Diabetes in the Workplace: A Guide For Employers and Employees
People with diabetes often face discrimination in the workplace simply because others do not understand diabetes and how it is managed. The word “diabetes” often leads employers to concerns about loss of work time and productivity, thereby influencing their willingness to hire, continue to employ or promote a person with diabetes.
People with diabetes may conceal their disease from their employers and colleagues in order to avoid negative reactions, rejection or outright discrimination. As a result, an insulin injection may be missed, a blood glucose test forgotten or a meal postponed, consequently jeopardizing an individual’s overall health and perhaps his or her safety on the job.
A person with well managed diabetes does not pose a threat to his or her colleagues or to the efficient operation of a business. In fact, the employer of a person with diabetes may well benefit in the long run; it has been observed that people with well managed diabetes often miss fewer days due to illness because, in order to manage their blood glucose effectively, they must lead generally healthier lifestyles.
It is important that everyone in the workplace have accurate information about diabetes. Communication, cooperation and accurate information will encourage a healthier and more productive environment.
More than nine million Canadians live with diabetes or prediabetes. There are two main types of diabetes:
Type 1 diabetes occurs when the pancreas is unable to produce insulin. Approximately 10 percent of people with diabetes have type 1. All people with type 1 diabetes require insulin injections.
The remaining 90 percent have type 2 diabetes. Type 2 occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Many people with type 2 can manage their diabetes with diet and exercise, while others also require medication, including insulin.
Insulin is a hormone that serves to drive glucose (sugar) from the bloodstream into the cells of the body where it is metabolized as energy to fuel the body, enabling the heart to pump, the brain to function and the muscles to move. Without insulin to cause glucose to cross the cell membrane, the glucose remains in the bloodstream where kidneys attempt to eliminate it through the increased production of urine.
People who do not know they have diabetes may display some or all of the following symptoms: fatigue, weight loss, excessive thirst, frequent urination and blurred vision. These symptoms worsen over time until a person receives proper medical care and diabetes education.
Undiagnosed or poorly managed diabetes will result in high blood glucose (hyperglycemia) whereas diabetes managed with insulin may result in low blood glucose (hypoglycemia). Ongoing fluctuations can lead to a variety of serious complications including heart disease, kidney failure and blindness. The goal of diabetes management is to keep the blood glucose within a “target” range.
With the medical advancements in the management of diabetes, people now engage in professions or participate in activities perhaps denied of them years ago. Good health practices and careful management enable people with diabetes to lead active and fulfilling lives.
The majority of people manage their diabetes by eating a healthy diet, maintaining a healthy body weight and exercising regularly. Some individuals require oral medications and/or insulin, administered by syringe, insulin pen or pump.
Diabetes is unique to each person. Therefore, a diabetes management plan is also unique to each person’s needs. A plan would include regular medical reviews, an exercise program and diet, insulin or other medication therapy.
Self-monitoring of blood glucose, with a blood glucose meter, enables a person with diabetes to adjust the timing and amount of insulin to match different activity levels, as well as the amount, timing and type of food consumed.
There have been very few studies conducted on people with diabetes who work shift work. (More on Diabetes and Shiftwork ). It has been found that managing diabetes is more difficult for those who are on a rapidly changing shift pattern. People who work shifts should consult with a diabetes educator and a dietitian to develop a management plan that would meet their individual needs.
Canadian Diabetes Association’s Position on Employment
A person with diabetes should be eligible for employment in any occupation for which he or she is individually qualified.
A person with diabetes has the right to be assessed for specific job duties on his or her own merits based on reasonable standards applied consistently.
Employers have a duty to accommodate employees with diabetes unless the employer can show it to cause undue hardship to the organization .
The Canadian Diabetes Association also believes that both the employee and the employer have equal responsibilities to each other and must work together to address new issues or resolve problems.
Workplace Accommodation and Confidentiality
Human rights codes provide that an employer must accommodate a person with diabetes up to the point of “undue hardship”. Reasonable accommodation of a person with diabetes may simply mean altering an employee’s work schedule to include regular breaks to eat a snack, to monitor blood glucose or to administer medication in a private location.
A person’s medical information is confidential. Therefore, unless health related questions are directly related to a specific job requirement, a person with diabetes is not required to report such private matters on an employment application or in an employment interview.
Similarly, the employer does not need to be provided medical information after employment begins unless the employee wishes to disclose it or, in some circumstances, the employer requires it in order to provide the appropriate accommodation.
To help address the issue of how to ensure employees receive the accommodation they need to do their jobs well, the Canadian Human Rights Commission has available the publication: A Place for All: A Guide to Creating an Inclusive Workplace. Its purpose is to help employers and employees understand their legal rights and obligations regarding the duty to accommodate, and aid in the creation of workplace accommodation policies and procedures. A Place for All is posted on the CHRC web site at http://www.chrc-ccdp.ca .
Occasionally, a person with diabetes who is being treated with either oral medications or insulin may develop low blood glucose (hypoglycemia). This can occur when insulin removes too much glucose from the blood as a result of increased physical activity, too much medication, too little food (or a missed or delayed snack or meal), and the effects of drinking alcohol.
The symptoms of hypoglycemia may include cold, clammy or sweaty skin, blurred vision or dizziness, shakiness or lack of coordination, headache, irritability or hostility, stomach ache or nausea.
If the person with diabetes is experiencing any of the above symptoms, they should check their blood glucose levels immediately. If the person does not have their glucose meter, they should treat the symptoms anyway. It is better to be safe. The person should consume a fast-acting carbohydrate (15 grams):
- 15 g of glucose in the form of glucose tablets (preferred choice)
- 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
- 175 mL (3/4 cup) of juice or regular soft drink
- 6 Life Savers® (1=2.5 g of carbohydrate)
- 15 mL (1 tablespoon) of honey
The person with diabetes should then wait 10 to 15 minutes, then check their blood glucose again. If it is still low:
- Treat again
- If their next meal is more than one hour away, they should eat a snack, such as a half-sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source.)
The person with diabetes can usually recognize early symptoms of hypoglycemia and treat on his or her own. There may be occasion when a person postpones treating their early symptoms and, as a result, requires assistance with ingesting the food or drink containing sugar, or their glucose tablets or gel.
If the treatment does not work or if the person becomes confused and disoriented, loses consciousness, or has a seizure an ambulance should be called immediately.
Fortunately, with the proper diabetes management, hypoglycemia can usually be prevented. Regular blood glucose monitoring, snack breaks, exercise and medication help people with diabetes maintain blood glucose within a target range. Self-motivation and the encouragement of others help make these responsibilities easier.
Millions of people with diabetes manage their disease very well both off and on-the-job. People with diabetes are employed in most occupations, including fire fighting, law enforcement, professional hockey and commercial driving.
For more information about policies and practices related to employing people with diabetes, consult with your local office of the provincial human rights commission. Links to the provincial commissions can be located at http://www.chrc-ccdp.ca/