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More than 2,000,000 people in the UK workforce have been diagnosed with diabetes and it is estimated that a further 750,000 people are unaware that they have the condition.
Liz Skelton of the website Croner-I examines the disease and its treatment in the workplace.
Diabetes is often known as “the silent assassin”. Research carried out by the organisation Diabetes UK tells us that the general perception of diabetes is that it is a mild and easily managed condition. However, the reality is that if not treated effectively, or if first aid is not given quickly during an episode, diabetes can cause heart disease, stroke, amputation, kidney failure and blindness.
What causes diabetes?
The hormone insulin, produced by the pancreas, keeps the level of glucose in blood within a fairly strict range. When the pancreas fails to produce the correct amount of insulin, this condition is called diabetes. Diabetes is caused by the effects of genetic pre-disposition in combination with lifestyle and environmental factors.
Type 1 diabetes normally starts in childhood and is caused by a severe lack of insulin from damaged cells in the pancreas.
Type 2 develops when the body cannot produce enough insulin or when the insulin produced does not work effectively. It usually starts after the age of 40 as genetic and lifestyle influences take effect over time.
Those at risk
- People at a higher risk of getting diabetes include:
white people over 40 and black or Asian people over 25 who have one or more of the risk factors
- African-Caribbean and Asian groups
- people with a close family member who has Type 2 diabetes
- people who are overweight or who have a large waist size
- women who have had diabetes in pregnancy (gestational diabetes)
- people who have had an infection that can trigger the genes that lead to the condition.
Diabetes at work
What to ask an employee
There is no legal requirement for an employee to tell their employer that they have diabetes. However, asking for an employee to declare it on a pre-employment questionnaire or after diagnosis and discussing their condition with them will help an employer understand more about the condition. The employer can then put appropriate reasonable adjustments and control measures in place so that the employee can work safely and without risks to their health.
When assessing the situation, it may be necessary to take into account whether:
- the diabetes is stable and well controlled
- the employee is insulin dependent
- they have had any “disabling” hypoglycaemia where they require assistance from another person
- they are aware of hypoglycaemia coming on
- they have had any severe complications, such as advanced retinopathy, kidney disease, peripheral neuropathy or circulatory problems.
There are some key areas of employment that have regulated health restrictions and preclude insulin-dependent diabetics from working. These include:
- driving HGVs, buses and taxis
- working in the armed forces
- working in the emergency services
- working in the prison service
- airline pilots, cabin crew and air traffic control
- working offshore on oil rigs and ships.
However, in most cases, having diabetes does not mean that an employee cannot do a job effectively. Diabetes is covered under the Disability Discrimination Act 2005. The Act was brought in to protect people with disabilities from being treated differently from other employees. Although most people with diabetes do not consider themselves disabled, diabetes is covered under the Act.
Work affecting people with diabetes
When a diabetic’s blood level falls below a certain level, hypoglycaemia can develop as their blood sugar levels drop. This can be caused by missing a meal or snack; overexerting themselves, without taking account of their extra sugar needs; or accidental overdose of their medication. Diabetes can also cause a greater level of fatigue in employees. Employers should look at the potential for this to happen in an employee’s work patterns and activities.
Shift work often leads to difficulties with diabetes control, especially for people on insulin. Changes to meal timings, different levels of activity at night, increased stress on the body and timing of sleep can cause problems for employees working out timing and dosage of insulin injections. If the employee is working on shifts, then daytime and evening shifts (6am to 10pm) are preferable to night shifts.
If the employee is taking part in strenuous physical activity, they should be encouraged to inform the person who is leading the activity of their health condition in case any problems arise, and so that sufficient recovery breaks can be taken.
Driving for work
If an employee has diabetes that is only treated by diet and tablets then there is no need for them to inform the Driving and Vehicle Licensing Agency (DVLA) and they should be able to drive at work providing they are given adequate rest breaks to ensure their blood sugar is kept at a stable level.
However, the law requires drivers to inform the DVLA if they have:
- diabetes that is treated with insulin alone or insulin and tablets
- diabetes as well as another relevant condition or complication, such as retinopathy (eye problems) or peripheral neuropathy (nerve damage to legs or feet)
- problems with vision or they require laser treatment for retinopathy
- frequent episodes of hypoglycaemia (low blood glucose levels)
- changes in treatment from diet and tablets to include insulin.
If an employee is travelling overseas, the organisation’s travel insurance company will need to know if an employee has diabetes; not informing them may mean that the insurance could become invalidated.
There are two types of episodes that a diabetic can have — hypoglycaemia (blood sugar too low) and hyperglycaemia (blood sugar too high). First aiders should be trained to recognise both.
Hypoglycaemia is usually indicated by such signs as:
- unusual behaviour such as day-dreaming, confusion and aggression
- shallow breathing, a strong racing pulse and palpitations
- weakness, faintness, hunger and muscle tremors
- cool, clammy, pale or sweaty skin.
In these cases, the first aider must:
- encourage the person to raise their blood sugar quickly by having a sugary drink, sweets, or chocolate
- offer more food and drink and, if they improve quickly, advise them also to discuss the episode with their doctor
- if they do not improve quickly, call an ambulance by dialling 999; first aiders are not medically trained to give invasive prescription medications therefore should not give a diabetic an insulin or glucogen injection.
Hyperglycaemia is relatively uncommon; therefore, if a first aider is unsure whether the casualty is suffering from low or high blood sugar, the chances are it is low. In cases where there is high blood sugar, the casualty may not know if they have diabetes. Other signs include:
- laboured and deep breaths and a fast pulse
- a faint smell of acetone (like pear drop sweets or nail varnish remover
- dry skin
- increased thirst, which leads to drinking more, which in turn leads to passing water more frequently and in greater amounts.
In either case, if the person is unconscious, an ambulance should be called immediately, they should be put in the recovery position and their airways should be cleared.
In most cases, a person living with diabetes can live a normal life at work and home. If someone at work reports that they have diabetes, the most important thing that any employer can do is to consult the person to find out what they need and find ways that they can work together to ensure their continued good health.
A number of organisations offer information, help and advice to people with diabetes and employers, including the DVLA for guidance on driving and Diabetes UK for information and support.