EMPLOYMENT CONSIDERATIONS FOR PEOPLE WHO HAVE DIABETES

Web Posted on: December 18, 1997

What is Diabetes?

Diabetes mellitus results from the body’s inability to use food effectively for energy, resulting in elevated blood sugar levels. Either the pancreas does not produce adequate insulin or the body cannot use the insulin effectively. There are two kinds of diabetes:

Type I, appropriately called insulin-dependent diabetes (formerly called juvenile onset); OR
Type II, known as non-insulin-dependent (formerly called adult onset diabetes). The title is not entirely accurate, since some Type II persons with diabetes must take insulin injections.

Type I diabetes represents only 10% of the 13,000,000 Americans with diabetes and is considered the more serious type. Once diagnosed, persons with diabetes Type I must monitor their blood sugar daily.

Persons with diabetes Type II, representing the other 95% of those with the condition, can control the disease with weight control, appropriate diet, and exercise. Many, but not all, take oral medication.

Half the people with diabetes do not know they have the condition. This may be dangerous since diabetes can lead to complications such as kidney problems, decreased vision, and foot disease, particularly if not well controlled. Employers may offer diabetes detection and education programs, using the resources of the local American Diabetes Association. This can alert employees to the symptoms of diabetes and encourage them to be tested so they can control the disease appropriately.

Diabetes cannot be cured, but it can be controlled. The person with diabetes needs to take responsibility for maintaining a good diet, exercising, and seeking appropriate medical care. Those who take good care of themselves can be healthier than other employees simply because they are knowledgeable about and participate in a healthy life-style.

Diabetes and the Americans with Disabilities Act (ADA)

The ADA defines disability in several ways, one of which is, "Someone who is regarded as having an impairment." Diabetes is not well known or understood by many employers. Many people with diabetes live and work successfully for years without negative impact on their work. Because their condition does not impact their ability to do their job, they may choose to not make their employer aware of their condition. Fear of discrimination keeps many employees with diabetes quiet. In what areas might employers discriminate? As with any disability, the potential to discriminate exists at any point in the employment process.

Examples:

A nurse sent her resume to 16 institutions, and in her cover letter mentioned her diabetes. She had only two responses, and no job offer.
A man with diabetes initially hired to run a shipboard boutique was rejected by the company doctor because a diabetic woman passenger slipped into a coma 20 years ago and died, setting a precedent.
An airline employee was forced to take two 10-minute breaks rather than one 20-minute break, during which time she had to test her blood sugar, take insulin, and eat. The change in her break schedule was insufficient time to complete the tasks required to maintain good diabetic control. These situations reflect the fear and misunderstanding surrounding this condition. As with any other disability, employers are required by ADA to look at the actual limitations, not perceived limitations.
Workplace Implications of Diabetes—

Despite good monitoring of diet, medication, and exercise, some people with diabetes may experience insulin reactions caused by hypoglycemia (low blood sugar). Insulin reaction can be caused by not eating at appropriate times, irregular working schedules, and/or change in exercise level.

A person experiencing hypoglycemia may become suddenly weak, shaky, or faint. Many people with diabetes recognize these symptoms and will immediately drink orange juice or eat something high in sugar. It only takes a few minutes for the persons blood sugar to return to normal.

The American Diabetes Association states, "Diabetes as such should not be a cause for discriminating against any person in employment. People with diabetes should be individually considered for employment weighing such factors as the requirements or hazards of the specific job, the individuals medical condition, and their treatment regimen (diet, oral hypoglycemic agents, and insulin). Any person with diabetes, whether insulin-dependent or non-insulin-dependent, should be eligible for any employment for which he or she is otherwise qualified."

What Types of Jobs Do People with Diabetes Do?

There are very few restrictions for people with well controlled diabetes. Some laws prohibit people with insulin-treated diabetes from serving in the armed services and in jobs involving interstate driving and as pilots. Local laws may prohibit people with diabetes from serving on a police force. This continues to be a problem and the American Diabetes Association recommends each situation be considered on a case by case basis, even though a lawsuit was filed against the Maryland-National Capitol Park Police after which an officer with diabetes was reinstated. Problems may occur with those who cannot maintain blood sugar control, and consequently they should not work in dangerous areas. However, since this is quite uncommon, the employee, based on his or her experiences, should generally make this decision, not the employer. Diabetes is a highly individualized condition. Ideally, the employee, his or her doctor, and the employer work together to ensure success.

Performance Management

For the most part, people with diabetes should need no special treatment from their supervisors. An understanding of the condition and the possible need for regular work schedules and meal breaks is usually helpful and appreciated. Living successfully with diabetes means that a person must be self-disciplined, self-aware, and self-responsible, all valued characteristics in many jobs.

Enhancing Productivity on the Job

The Americans with Disabilities Act requires employers to "reasonably accommodate" the limitations imposed by a persons physical or mental disability. Reasonable accommodation is defined as modification or adjustment of a job, employment practice, or the work environment that makes it possible for a qualified person with a disability to be employed. The law states that the employer needs to accommodate from the first contact with the person with the disability, during the application process, on the job, in training, on the worksite, and when considering promotions and layoffs. If job duties change, new accommodations may need to be made. The ADA requires an employer to accommodate unless doing so would cause the employer an undue hardship.

If we think of accommodations as "productivity enhancements" similar to others made in the workplace, they become part of the cost of doing business. If that cost is an undue burden, however, the employer may offer the person with the disability an opportunity to provide the accommodation or assist in finding resources to pay for it. The ADA requires that employers only accommodate known disabilities. Some people with diabetes do experience complications such as vision loss. Visual impairment due to diabetes may be quite gradual, and the vision may fluctuate from day to day.

If the diabetes has resulted in visual loss, accommodations can be made. Low vision aids may prove useful. The employees eye care professional may suggest magnification, appropriate lighting, or large print materials. The employee may want to contact a local resource center for people who are blind or visually impaired for a low vision assessment on the job to find useful aids. In some cases of diabetes, despite ones best efforts at maintaining good blood sugar control, the condition will progress. Ones vision loss may be great enough that the person will need to learn alternative ways of performing activities. The employee may need to take a leave of absence to attend a formal program of vocational rehabilitation, where he or she will learn new ways to perform job duties. Vocational rehabilitation training will teach the person how to get around safely (perhaps with a white cane), use adaptive equipment, and perhaps perform job tasks in a somewhat different manner.

Training and Promotion

For most people with diabetes, the employer should have no concerns about training and promotion. If the employees diabetes has caused significant functional limitations, and if training activities are planned, consult the employee about possible accommodations needed in the training environment.

These may include:

regular testing of blood glucose levels and meal breaks
training materials put into alternative formats such as large print
having another trainee copy his or her notes if training is conducted in a darkened room Employers should assume that people with diabetes have the same career goals and aspirations as any other employee. A persons diabetes should play no part in decisions about transfers and promotions. Concentrate only on the appropriateness of the persons skills for a new position and determine if reasonable accommodations are needed. Capitalize on the person’s strengths and accommodate limitations to gain greatest productivity from the employee.
Resources—

ADA Regional Disability and Business Technical Assistance Center Hotline

(800) 949-4232 (voice/TTY).

Equal Employment Opportunity Commission, 1801 L Street, NW, Washington, DC 20507, (800) 669-4000 (voice), (800) 800-3302 (TTY), (800) 666-EEOC (publications)

American Diabetes Association, National Service Center, 1660 DukeStreet, P.O. Box 25757, Alexandria, VA 22314, (703) 549-1500

If visual functioning is affected by diabetes, the employee or employer may wish to contact the local office of the state Commission (or Services) for the Blind and Visually Impaired. Look in your telephone directory under state services. This publication was developed by Mary B. Dickson, President of Creative Compliance Management, a human resource consulting and training firm whose mission is to maximize human potential in the workplace. She is the author of Supervising Employees with Disabilities: Beyond ADA Compliance, published in 1993 by Crisp Publications, Inc. For more information, write to: 13629 SE Grant Court, Portland, OR 97233, or call (503) 255-9318.

Significant assistance was provided by: Beth Ruml, RN, MSW, CDE (Certified Diabetes Educator), Portland, Oregon

Frierson, James G. Employers Guide to the Americans with Disabilities Act, Washington, DC: The Bureau of National Affairs, Inc., 1992.

Materials provided by the American Diabetes Association.

Funding Source—

This material was produced by the Program on Employment and Disability, School of Industrial and Labor Relations - Extension Division, Cornell University, and funded by a grant from the National Institute on Disability and Rehabilitation Research (grant #H133D10155). It has been reviewed for accuracy by the U.S. Equal Employment Opportunity Commission. However, opinions about the Americans with Disabilities Act (ADA) expressed in this material are those of the author, and do not necessarily reflect the viewpoint of the Equal Employment Opportunity Commission or the publisher. The Commission’s interpretations of the ADA are reflected in its ADA regulations (29 CFR Part 1630) and its Technical Assistance Manual for Title I of the Act.

Cornell University is authorized by the National Institute on Disability and Rehabilitation Research (NIDRR) to provide information, materials, and technical assistance to individuals and entities that are covered by the Americans with Disabilities Act (ADA). However, you should be aware that NIDRR is not responsible for enforcement of the ADA. The information, materials, and/or technical assistance are intended solely as informal guidance, and are neither a determination of your legal rights or responsibilities under the Act, nor binding on any agency with enforcement responsibility under the ADA. In addition to serving as a National Materials Development Project on the Employment Provisions of the Americans with Disabilities Act of 1990, the Program on Employment and Disability also serves as the training division of the Northeast Disability and Business Technical Assistance Center. This publication is one of a series edited by Susanne M. Bruyere, Ph.D., C.R.C., Director of the ILR Program on Employment and Disability at Cornell University.

Other Titles in this Implementing the ADA Series—
Working Effectively with Persons who have Cognitive Disabilities
Employment Considerations for People who have Diabetes
Causes of Poor Indoor Air Quality and What You Can Do About It
Working Effectively with Employees who have Sustained a Brain Injury
Employing and Accommodating Workers with Psychiatric Disabilities
Working Effectively with Individuals who are HIV-Positive
Accommodating the Allergic Employee in the Workplace
Workplace Accommodations for Persons with Musculoskeletal Disorders
Working Effectively with People with Learning Disabilities
Working Effectively with People who are Deaf or Hard of Hearing
The Americans with Disabilities Act of 1990 and Injured Workers
Employing and Accommodating Individuals with Histories of Alcohol and Drug Abuse
- Working Effectively with People who are Blind or Visually Impaired
For further information about publications such as these, contact the ILR Program

on Employment and Disability, Cornell University, 102 ILR Extension, Ithaca, New York 14853-3901; or at 607/255-2906 (Voice), 607/255-2891 (TDD), or 607/255-2763 (Fax)

| Top | | DINF Home Page |

Go to the top of this page. | Go to the upper category.