Diabetes in the Workplace

More than 4.9 million people in the UK have diabetes. Around 90% of people with diabetes have type 2 diabetes and around 8% of people with diabetes have type 1 diabetes. About 2% of people with diabetes have rarer types of diabetes and 850,000 people are currently living with type 2 diabetes but are yet to be diagnosed.

Many people with diabetes lead active fulfilling lives, including having successful working lives, for example:

• Theresa May – she was initially diagnosed with type 2 in 2013; however, former British Prime Minister May subsequently learned she actually has type 1 diabetes.
• Tom Hanks – he revealed he had been diagnosed with type 2 diabetes on the Late Show with David Letterman in 2013. Hanks maintains a healthier lifestyle, has slimmed down, and maintains that he won’t take any roles that require him to gain weight.
• Halle Berry – she was diagnosed with type 1 diabetes in her early 20s after becoming severely ill while filming the TV show Living Dolls. She said her strict adherence to diet had helped her manage her ongoing diabetes.
• George Lucas – his diagnosis may have led to his fame. It came during a medical induction physical at the age of 23, after he was drafted into the Vietnam War. The diagnosis exempted him from military service, and he went back to film school, got a graduate degree, and went on to Star Wars fame.

What is diabetes?

Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high.

There are two main types of diabetes:

Type 1 diabetes

Type 1 diabetes – is a serious and lifelong condition where the body’s immune system attacks and destroys the cells that produce insulin. When you have type 1 diabetes, your body still breaks down the carbohydrate from food and drink and turns it into glucose. But when the glucose enters your bloodstream, there’s no insulin to allow it into your body’s cells. More and more glucose then builds up in your bloodstream, leading to high blood sugar levels. Experts are still not sure what causes type 1 diabetes to develop; however, it has nothing to do with diet or lifestyle.

Type 2 diabetes

Type 2 diabetes – is a serious condition where the body does not produce enough insulin, or the body’s cells do not react to insulin. When you have type 2 diabetes, your body still breaks down carbohydrate from your food and drink and turns it into glucose. The pancreas then responds to this by releasing insulin. But because this insulin can’t work properly, your blood sugar levels keep rising. This means more insulin is released. For some people with type 2 diabetes this can eventually tire the pancreas out, meaning their body makes less and less insulin. This can lead to even higher blood sugar levels and mean you are at risk of hyperglycaemia (high blood sugar). There isn’t a permanent cure for type 2 diabetes yet; however, strong evidence shows that some people can put their type 2 diabetes into remission by losing weight. Remission in type 2 diabetes means your blood sugar levels are below the diabetes range, and you don’t need to take diabetes medication. Family history, age and ethnic background affects someone’s risk of developing type 2 diabetes.

People living with type 2 diabetes have a higher risk of developing cardiovascular disease which is a major cause of death and disability.

Poorly controlled diabetes can lead to:

• Heart disease and stroke.
• Kidney disease.
• Eye disease.
• Foot ulcers and nerve damage.
• Amputation due to poor circulation.
• Depression.
• Sexual dysfunction.
• Complications during pregnancy.
• Gum disease.
• Increased incidence of bacterial infections.

Is diabetes a protected characteristic?

Disability is one of the nine Protected Characteristics under the Equality Act 2010. This legislation gives legal protection against disability discrimination at work. Under the Equality Act it is unlawful to discriminate against a person because of a disability:

• When applying for a job.
• During employment.
• When employment ends.

The Equality Act describes a disability as a physical or mental impairment that has a substantial long-term effect on someone’s ability to do normal day-to-day activities. Although diabetes is not an automatic disability under the Equality Act, if the person’s condition means that they are significantly impacted on a day-to-day basis, their diabetes diagnosis could be classed as a disability under the Act, especially if it is type 1 diabetes.

In most occupations, there is no legal obligation for someone to tell their employer that they have diabetes, and it is against the law under the Equality Act 2010 for any employer to ask someone about their health before offering them a job.

Even though a person doesn’t have to tell their employer, being open and honest about diabetes can really help at work, particularly if diabetes is causing ongoing health issues. This can give the employer the opportunity to provide you with any support needed.

Does diabetes affect an employee’s productivity?

Research published in the British Medical Journal (BMJ) suggests that both work and diabetes related factors are related to fatigue in employees with diabetes. If employees suffer from fatigue, their performance may drop. This may also have consequences for their sickness absence rate and work disability. The BMJ found that the frequency and duration of sickness absence is higher in diabetics than in non-diabetics. However, it seems that only a small proportion of the employees with diabetes is responsible for the high sickness rates.

The BMJ cite other studies that have found that people with diabetes work as many hours as people without diabetes, but that they report more work-loss days, more days of total disability, and more days of poor physical and poor mental health than control subjects without diabetes. In the case of people with diabetes, fatigue may directly result from physiological processes, as it is a symptom of hypoglycaemia as well as hyperglycaemia.

Most people, however, can manage their diabetes so it doesn’t affect their work productivity. Diabetes management can mean taking medication at specific times and checking blood glucose (blood sugars) throughout the day. People with diabetes will need to go to several healthcare appointments a year; these are an essential part of managing diabetes and help reduce the risk of serious complications.

How can diabetes affect employees?

For the majority of employees with diabetes, they have a management routine and are able to manage the condition so that it has little or no impact on their working lives.

Sometimes living with a demanding condition like diabetes can lead to diabetes burnout, also known as diabetes distress. It is the term given when people feel frustrated, defeated and/or overwhelmed by diabetes. Stress and stressful situations in the workplace such as attending interviews, workload, pressure situations and the threat of redundancy, can in turn affect blood glucose levels and diabetes management.

There are three primary emergency situations that a person with diabetes is susceptible to:

• Low blood sugar levels – hypoglycaemia (needs glucose/sugar).
• High blood sugar levels – hyperglycaemia (may need insulin).
• Diabetic coma – unconscious.

A conscious person with low blood sugar will likely show these symptoms:

• Pale, clammy skin.
• Change in behaviour, can appear drunk or confused, not themselves, can be aggressive or quiet.
• Shaking, trembling.
• Weak, tired, lethargic.
• Fast but weak pulse.

A conscious person with high blood sugar will likely show these symptoms:

• Change in behaviour, confusion.
• Weak, tired, lethargic.
• Thirsty.
• May have acetone-like smell to their breath.

These emergencies should be dealt with by a qualified first aider; however, if the employee is conscious, they can tell you what they need in order to control the situation. If they are unconscious, then you should call 999 immediately.

People with diabetes used to be discouraged from doing shift work, but improvements in blood glucose testing and more flexible insulin regimes mean that diabetes is less likely to cause any issues.

If a person with diabetes is managing an illness as well as diabetes, it may take longer for them to recover than a person without diabetes. It is good for employers to be aware of this and, if necessary, for them to make adjustments in the workplace, such as changing practices, policies and procedures to accommodate a higher level of sickness absence when necessary.

What does diabetes mean for employers?

Diabetes is a uniquely personal condition; how it affects someone and how they manage it varies from person to person. Depending on whether the employee has type 1 or type 2 diabetes, the management of their condition will be very different.

If the employee is managing type 1 diabetes, they may need somewhere private to monitor their blood glucose levels or inject insulin to control their condition or be given time to eat at certain points in the working day.

If the employee is managing type 2 diabetes, they may be controlling their condition with their diet or medication or they may even be in remission.

Whether they are managing type 1 or type 2 diabetes, they should be allowed to manage their condition in a way that they are comfortable with. People with either type of diabetes will be required to have annual check-ups relating to their diabetes because of the impact it can have on their whole body. They may need to book time off work to make these appointments, as there are many different services in the NHS involved in diabetic care.

In some job roles employees may need a risk assessment, particularly when in safety-critical environments, as they are at risk of episodes of hypoglycaemia which can cause sudden incapacity and high blood sugar can cause blurred vision. It would be considered best practice for employers to risk assess all employees who are diabetic so that any identified issues can be addressed.

Since the risk of developing and managing type 2 diabetes is so closely linked to lifestyle, employers could promote ways to be healthier in the workplace. This could include initiatives to help employees eat healthier such as offering free fruit, encouraging employees to be more active such as offering discounted gym membership, and supporting mental wellbeing such as putting policies in place to support work-life balance.

What are your rights with diabetes at work?

If your diabetic condition affects you on a daily basis whilst you are at work, your employer is legally required to make reasonable adjustments to help you.

Your employer might help you by:

• Offering you a flexible working pattern.
• Allowing you to have more breaks to test your blood, eat or take your medication.
• Allowing you to attend your medical appointments and any diabetes education courses.

If your employer is not making reasonable adjustments for your diabetes, you could have a claim for disability discrimination at work under the Equality Act 2010.

You do, however, have a responsibility to tell your employer about your diabetes and to explain the reasonable adjustments that you need them to make for you to be able to manage your diabetes at work. By informing your employer about your diabetes condition and outlining the importance of these needs, they can understand your position better.

It can also be helpful for you to inform colleagues of your diabetes. A situation where this is especially important is for people who treat their diabetes with insulin (or some other medications) as it makes hypoglycaemia (low blood glucose levels) more likely. By raising awareness with colleagues, it helps them to know what to do should a situation arise.

What should a workplace do if someone has diabetes?

There are many small and simple changes that an employer can make to support an employee with diabetes. It would be helpful for both employees and line managers to include diabetes specifically in any Disability or Equal Opportunities Policy to outline provisions and rights that apply to the individual, and details of who they should contact should they need to arrange a meeting regarding their condition.

An employer should meet with their employee to understand the employee’s needs and to ensure both parties are clear about what reasonable adjustments can be put in place to ensure maximum productivity and to check that their diabetes will not become a barrier to them completing tasks efficiently.

Open up the conversation – enabling conversations to open up around diabetes can help in a variety of ways such as improving the mental health and wellbeing of the employee; dispelling any stigma and preventing discrimination; gaining a better understanding of how employees are coping; and the opportunity to provide initiatives and measures that everyone gains from.

Be flexible – by understanding what your employees with diabetes need means that you can then put measures in place to help them. You can do this by being accommodating to employees attending healthcare appointments, supporting them with flexible working hours, and showing patience for when the disease becomes debilitating. Have an agreed regime of breaks and meal times to ensure that the employee with diabetes eats and checks their blood sugar regularly, especially to avoid hypos. If the employee has a hypo, allow them to have at least a 20-minute break so that they can recover.

Providing privacy – employees with diabetes may need to take injections of insulin or check blood sugar levels throughout the working day. Giving them a private and clean space to do this will provide peace of mind and inclusivity, and reduce stress.

In the kitchen / rest area – ensure that an employee with diabetes has access to a kitchen or a snack drawer that contains sugary snacks, glucose tablets and some carbohydrate-dense snacks or arrange that they can keep them in their work area. Also, provide a secure fridge compartment for them to be able to store insulin.

Train employees in first aid – all employees should know what to do in an emergency situation, especially in a diabetic emergency.

Laws and regulations around diabetes in the workplace

Many people with diabetes usually don’t think of it as a disability and can manage their diabetes so it doesn’t affect their work. However, diabetes can potentially be seen as a disability under section 6 of the Equality Act 2010 due to its long-term and detrimental impact on a person’s capacity to undertake day-to-day activities.

Whilst an employer can not have a ban on employing someone with diabetes, there are a few jobs or roles where safety-critical work may mean that you would need to carefully assess someone’s ability to carry it out because of their diabetes, or the way that it is treated. In most cases, diabetes won’t stop someone from doing their job.

Exceptions include:

• The armed services which are exempt from the Equality Act 2010.
• The emergency services – that is fire, ambulance and police – whilst not exempt from the Equality Act 2010, each local service has their own rules, and they must risk assess the role and look at each individual case.

If someone tells their employer that they have diabetes, the employer has a legal duty under the Health and Safety at Work Act etc.1974 to make “reasonable adjustments”, so they can manage their diabetes and do their job. Employers are required to carry out risk assessments under the Management of Health and Safety at Work Regulations 1999 (Great Britain) and The Management of Health and Safety at Work Regulations (Northern Ireland) 2000, NI Regulation 3(1), which should include any specific risks to people with diabetes. It is advisable for an employer to discuss the adjustments with the employee who has diabetes, otherwise the adjustments may not be effective.

If a person with diabetes has a car, motorbike, bus, coach or lorry driving licence, then they must tell DVLA as diabetes or taking insulin is a ‘notifiable’ medical condition or disability. They should also inform their employer of their diabetes if driving forms any part of their job. Failure to do so may invalidate the employer’s motor insurance and the individual may be fined up to £1,000.

Final thoughts

Diabetes UK estimates that by 2025, over five million people will have diabetes in the UK, so whether you are newly diagnosed, looking to improve your diabetes management, or in need of information to support others, there are many sources of support and advice such as:

• Diabetes UK helpline on 0345 123 2399
• Diabetes.co.uk forum – discussions about living with and managing diabetes.
• Diabetes UK blogs – a collection of blogs on work and diabetes, food, eyes and more.
• Diabetes Chat – scheduled chats with healthcare professionals or just the chance to talk to others.
• NHS Apps Library – find apps and tools to help you manage your diabetes, including some that link you to a lifestyle coach.
• World Diabetes Day is held on 14th November, hosted by the International Diabetes Federation, and 2022 has the theme “education to protect tomorrow”.
• Healthy living for people with type 2 diabetes – online course from the NHS. If you are aged 18 or over and live in England, you can sign yourself up. You will not need a referral.
• Diabetes education and self-management for ongoing and newly diagnosed (DESMOND) – NHS courses either in person or online. Your GP will need to refer you, but you can phone your GP surgery to get a referral letter, so you do not need to make an appointment.