Diabetes in the Workplace

Patients with diabetes face a great paradox. On the one hand they have a disease that is the leading cause of blindness, kidney failure, amputations and disease-related heart attacks in the United States. On the other hand, if their diabetes is well controlled they can avoid these terrible complications of diabetes and lead happy, productive, fulfilled lives. The paradox is most apparent in the workplace.

On the one hand employers worry about excess absenteeism due to diabetes. Employers worry about persons with diabetes hurting themselves or others because of low blood glucose reactions causing accidents. They worry about driving up the cost of their group health insurance rates because of the increased costs related to hiring a person with diabetes.

On the other hand, they do not want to fail to hire a good employee just because they have diabetes. Also, they do not want to violate any of the provisions of the Americans with Disabilities Act that offers protections to persons with diabetes. The Act requires employers with 15 or more employees to make “reasonable accommodation” for persons with disabilities.

Since 1984 the American Diabetes Association has had a consistent position on employment of persons with diabetes: Any person with diabetes, whether insulin treated or non–insulin treated, should be eligible for any employment for which he/she is otherwise qualified. Further they state that people with diabetes should be individually considered for employment based on the requirements of the specific job and the individual’s medical condition, treatment regimen, and medical history.

Employers should not make assumptions about the impact of an individual’s health on the job based on their general knowledge of diabetes. Employers cannot ask a job seeker about their health during an interview and you are not obligated to volunteer your health history. You need to share your diabetes with your employer if you are asking for “reasonable accommodation” under the Americans with Disabilities Act.

Reasonable accommodations may include things like providing a clean space and time for you to check your blood glucose levels or take insulin. You may also need to request permission to keep food available to address hypoglycemic reactions. Employers are routinely expected to make accommodations so that your diabetes will be well controlled and avoid illness and accidents.

The greatest barrier to licensure and employment for persons with diabetes is low blood glucose reactions. Hypoglycemia – a low blood glucose reaction – is defined as a glucose value that is less than 70 mg/dl. Severe hypoglycemia is defined as a glucose value below 40 mg/dl or an episode of hypoglycemia that requires the assistance of others to treat. Early symptoms of hypoglycemia are uncomfortable but do not compromise your ability to work. These symptoms are called adrenergic symptoms and they include: shaking, sweating, rapid heart beating and anxiousness. If these symptoms are not address, then additional symptoms occur that reflect an inadequate amount of glucose getting to the brain. These symptoms are call neuroglycopenia and include: headaches, confusion, slurred speech and may even cause seizures, loss of consciousness and even death.

Some persons with diabetes lose the ability to sense the adrenergic symptoms and go immediately to the neuroglycopenic symptoms. Hypoglycemic unawareness is the medical term for the loss of the ability to sense low glucose reactions. Frequent low glucose reactions, severe low glucose reactions and hypoglycemic unawareness can lead to loss of employment or limitations on the types of work you are allowed to do.

Your doctor can work with you to minimize the frequency of low glucose reactions by adjusting your diabetes regimen.

Hypoglycemia unawareness can also be reversed with proper care.