Managing Diabetes at Work

As a person with diabetes, it is vital to understand your rights and how to handle your diabetes at work.

Whether you have prediabetes, type 1 diabetes, or type 2 diabetes, managing your workplace rights and being knowledgeable about your employer’s responsibilities can help you feel more confident and successful.

Whether you are in the UK or abroad, there are many resources such as Diab­­etes UK to help you navigate the workforce.

Having a diagnosis of diabetes classifies you as having a disability. This is defined as “If he has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities” .3

Employement regulation

Within UK legislation, The Disability Discrimination Act 1995 3, and the Equality Act 2010 2, all employers must make reasonable accommodations for their employees.

Reasonable adjustments are requirements an employer must adhere to in modifying the workplace to be suitable towards your needs and are outlined in the Disability Discrimination Act.

Eliminating disadvantages that may set you apart from a non-disabled counterpart is a reasonable accommodation. An example of this would be providing you with a special piece of machinery or equipment that helps you complete the job. Types of discrimination are addressed in the Equality Act and are outlined as such:

It is against the law to discriminate against anyone because of:

• Age­­­­­­
  
  
• Gender reassignment
  
  
• Being married or in a civil partnership
  
  
• Being pregnant or on maternity leave
  
  
• Disability
  
  
• Race including color, nationality, ethnic or national origin
  
  
• Religion or belief
  
  
• Sex
  
  
• Sexual orientation

These are considered ‘protected characteristics.

You’re protected from discrimination:

• At work
  
  
• In education
  
  
• As a consumer
  
  
• When using public services
  
  
• When buying or renting property
  
  
• As a member or guest of a private club or association

The Equality Act 2010 details further discrimination protection if:

• You are associated with someone who has a protected characteristic, for example, a family member or a friend
  
  
• You’ve complained about discrimination or supported someone else’s claim2

Your health insurance company is under the direct guidance of the two anti-discrimination laws mentioned previously. These regulations ensure equal access and coverage to all people.

As a person with diabetes, certain disability benefits may be available for you if you cannot work for some time. Some benefits include mental health evaluations, housing subsidy, and personal independence payments to contribute towards daily living expenses. 

Day to day management

Diabetes self-management skills are extremely important when navigating your way into the workplace. Keeping track of your blood sugar through daily finger sticks and recording your results can help you identify trends and feelings.

When blood glucose readings fall out of your desired range, it helps identify why it may be as such. As we have learned previously in A guide to diabetes medications, we know that diabetes in itself is a stress to the body. Good glucose control ensures you stay healthy, feel well, and are up to the tasks at hand.

Keeping track of your blood sugar level will help you regulate insulin dosage. Utilizing tracking apps or a pocket-size logbook is discrete and requires minimal time. 

Your employer should work with you to accommodate adequate blood sugar test checks and insulin injections for adequate breaks. As part of a daily diabetes care regimen, you may require more frequent meals or snacks, and your employer should work with you to find ways to accommodate that. 

Nerve damage can occur as diabetes progresses, and blood glucose levels are uncontrolled. It is thought that a high glucose level affects the nerves by damaging the blood vessels which supply them. In addition, high blood pressure also has a detrimental effect on the nerves.

Smoking and alcohol are also known to increase the risk of nerve pain occurring. The topic of nerve damage is particularly important to acknowledge when you are disclosing information to your employer. As insulin resistance persists, nerves are damaged by the excessive circulating sugar in your blood.

Long term complications like diabetic Neuropathy can affect many body areas in particular hands and feet. Neuropathy can cause numbness or tingling and loss of feeling. This can be impactful when working with both large pieces of equipment or small instruments.

Here a reasonable accommodation or safety measure may be taken to ensure safety and ease of job completion in the workplace. Long term complications can be avoided by having optimal blood sugar control and consistently working with your health care professionals.

Awareness in the workplace

When you are comfortable speaking to your employer and coworkers, it may help disclose what sort of symptoms you may experience if your blood sugar levels are not within normal ranges. If others are aware of what your symptoms, maybe they may be apt to check in with you more frequently. 

Low blood sugar (also known as hypoglycemia) is when your blood sugar levels have fallen low enough that you need to act to bring them back to your target range. This is usually when your blood sugar is less than 70 mg/dL. A low blood sugar level triggers the release of epinephrine, the “fight-or-flight” hormone.

Epinephrine can cause hypoglycemia symptoms, such as rapid heartbeat, sweating, and anxiety. If blood sugar levels continue to drop, the brain does not get enough glucose and doesn’t function as it should. This can lead to blurred vision, difficulty concentrating, confusion, slurred speech, and drowsiness.

If blood sugar stays low for too long, starving the brain of glucose may lead to seizures, coma, and very rarely, death. Each person’s reaction to low blood sugar is different.

Learn your own signs and symptoms of when your blood sugar is low. Writing these symptoms down may help you identify common stressors, behaviors, activities, and foods that can cause the low. Some symptoms are milder, more common like fatigue. Some other symptoms include:

• Feeling shaky
  
  
• Being nervous or anxious
  
  
• Sweating, chills and clamminess
  
  
• Irritability or impatience
  
  
• Headaches
  
  
• Coordination problems, clumsiness
  
  
• Confusion
  
  
• Fast heartbeat
  
  
• Feeling lightheaded or dizzy
  
  
• Hunger
  
  
• Nausea
  
  
• Color draining from the skin (pallor)

Severe hypoglycemia can occur when blood sugar levels plummet lower than 54 mg/dL.

When severe hypoglycemia occurs a person is unable to function because of mental or physical changes. They may need help from another person. Confusion and disorientation can occur. Other issues can arise such as:

• Convulsions / fitting / seizures
  
  
• Intense nightmares whilst asleep
  
  
• Loss of consciousness
  
  
• Feeling weak or having no energy
  
  
• Blurred/impaired vision
  
  
• Tingling or numbness in the lips, tongue, or cheeks
  
  
• Nightmares or crying out during sleep
  
  
• Seizures

For these above reasons, hypoglycemia is especially important to track. Preventing hypoglycemia includes eating regularly, being consistent with the number of carbohydrates consumed, and taking precautions while exercising.

In a study conducted in 2005, researchers found the most severe hypoglycemia symptoms are treatable and occur in 1% of the population studies. They also concluded “On the basis of the frequency and severity of hypoglycemia observed in the present study, restriction of employment opportunities for most people with insulin-treated diabetes may be difficult to justify.” 7

Exercising can induce hypoglycemia up until 24 hours after an activity is completed. If your job is particularly active, it may make you prone to hypoglycemia. Treatment involves quickly getting your blood sugar back to normal, either with high-sugar foods or drinks or with medications. The 15:15 rule applies to raising blood sugars. Utilizing 15 g of fast-acting carbohydrate to raise blood sugars these include:

• 5-6 LifeSaver candies
  
  
• 4-6 ounces regular (non-diet) soda
  
  
• 4-6 ounces of orange juice
  
  
• 2 tablespoons of raisins
  
• 8 ounces of nonfat or low-fat milk
  
  
• One tube (0.68 ounces) of Cake Mate decorator gel
  
  
• 3 glucose tabs
  
  
• Glucose gel

Retest your blood sugar levels after 15 minutes and consumption of the fast-acting carb. If the low blood sugar persists, these steps should repeat. Long-term treatment requires identifying and treating the cause of hypoglycemia.

In the workplace may find it helpful to keep the above items handy in their desk or the car if you are mobile. It is imperative to have proper identification and shows you as a person with diabetes if a medical situation arises.

Some people who have frequent low blood sugars may not develop typical symptoms and learn to function while having them. This is Hypoglycemic Unawareness. This is dangerous because confusion may keep you from treating the low blood sugar appropriately. This can allow low blood sugar to become more severe and result in serious problems.

Those with this condition cannot treat their low glucose without help; a medicine called glucagon needs to be used. With the help of friend or coworker, injecting glucagon can bring the glucose level back up to a normal range. When a person with diabetes is this low, it is not safe to consume a fast-acting carbohydrate. 

High blood glucose, known as Hyperglycemia, occurs as blood glucose levels rise >6.0 mmol/L (108 mg/dL). Similar symptoms to a low blood sugar take place, including: 

• Increased thirst and a dry mouth.
  
  
• Frequent urination
  
  
• Tiredness
  
  
• Blurred vision
  
  
• Stomach pain 
  
  
• Nausea
  
  
• Breath that smells fruity

Diabetic ketoacidosis (DKA) is a condition caused by the body needing to break down fat as a energy source. This can lead to a diabetic coma; this tends to affect people with type 1 diabetes. 

Hyperosmolar hyperglycemic state (HHS) is severe dehydration caused by the body trying to get rid of excess sugar. This tends to affect people with type 2 diabetes. Regularly having high blood sugar levels over months or years can permanently damage parts of the body such as the eyes, nerves, kidneys, and blood vessels. This nerve damage can have implications on your work, as previously mentioned.

Illness and diabetes

Having a sick day plan in place is imperative. When under stress and illness, people may tend to have higher blood sugar readings or lower. More frequent testing should occur, and your insulin dosage may need to change.

For people who tend to run low, having items on hand containing carbohydrates such as regular soda and jello may be helpful. Those with higher blood sugar readings would want to have sugar free options like diet jello and soda.

Under the National Health Service, health benefits, you may receive money towards your care while ill or disabled. As you work with your practitioner, you will begin to understand what normal blood sugar levels are for yourself. When you understand what stress, daily activity, food intake, and illness do to your body, you will have a better idea of reacting and treating these situations. 

Pregnancy and Diabetes

Gestational diabetes can be unique to the pregnancy or can continue postpartum. A small percentage of women will develop this while pregnant. Detected by an oral glucose tolerance test between 24-28 weeks gestation.

The diagnosis comes if abnormal amounts of glucose are in the urine. Many can control this type of diabetes with lifestyle changes. Some cases may need insulin. When treated, there is little risk of complications. Untreated, it may cause complications during and after birth. These include:

• High Birth Weight
  
  

• Incidence of C-section
  
  
• Preterm Labor
  
  
• Stillbirth
  
  
• Respiratory distress during labor
  
  
• Later Onset of Type 2 diabetes for both the mother and child

There are some risk factors involved, including:

• Pre-pregnancy overweight
  
  
• Genetic factors
  
  
• Non-white ethnicity
  
  
• Previous birth of a baby 9lbs+
  
  
• A direct relative that has diabetes
  
  
• A lack of physical activity
  
  
• Polycystic Ovarian Syndrome

During your pregnancy, you must ask for accommodations that include additional break and blood sugar testing times.

Some find that their work area needs adjusting such altered workspace and uniforms. The employer should allow flexibility to meet the needs of your maternal health visits. Risk assessments include

• Heavy lifting or carrying
  
  
• Standing or sitting for long periods 
  
  
• Exposure to toxins
  
  
• Working long hours

If the employer has difficulty removing the risks, an alternate position may be possible. If this is not available, the employer should suspend the employee with full pay. 

COVID-19 and Diabetes

We are in uncharted territories with the COVID 19 pandemic. With diagnosed diabetes, risks increase. Risk factors making you more susceptible to contracting the COVID-19 virus.

The NHS in the UK reports in May that “A wide range of health conditions have been linked to an increased risk of developing severe symptoms of Covid-19, including heart disease, obesity, and diabetes, with the latter alone affecting 3.9 million people in the UK.

NHS England figures from May found that people with diabetes accounted for a quarter of UK coronavirus deaths in hospital.” 7. In particular, interest right now is the COVID-19 virus exposure risk in the workplace. If you are a person with diabetes, it is reasonable to ask for your employer to complete a risk assessment.

The clinical manifestations of Covid-19 are, according to the latest reports, heterogeneous. On admission, 20-51% of patients reported having at least one comorbidity, with diabetes (10-20%), patients with any comorbidity yielded poorer clinical outcomes than those without.

A more significant number of comorbidities also correlated with poorer clinical outcomes.8 Returning to the workplace means that it is “COVID Secure.” All risks have been assessed, and reasonable accommodations made. 

For possible disease control and minimizing exposure, people with diabetes are recommended an extended period of working remotely. Sickness absence policy differs among employers.

Generally speaking, an illness of 7 days or less does not require a note from a health care provider. Understanding your employer’s policy can be helpful.

If you have been employed for more than 26 weeks, you can make a flexible remote work request that extends beyond the October 2020 cutoff. 

Undue hardship laws under the USERRA Act of 1994 protect employers from significant difficulty or expense on the employer to make accommodations. Examples of this will be retraining and individual or religious accommodations if it affects the other workers. 

Conclusion 

If you feel you are experiencing workplace discrimination, an advocate from ACAS may be helpful. An individual’s diabetes care starts with great diabetes management skills. Start by having conversations with your employer about your risk.

National Service Framework for people with diabetes has been developed to “Ensure that people with diabetes are empowered to enhance their control over the day-to-day management of their diabetes in a way that enables them to experience the best possible quality of life.”

Further, it leads healthcare to provide tailored supports and approaches. (NSF) If you feel uncomfortable returning to work because of the population in that area or level of outbreak, consider taking leave if work remotely has expired. Parental leave has also allowed some to be flexible with the location of work or the hours. Your health care starts with managing diabetes first independently, then cohesively with your health care provider and employer.

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