Diabetes in the workplace: What you need to know

While Type 1 and Type 2 diabetes are often invisible, employers still need to know how to work with employees affected by the disease.

There are any number of medical conditions that can affect a person at work but perhaps one of the most misunderstood is diabetes.

This is in no small part because with two main forms of the disease — Type 1 and Type 2 — there’s general confusion about what diabetes is and how it needs to be managed. As November 14 is World Diabetes Day, IB is taking a look at how diabetes can affect professionals in the workplace and what employers need to know.

To begin, Type 2 diabetes, the most common kind, was formerly called adult-onset diabetes. According to the 2017 National Diabetes Statistics Report, there were 30.3 million in the United States living with diabetes, or close to 10 percent of the total population. Among all these people living with diabetes, 90 to 95 percent have Type 2 diabetes.

Type 1 diabetes was formerly called juvenile diabetes, and while less common it has been increasingly diagnosed in recent years.

According to Healthline, both types of diabetes are chronic diseases that affect the way a person’s body regulates blood sugar, or glucose. Glucose is the fuel that feeds an individual’s cells, but to enter those cells it needs a key. Insulin is that key.

People with Type 1 diabetes don’t produce insulin — think of it as not having a key.

People with Type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin — think of this as having a broken key.

While both Type 1 and Type 2 have many similarities, they are not the same.

Type 2 diabetes is often associated with being overweight, a poor diet, and lack of exercise and is typically diagnosed later in life, though those risk factors aren’t always necessary to develop Type 2. Risk of developing Type 2 can be lowered by maintaining a healthy weight, eating a balanced diet and reducing intake of sugary or overly processed foods, and regular exercise. Type 2 is typically believed to be a metabolic disorder that occurs when your body’s natural chemical processes don’t work properly.

Type 1 diabetes cannot be prevented and has no cure. An autoimmune disease, Type 1 occurs when the body’s immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin and Type 1s must inject artificial insulin into their bodies using a syringe, insulin pen, or insulin pump multiple times throughout the day, every day, in order to live. While Type 1 is most often diagnosed when people are children, increasingly young adults in their 20s and even 30s are being diagnosed with the disease.

Emergency situations

In particular, Type 1 diabetes can be life-threatening very quickly if high and low blood sugars aren’t properly treated, and employers should be aware of warning signs of hypoglycemia, hyperglycemia, and diabetes ketoacidosis (DKA) and be prepared to respond accordingly.

Signs and symptoms of hypoglycemia (low blood sugar) include:

  • Anxious feeling
  • Behavior change similar to being drunk
  • Blurred vision
  • Cold sweats
  • Confusion
  • Cool pale skin
  • Difficulty in concentrating
  • Drowsiness
  • Excessive hunger
  • Fast heartbeat
  • Headache
  • Nausea
  • Nervousness
  • Nightmares
  • Restless sleep
  • Shakiness
  • Slurred speech
  • Unusual tiredness or weakness

Signs and symptoms of hyperglycemia (high blood sugar) include:

  • Unquenchable thirst
  • Dry mouth
  • Fatigue
  • Frequent urination
  • Blurred vision
  • Recurring infections
  • Slow-healing cuts or sores 

Signs and symptoms of diabetes ketoacidosis (DKA) include:

  • Fruity-smelling breath
  • Weight loss
  • Abdominal pain
  • Confusion
  • Presence of ketones
  • Vomiting
  • Exhaustion
  • Coma

If a Type 1 diabetic employee is ever passed out or unconscious, a co-worker or manager should immediately call emergency services and react to the situation as if the employee were “having a low” or experiencing severe hypoglycemia. If the employee is unconscious, a co-worker may have to administer emergency glucagon, which should always be close by with Type 1s.

If an employee is conscious, fast-acting glucose needs to be taken immediately. This means juice boxes, candy, glucose tablets, or any other sugary food or drink that can be consumed easily.

What employers need to know

While people with both types of diabetes look normal and healthy when the disease is managed appropriately, diabetes is considered a disability under the law.

The Americans with Disabilities Act prohibits employers from discriminating against employees for their Type 1 or Type 2 by any of the following:

  • Failure to hire or promote an employee because of diabetes;
  • Terminating someone because of diabetes, unless they pose a direct threat; and
  • Discriminating with regard to employer-provided health insurance.

According to the American Diabetes Association, the first step in evaluating safety concerns and whether and employee could be a “direct threat” because of their diabetes is to determine whether the concerns are reasonable in light of the job duties the individual must perform. For most types of employment — such as jobs in an office, retail, or food-service environment — there is no reason to believe that the individual’s diabetes will put employees or the public at risk.

In other types of employment — such as jobs where the individual must carry a firearm or operate dangerous machinery — the safety concern is whether the employee will become suddenly disoriented or incapacitated. Such episodes, which are usually due to severely low blood sugar (hypoglycemia), occur only in people receiving certain treatments such as insulin or certain oral medications, and even then occur infrequently.

Direct threat is a term used in federal antidiscrimination law that means the person with a disability poses a significant risk of substantial harm to the health or safety of the person or other employees that cannot be eliminated by reasonable accommodation. It is a defense available to employers charged with discriminating against a worker because of a disability.

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Employers who claim that a worker with diabetes poses a direct threat must first conduct an individual assessment of that worker’s diabetes before taking any action that would harm the employee, like firing or transferring to a lower paying job. The employer must assess the worker’s present ability to safely perform the essential functions of the job, and the assessment must be based on reasonable medical judgment that relies on the most current medical knowledge or best available objective evidence.

In determining whether a worker poses a direct threat, employers must consider:

  • The duration of the risk;
  • The nature and severity of the potential harm;
  • The likelihood that the harm will occur; and
  • The imminence of the potential harm.

If an employer has workplace conduct rules that are applied uniformly to all employees, employees can be disciplined if their conduct violates these rules — even if that conduct was because of diabetes (e.g., your behavior was caused by hypoglycemia).

If the employee has not violated any conduct rules, the most likely result from an episode of hypoglycemia on the job is that the employer may require a medical evaluation. Employees cannot be fired for having hypoglycemia without first conducting an individual assessment to determine safety risk, and without considering whether there are any reasonable accommodations that could eliminate the safety risk.

There are currently only a handful of professions that exclude people with diabetes from applying through so-called “blanket bans.” Diabetics can pilot private aircraft but are still prohibited from becoming commercial airline pilots. Similarly, all branches of the military still do let diabetics join, though if an individual is diagnosed after being accepted, certain accommodations may be made in lieu of a discharge.

However, occupations that in the past banned diabetics have in more recent years changed their tune. Law enforcement and the fire service are two such examples, and commercial interstate truck driving is another industry in which the doors have been opened to diabetics. Even NASA has relaxed its requirements for astronauts and now allows diabetics to apply, though so far there have been no astronauts with diabetes in space.

Disclosing diabetes at work

While many diabetics will notify their current or prospective employer about their condition, some people might be more hesitant to tell their employer. As long as the job does not affect the safety of others, an individual’s medical information is confidential and the decision to share is up to that person alone.

However, it might make sense to communicate the details of one’s condition, especially if accommodations are required for their work situation to help manage their diabetes, such as ensuring meal breaks.

It’s important to note, factors like stress, variable work hours, physical activity, and even temperature can all affect a diabetics blood sugar levels, and no two days are ever the same when managing diabetes. Patience and understanding are key.

If an employee does decide to officially disclose his or her condition, they may also specify some accommodations that they’d like the employer to put in place, such as:

  • Breaks throughout the workday to check blood glucose levels, eat a snack, take medication, inject insulin, or go to the bathroom;
  • A place to rest if needed, and to test their blood glucose and inject insulin;
  • The ability to keep diabetes supplies and food nearby;
  • Time off for doctor’s appointments;
  • Ability to work from home or set up a modified work schedule;
  • Permission to use a chair or stool if the individual has neuropathy — a nerve disorder — and are in a job that requires standing; and
  • A large-screen computer monitor or other assistive device if they have retinopathy, an eye disorder.

All of these are considered “reasonable accommodations” and they are required by federal anti-discrimination laws. Most people with diabetes only need minor changes that can be provided at little or no cost to their employers. However, employers may have to change an otherwise valid workplace policy for their diabetic employees. Workers cannot be denied a reasonable accommodation just because it goes against standard policies or because non-disabled employees are not entitled to it.

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