Employees with diabetes present unique questions for employers. How can an employer know when the disease poses a legitimate safety risk? How should employers handle needle disposal? In fact, there are three main concerns for employers who have employees with diabetes:
- Hypoglycemia
- Testing logistics
- Syringe safety
Primary concern for employees with diabetes: Hypoglycemia
Hypoglycemia is the biggest concern for most employers. Hypoglycemia is the situation where a diabetic person has low blood sugar (below 70 mg/dL). This is a potential side effect of some diabetes treatments, such as insulin and some oral medications (sulfonylureas). The symptoms can range from sweatiness, palpitations, shakiness, anxiety, confusion, mood change, drowsiness, seizure, and loss of consciousness.
“Obviously, in situations that involve heavy equipment, in situations that involve dangerous equipment, that involve working at heights, dangerous situations—this could potentially be extremely threatening to the person’s health and life.” Daniel Lorber warned in a recent CER webinar.
“It also – in most cases – can be easily prevented with appropriate management and appropriate care.” He told us. Hypoglycemia can be effectively treated or prevented by eating or drinking. If patients are able to monitor their blood glucose at work, it minimizes their risk of incapacitation. In fact, the risk is low overall.
“People with diabetes treated only with diet and exercise or taking the newer medications (or metformin, which is the most commonly-used medication now) have little or no risk of hypoglycemia.” Lorber explained. It is also important to remember that a single episode of severe hypoglycemia (requiring the assistance of another) should not be disqualifying. Most people with diabetes never experience severe hypoglycemia. If it does occur, it may be an isolated incident and frequently can be avoided in the future.
In general, for non-safety-sensitive jobs, there is no reason to believe diabetes will present health or safety risk. For safety-sensitive jobs, the only legitimate concern is whether one would become suddenly disoriented or incapacitated due to severe hypoglycemia, but just because one has diabetes, does not mean one will experience problems with severe hypoglycemia. Sudden incapacitation is rare.
If there is a concern about hypoglycemia, a health care professional should determine cause of hypoglycemia and whether adjustments may limit future risk of recurrence. The employer should consult with the worker and his/her treating physician to see if there is an explanation for any incidents.
Secondary concerns for employees with diabetes: Testing logistics and syringe safety
Separate from hypoglycemia, employers may be concerned about testing logistics for employees with diabetes and syringe safety for everyone.
Diabetic employees do need to be able to monitor their blood glucose level. Unlike in the past, there are now plenty of options for this, most requiring very little blood to complete the test. It is not enough to present a problem to coworkers.
However, syringe disposal is a legitimate concern. People using needles at work need to be conscious of how to dispose of those needles safely. Most diabetics put the needle back in their kit and dispose of it later or use their own plastic disposal box.
The above information is excerpted from the webinar “Accommodating Diabetic Employees: Legal and Practical Answers for HR.” To register for a future webinar, visit CER webinars.
Daniel Lorber, MD, FACP, CDE, is currently serving as the director of endocrinology and associate director of the Lang Center for Research and Education at New York Hospital Queens. He is also a clinical associate professor of medicine at the Weill Medical College of Cornell University, and the medical director of the Diabetes Control Foundation and the Diabetes Care and Information Center of New York.