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Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.
Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes.
Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.
Gestational diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes.
Other specific types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses.
Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.
Diabetes and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Diabetes
People with diabetes may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with arthritis will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Hypo/Hyperglycemia: Individuals with diabetes may need to monitor glucose levels periodically and take appropriate action to ensure stability. Various methods may be used to monitor glucose levels, including lancing devices, apps, and service animals. Medication such as insulin may need to be stored in an area that is temperature-controlled and quickly accessible to the individual at all times. Scheduled meals or snacks may be necessary.
- Allow for storage of medications, such as insulin and/or food
- Provide an area to test blood sugar levels
- Provide an area to administer medications (insulin)
- Provide appropriate containers for needles/syringe disposal
- Provide a rest area for reorientation after hypo/hyperglycemic episode
- Allow frequent breaks for food as needed
- Provide appropriate food for office-sponsored events and reward programs
- Consider modifications to policies involving food storage and consumption
- Allow service animal access
Neuropathy (Nerve damage): Individuals with diabetes may experience neuropathy resulting in pain, numbness, and weakness in parts of the body. This is most common in the legs and feet, but can impact other systems as well.
- Modify job tasks requiring fine finger dexterity
- Provide protective clothing and equipment
- Eliminate or reduce the need to use sharp objects
- Provide anti-fatigue mats or padded carpeting
- Allow flexibility to sit or stand
- Provide parking accommodations
Fatigue or Weakness: Decreased stamina can make it challenging for employees with diabetes to perform physical work tasks as well as maintain extended work hours. Rotating shifts and overtime can be particularly problematic.
- Allow frequent rest breaks
- Reduce or eliminate strenuous activities
- Provide anti-fatigue mats or padded carpeting
- Provide a rest area with cot
- Allow flexibility to sit or stand
- Allow job sharing
- Shorten work day and extend work week
Vision Impairment: Vision impairment and blindness may result from diabetes. Vision may be blurred or obstructed and loss of sight can be progressive. Accommodations for diabetic vision loss are often similar to those resulting from other types of eye disease.
- Note: Not an inclusive listing of accommodation ideas. See Accommodation and Compliance: Low Vision and Accommodation and Compliance: Blindness
- If the individual benefits from magnification, consider external magnification devices or computer screen magnification software
- If the individual does not benefit from magnification, consider Braille, tactile graphics, or assistive technology (e.g., screen reading software)
- If the individual is experiencing blurriness or haziness use of high contrast settings and themes may be helpful
- Provide a digital voice recorder
- Provide a qualified reader
- Allow flexible schedule to use public transportation to and from work
- Allow use of service animal for assistance with vision and/or mobility
- If the individual experiences photosensitivity, consider alternative lighting such as lamps or fluorescent light filters
Kidney Disease: Some individuals with diabetes may experience impairments to kidney function. Depending on the advancement of the impairment, individuals may require dialysis to replace the filtration generally done by the renal system.
- Provide easy access to restroom facilities
- Allow a flexible schedule or time off for treatment (dialysis)
- Some individuals may be able to telework from the dialysis site
Cognitive Limitations: Impaired cognitive function may result in memory loss, difficulty managing time, organizational limitations, and executive dysfunction.
- Provide written job instructions and prioritize assignments
- Increase job structure
- Use of day planner or electronic organizer
- Provide reminders
- Provide flexible work hours
- Minimize distractions
Psychological Limitations: Stress can cause a temporary rise in blood glucose levels, which may be detrimental to individuals with diabetes. Managing workplace stressors may be a necessary component to accommodating diabetes.
- Reduce stress
- Allow time off for counseling or therapy
- Provide area to brush teeth to prevent periodontal gum disease
- Evaluate safety hazards
- Avoid temperature extremes to help deal with poor circulation
- Educate coworkers on emergency situation procedures and identification of symptoms of hypoglycemia or hyperglycemia
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A cafeteria worker with diabetes had difficulty standing in one place for long periods of time.
Accommodations included anti-fatigue mats, sit/stand/lean stool, and flexible rest breaks.
A production assembly line worker had symptoms of frequent urination and diabetic neuropathy in his legs.
The employee could not leave his work area except during scheduled breaks. Accommodation included the use anti-fatigue mat, sit/stand/lean stool, and an in-house paging system to notify the supervisor that a replacement is needed while the employee takes a restroom break.
A paralegal with diabetes was having trouble keeping his blood sugar under control, which led to very bad breath.
He and her employer agreed that he would temporarily be excused from going into court during trials. They agreed to reassess the situation in three weeks, the amount of time his doctor estimated it would take to get his condition under control.
An employer received a request from an employee who disclosed that he had diabetes and needed to modify his break times so he could check his blood sugar levels and administer insulin.
Because diabetes virtually always meets the definition of disability (substantially limits the functions of the endocrine system), the employer did not require medical documentation to show the employee has a covered disability, but instead focused on the need for accommodation.
A retail sales associate with diabetes developed complications that affected the functioning of her kidneys.
She required hemodialysis three times a week. Hemodialysis requires adhering to a fixed schedule. The employee requested a transfer to a store closer to the dialysis center as an accommodation under the ADA, and applied leave under the FMLA, when needed, to receive dialysis.
An employee in a manufacturing plant had difficulty working through an 8-hour shift without a break due to his diabetes.
Typically, employees work straight through. Accommodations were made so that the employee could have a flexible schedule where a break can be provided if employee makes up the time by coming in 15 minutes early and staying 15 minutes later.
A data entry clerk with diabetes was having problems with vision.
Her employer installed additional lighting in the file room and purchased a glare filter for her computer monitor to reduce eyestrain.
A nurse with insulin-dependent diabetes and hypoglycemia was having problems regulating her condition (specifically, eating regularly while at work).
Her schedule was altered by eliminating the evening rotation until her blood glucose levels could be controlled on a consistent basis.
An investigator was having problems balancing between reading text and his computer screen due to diabetic retinopathy.
Accommodations were made so he could use task lighting, a glare filter for computer monitor, and closed circuit television with a split screen to view text and the computer monitor at same time.
A social worker with Type 2 diabetes was experiencing vision loss. The individual requested a reduced workload.
The employer contacted JAN looking for alternatives to lowering productivity standards. JAN suggested stand magnification equipment for reading print materials and screen magnification software for reading from the computer screen.
JAN Publications & Articles Regarding Diabetes
Accommodation and Compliance Series
Consultants' Corner Articles
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