CF Related Diabetes - Did you know?

According to CF Registry of Ireland, 30% of the Irish adult CF population (over 200 people with CF) also have CF related diabetes. Additionally, many people with CF may be pre-diabetic with varying levels of glucose intolerance.

One of the risks of diabetes is having a low blood sugar level. This is also known as hypoglycaemia, or commonly referred to as “having a low” or as "having a hypo”. If your blood sugar level falls below 4.0 mmol/L this is deemed to be a low blood sugar level.

Part of the management of diabetes is learning to successfully manage hypoglycaemia whenever it happens, or to try to prevent future occurrences.

However, for those on insulin treatment, a side effect of insulin therapy is a low blood sugar level if the dose of insulin is mis-matched with to the quantity of carbohydrate you have eaten. So, if you take too much insulin in other words, you will experience a low-blood sugar somewhere between 1-3 hours post insulin dose.

Another reason you might experience a low is if you take your insulin too early or too late with your meal, if you skip a meal or if you have performed an intense exercise session without eating sufficiently afterwards.

It is a very fine balancing act between insulin dose, activity level and food intake of carbohydrate and of course any sugar content in foods. Those with CF related diabetes know this only too well.

An additional complicating factor is that your insulin dosage might need to change if you become unwell, for example with a chest infection. Your insulin sensitivity may also change over time. Anyone experiencing challenges maintaining their blood sugar control should discuss this with their specialist diabetes team.

One critically important impact of diabetes is how it can affect your driving.

It is dangerous to drive if your blood sugar is low. In fact, driving with a low blood sugar is viewed in legal terms on similar terms as driving under the influence of alcohol. If you were involved in a motoring accident caused by you having a low blood sugar event while you were driving, you could lose your driving licence. Low blood sugar can cause confusion, dizziness and lack of concentration. In a most severe hypoglycaemic event you could lose consciousness.

If you feel low while driving pull over and stop as soon as it is safe to do so. Treat your low with a rapid-acting sugary snack or Glucagon pen if you have one. Do not drive for 45 minutes post treating your low.

Useful Links

The National Driving Licence Service (NDLS) have published a booklet on Driving with Diabetes: https://www.ndls.ie/images/Documents/Forms/Diabetes-and-Driving.pdf

The more specific detail around the impact of driving with diabetes is summarised in a document online at https://www.diabetes.ascensia.ie/about-diabetes/driving-diabetes-and-the-law/

Additional information about diabetes can be found at Diabetes Ireland https://www.diabetes.ie/

Key points advised by NDLS for those driving with diabetes:

- You must notify NDLS that you have diabetes- it will be stated on your licence

- You must notify your motor insurance company that you have diabetes

- Keep personal ID with you at all times documenting your diabetes in case of accident

- You should monitor your blood sugar routinely and before you set out to drive

- If driving on a long journey, you should stop to check your blood sugar level at set breaks in the journey- recommend every 2 hours

- Always keep fast acting sugary snacks in your vehicle to treat a low should it happen

- If your blood sugar is 4.0 mmol/L or less- Do Not Drive. Take a snack and do not drive until your blood sugar has returned to above 5.0 mmol/L. Wait at least 45 minutes post treating a low before you drive again.

- “Do not drive below 5”: If your blood sugar is below 5.0 mmol/L – take a snack and wait 10 – 15 minutes until your blood sugar is above 5.0 mmol/L