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Diabetes For Hire!

Posted on November 16, 2018 | No Comments on Diabetes For Hire!

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.” This was the position adopted by the American Diabetes Association (ADA) as early as 1984 regarding employment of people with diabetes.

Locally, there is no legislation or law preventing people with diabetes from being employed. However, several companies require a medical check-up to screen for illnesses that might interfere with the job performance of the prospective employee.

Having diabetes, in itself, should not discriminate someone from landing a good job. Rather, the initial screening should focus on identifying those diabetic individuals who are at sufficiently high risk of complications that will interfere with work to warrant further investigation or direct action. The acute complication that is of greatest concern is hypoglycemia that may cause sudden unexpected incapacitation.

Low blood sugar risk
Hypoglycemia happens when there is an excessively low blood sugar level because of a relative excess of insulin in the blood. It usually occurs gradually and is generally associated with typical warning signs, which may include rapid heartbeat, perspiration, shakiness, anxiety, and hunger. When symptoms occur, preventive action can be taken by eating carbohydrates, such as sugar or sweetened beverages and snacks.

A hypoglycemic reaction is not ordinarily associated with a loss of consciousness or a seizure. However, if warning signs are absent or ignored and the blood glucose level continues to fall, more severe hypoglycemia may lead to an alteration of mental function that proceeds to confusion, stupor, and finally to unconsciousness. What is more important to remember is that most individuals with diabetes never suffer such severe hypoglycaemia.

It does not occur in people with diabetes who are treated with only diet or medical nutrition therapy (MNT) and exercise. There are also anti-diabetes medications which hardly ever produce this condition. These include drugs that belong to the categories of alpha-glucosidase inhibitors (acarbose, voglibose), biguanides (metformin) and thiazolidinediones (rosiglitazone, pioglitazone). Even with other common medications used to control diabetes, severe hypoglycemia is unlikely to occur when appropriate doses of the drugs are used.

Employment screening for diabetics
Part of the screening for employment of people with diabetes should therefore include the individual’s medical condition, treatment regimen (MNT, oral glucose-lowering agent, and/or insulin), and medical history, particularly in regard to the occurrence of incapacitating hypoglycemic episodes.

In the person’s medical condition, information that is pertinent include the presence of risk factors that predispose to increased incidence of hypoglycemia such as liver and kidney disease. This can be assessed in the history and by certain laboratory tests that include examination of the blood for liver enzymes and kidney function, like creatinine and examination of the urine to test for presence or absence of protein.

Long-term alcoholic abuse may lead to liver cirrhosis that will prevent the liver from responding to an episode of hypoglycemia by increasing its release of glucose or sugar. People with kidney failure may develop hypoglycemia if their medication dose is not properly adjusted to prevent retention of the drug in the body over a longer period of time. However, as long as the diabetes is well-controlled and the patient is fully compliant to diet and prescribed medications, these conditions should not present grave danger of hypoglycemia.

Medication-related issues
Medications for diabetes are, in general, safe. The risk of developing severe hypoglycemia is greater only in the elderly, the severely-ill or the person with severe complications or psychiatric illness.

Among people injecting insulin, it is important that their blood glucose is monitored regularly, especially using a glucometer they can bring to the office so they could do self-monitoring of blood sugar. This is especially important in situations where the patient experiences the symptoms of hypoglycemia and wants to confirm if it is indeed due to this condition. The doses of insulin can be revised upon the advice of the physician in order to maintain blood sugar levels within acceptable limits and to prevent severe hypoglycemia.

It is very important that a review of the medications be done on initial medical examination and to report any changes in medication along the course of regular medical check-ups. Individuals who have had episodes of severe hypoglycemia requiring hospitalization should be assessed as to the possible causes and evaluated accordingly to prevent future recurrence.

No limits
Job opportunities should not be limited among people with diabetes. However, there are jobs which, traditionally, have been restricted to people with no major medical illnesses, including poorly controlled diabetes or those with complications. These include jobs such as airline pilots, drivers of heavy vehicles or operators of machinery that may cause loss of limb or life. The reason for this is again related to the possibility of losing consciousness on the job if the person develops severe hypoglycemia. However, a thorough medical check and regular follow-up with physicians and adherence to the treatment plan should reduce this risk to a very minimum level that will not pose a threat to the safety of the person or the public, in general.

The more important issue to consider in screening a prospective employee with diabetes is his overall health and not just the sugar control, although the latter plays a big role in preventing complications.

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