People living with diabetes sometimes face discrimination in the workplace simply because others do not understand diabetes and how it is managed.
The word "diabetes" can lead employers to concerns about reliability and productivity, thereby influencing their willingness to hire, continue to employ or promote an individual living with diabetes. Also, coworkers who lack information about diabetes can feel uncertain about how to treat their colleagues with diabetes who are testing their blood glucose, administering insulin and treating hypoglycemia throughout the workday.
Therefore, it is not uncommon for people living with diabetes to conceal their disease from their employers and colleagues in order to avoid negative reactions or 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.
An individual with well managed diabetes, and whose employer encourages his or her diabetes management in the workplace, does not pose any more threat to his or her colleagues or to the efficient operation of a business. However, it is important that everyone in the workplace have accurate information about diabetes and how it is managed. Communication, cooperation and accurate information will encourage a healthier and more productive environment.
There are three types of diabetes:
Type 1 diabetes is an autoimmune disease in which the pancreas stops producing insulin. Insulin is a hormone that helps your body to control the level of glucose (sugar) in your blood. Without insulin, glucose builds up in your blood instead of being used for energy. Your body produces glucose and also gets glucose from foods like bread, potatoes, rice, pasta, milk and fruit.
Type 2 diabetes 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.
Gestational diabetes is first diagnosed or first develops during pregnancy. It affects 2%-4% of all pregnancies. Blood glucose levels usually return to normal following delivery. Both mother and child are at higher risk of developing type 2 diabetes later in life.
People who do not know they have diabetes or whose diabetes is poorly managed 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 an individual receives proper medical care and diabetes education.
Undiagnosed or poorly managed diabetes will result in high blood glucose (hyperglycemia) whereas diabetes managed with insulin or some oral medication may result in low blood glucose (hypoglycemia). Ongoing fluctuations can lead to a variety of serious complications including heart disease, kidney failure, stroke, heart attack and blindness. The goal of diabetes management is to maintain the blood glucose within a “target” range by balancing food, activity and medication.
With the medical advancements in the management of diabetes, people now engage in professions (e.g. firefighting, policing, piloting) or participate in activities (e.g. scuba diving, mountain climbing) perhaps denied to them years ago. Good health practices and careful management enable people with diabetes to lead active and fulfilling lives.
Many people manage their diabetes by eating a healthy diet, maintaining a healthy body weight and exercising regularly. Most individuals require oral medications and/or insulin, administered by syringe, insulin pen or pump.
Diabetes is unique to each individual. 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 living 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. 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.
Diabetes Canada’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.
Diabetes Canada 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 legislation specifies that an employer must accommodate an individual 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 so he or she can eat, monitor blood glucose or administer medication.
An individual’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.
Occasionally, a person living with diabetes who is being treated with insulin or specific oral medications (e.g. insulin secretagogues) 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 left untreated, the individual could lose consciousness or even die.
What should I do if someone has hypoglycemia?
If an individual is experiencing any of the above symptoms, his or her blood glucose level should be checked immediately. If their glucose meter is not available, their symptoms should be treated anyway. It is better to be safe. The individual 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 LifeSavers® (1=2.5 g of carbohydrate)
15 mL (1 tablespoon) of honey
The individual with diabetes should then wait 10 to 15 minutes, and then recheck their blood glucose again. If it is still low:
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).
People living with diabetes can usually recognize early symptoms of hypoglycemia and treat on their own. There may be occasion when an individual 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, 9-1-1 should be called immediately.
Fortunately, with 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 living 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, commercial driving and piloting.
For more information about policies and practices related to employing people with diabetes, consult with your local office of the provincial human rights commission.