviews with your treating doctor to track any progression of your diabetes. If your diabetes is managed by certain glucose lowering medication, insulin or if you have a commercial licence, you may be required to undergo a medical review to assess your ‘Fitness to Drive’. These assessments may need to be repeated every one to five years. A ‘Fitness to Drive Declaration’ is usually sent to you from DoT approximately 12 weeks prior to the expiry of your licence. This is to make sure that your driving ability is not impaired, which keeps you and other road users safe. Most people with diabetes can make an appointment with their GP to have their ‘Fitness to Drive” medical assessment completed and lodged electronically. Some people however may require a referral from a GP to an endocrinologist or consultant physician specialising in diabetes to conduct this assessment and review their diabetes management. Sometimes accessing a diabetes specialist in a timely manner can be difficult, due to waitlists, lack of appointment availability and associated costs (if seeing a private specialist). People with diabetes on multiple medications or those with commercial driver’s licences are encouraged to have a current referral to a diabetes specialist from their GP. This may require advanced planning! Diabetes Australia and the NDSS have provided simple tips to support safe driving in the ‘Diabetes and Driving’ booklet, available from the NDSS website.

Our helpline is available to anyone living in WA for the cost of a local call. Contact us on 1300 001 880 or email info@diabeteswa.com.au for further information. People living with diabetes in regional WA can also access our diabetes health professionals including an endocrinologist via the Diabetes Telehealth Service.

Nyaree Lawler

Nyaree is a registered nurse who has been working as a diabetes educator for 20 years. Nyaree has a passion for working in Aboriginal health and rural health. Even though she has worked at Diabetes WA for five years, she still lives in Toodyay and continues to provide diabetes services in the Wheatbelt. During her nursing career, Nyaree has worked overseas in England, Ireland and Angola. As a diabetes educator, she has worked in the Gascoyne, Wheatbelt and Perth, as well as providing some diabetes group sessions in various remote Aboriginal communities. Nyaree enjoys jogging and hiking. Competing in an ultramarathon and completing the Cape-to-Cape hike are among her personal highlights. I’m not feeling well and my blood glucose levels have gone up. What should I do?

This is a common enquiry we get on our helpline, from people with either type 1 or type 2 diabetes. When you are unwell or have an infection, the body releases stress hormones, such as adrenaline and cortisol, as it prepares for the ‘fight or flight’ response. These stress hormones increase the amount of glucose going into your blood stream from the liver, as well as making it harder for insulin to work, which allows glucose to enter the cells and be used for energy. This is the body’s way of getting enough energy (glucose) in the blood to ‘fight’ the illness.

As our glucose levels increase, we need more insulin. So what does that mean for people with diabetes who may not be producing any insulin themselves, or may not be able to produce enough extra insulin? A sick day plan can help you. This is a plan that you follow when you have an infection, or when you feel unwell. Having a plan can also help you be prepared if you contract COVID-19. The plan will guide you on how to manage your diabetes during this time and includes information on how often to check blood glucose levels, how often to check for ketones if you have type 1 diabetes, how much fluid to drink to prevent dehydration, what medications you may need to stop taking, and, most importantly, when to seek medical assistance. For people who are using insulin to manage their diabetes, the sick day plan will guide you as to how much insulin to have and how often. This is particularly important for people with type 1 diabetes because if you don’t have enough extra insulin then you can develop diabetes ketoacidosis (DKA), which is a serious and life-threatening condition. Whether you have type 1 or type 2 diabetes, having higher glucose levels, in this case due to illness, can cause dehydration as the body tries to excrete more glucose through the urine. Your sick day plan will suggest how much fluid to have each hour to try and prevent dehydration. Illnesses that cause vomiting or diarrhoea can drive your glucose levels too low because the glucose from food or drink may not be absorbed properly. This situation can be difficult to manage, especially for people with type 1 diabetes, because they need to continue to have some insulin, or they may develop DKA. Again, how to manage this situation will be part of your sick day plan. You may be interested in attending one of Diabetes WA’s online webinars that focus on sick day plans and sick day management – we have specialised sessions for type 1 and type 2. Book by visiting our website or calling our helpline on 1300 001 880.

Next time you are talking to your GP or credentialled diabetes educator, ask them for a sick day plan. There are sample plans readily available, but they will need to be personalised for you according to the type of diabetes you have and the medications you are on. If you have diabetes, are unwell and you are not sure what to do, please seek urgent medical attention.