The reason it is a show stopper is because of the potential side effects of long term high blood glucose levels. People with diabetes have an increased risk for so many life ending diseases. You don’t hear about people dying from diabetes as it is not frequent that someone goes into a coma and dies as a result of ketoacidosis or hypoglycemia. You don’t normally hear how the heart disease, kidney failure, or liver failure that ended someone’s life was due to complications from diabetes. Fact of the matter is Diabetes is the number one contributing factor to so many deaths, it’s just not the primary cause of death.
Until blood glucose levels are brought under control and a pattern of control has been established, there is simply no way of knowing when a sudden incident may occur that inhibits your ability to safely perform your job duties. As such, it’s simply not worth the risk. You state that your morning blood glucose level is still high, what is it at 0100? Is your blood glucose level high from 2100 after dinner until 0600? This can be very detrimental to your ability to do your job safely. While the factors and effects tend to be more extreme with Type I, the same rules apply with Type II. Those rules are, there are no rules. The lowest recorded blood glucose level we have for my daughter is 23. She looked and acted fine, neither my wife nor I can specify what didn’t “feel right” that caused us to test her. Fortunately we have never had to administer glucagon, call 911 because she’s passed out due to low blood glucose level, or experienced her going into seizures. A friend of ours son, who is also diabetic, has seized with a blood sugar of 63. When she is acting out or not following direction we usually have her test her blood glucose level, 99 times out of 100 her reading is high. We’ve watched patterns of good control and all of a sudden the numbers go wild and we are desperately searching for a cause. It took us about 6 years to realize it, but usually within 72 hours of her control getting out of hand she’s sick. Be it vomiting and flu like symptoms down to a common cold or strep throat. The point I’m trying to make is twofold. Number one, you may not realize the adverse effects poor control may be having on you. Number two, the disease is different for every person AND different within every person. What works for you may not work for someone else. At the same time, what works for you today may not work tomorrow, there are simply too many factors and unknowns.
As far as your morning blood glucose levels are concerned. First of all find out what they are doing overnight. Test right before you go to bed and set an alarm to test at the midpoint of your sleep cycle. If you are consistently high with both you may need to adjust your evening meal, activity, or both. If you are normal at bedtime but extremely high or low at the midpoint, you may need adjust or have a bedtime snack. The body can “panic”. When it does so it causes the liver to dump stored glucose in an attempt to preserve your life (the same thing giving my daughter an injection of glucagon does). When my daughter was young after diagnosis we had problems with her going low during the night. We learned a little “trick”. Just before bedtime we made her a “cocktail”. It consisted of a drinkable, lowfat yogurt (the protein) and 1 tablespoon of corn starch. Corn starch is the most pure carbohydrate, it’s also very complex. This “cocktail” carried her through the night as the combination of protein and longer processing time of the complex carbohydrate resulted in more even numbers. Make sure you test before exercising. If need be, wait until it is below 250, if you don’t you will only drive it higher.
Chief Cavo is an invaluable contributor to this board. I know he studied law and, if I remember correctly, was a lawyer at some time during his maritime career. If he knows the answer to a question he will state it as such, if it is merely an educated opinion he makes that clear. You’ll have to wait until he weighs in on your further questions or attempt to obtain an answer from the NMC because I simply don’t know.
I hope you find some of my suggestions useful and/or beneficial. However, please note that they are merely suggestions based on my own personal experience with my daughter. I am not a medical professional and no opinion offered is to be construed as medical advice.