Diabetes and Your Career
Barriers in the workplace are gradually being dismantled
Despite having faced discrimination early in his career, Adam Roth, a special agent with the Department of Commerce, says diabetes doesn't have to hold you back.
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In school, they like to say you can be anything. A ballet dancer. A firefighter. President of the United States. The sky's the limit, they say, and most kids believe it. But doubt scratches at the back of some kids' minds: Can I be a firefighter? Can I fight crime? Will my diabetes dictate which job I can take?
Not too long ago, the unfortunate answer to the last question would have been yes. People with diabetes were shut out of jobs because companies feared that workplace episodes of low blood glucose would put their employees in danger and that caring for diabetes would disrupt their work. But that misguided view is being challenged by advocacy efforts and new laws and guidelines. Diabetes self-care can be accommodated reasonably in most work situations.
|The American Diabetes Association is committed to making sure every workplace is a fair one for people with diabetes. If you have questions about your rights or treatment you feel is unfair, call 1-800-diabetes (1-800-342-2383).|
Before you enter the job market, it's important to know your rights as a person with diabetes. There's no law that requires you to disclose your diabetes, and employers aren't allowed to ask about your medical background before offering you a job.
That said, some job offers (such as for police officers) may hinge on your ability to pass a medical evaluation, which takes place after a formal offer has been made. A job offer may be rescinded based on exam results, but only if your health will prevent you from doing your job or if it may put you or your coworkers at risk. Who conducts this evaluation? It depends. Some employers have their own medical staff while others will accept reports from your doctor.
Most jobs don't require a medical evaluation, so whether or not you talk about your diabetes is up to you. But staying mum on the topic can put you in a tricky place. If your employer doesn't know about your diabetes, you may have a hard time proving discrimination based on the condition.
Though there are state laws regarding workplace discrimination and others specifically covering government employees, the most significant legislation for people with diabetes is the Americans with Disabilities Act, which protects most people from being denied jobs or fired from a position because of their diabetes. (Although many people with diabetes do not think of themselves as being at all disabled, diabetes is considered a disability under the law.) The law also requires employers to provide reasonable accommodations to enable people with diabetes to do the job.
Employment limitations on people with diabetes are mostly based on outdated beliefs about the disease. "Most of these restrictions were made at a time when diabetes was managed in a much more crude way than we do today," says John Griffin, Jr., a Victoria, Texas, attorney and former chair of the American Diabetes Association's board of directors, who has won many workplace discrimination cases involving people with diabetes. "No one had a way of knowing what their blood sugar was at any time. Meters weren't as accessible as they are now. Insulins weren't as short acting and precise as they are now."
Yet for some occupations diabetes is still considered a major risk, mostly because of the chance of low blood glucose. "The biggest obstacle to employment is having had a serious hypoglycemic episode in the one to two years preceding employment," says Daniel Lorber, MD, FACP, CDE, a New York City endocrinologist and vice chairman of the American Diabetes Association's Advocacy Committee. Some careers (such as law enforcement) may require you to have had no more than one or two severe lows—in which you might need glucagon, have a seizure, become unconscious, or go into a coma—during the few years before applying.
Such rules can complicate your diabetes care. "You may need to loosen control a bit and raise the A1C in order to prevent hypoglycemia," says Lorber. "It [puts you] between a rock and a hard place." That is, you may be forced to choose between strict blood glucose control, which may lead to hypoglycemia, or raising your A1C by half a percentage point to win the job.
"The difference between a 7 and 7.5 percent A1C is small, but it may help reduce hypoglycemia risk," Lorber says. But not everyone's comfortable with loosening their control. "It's hard because they've been hammered about complications of [high blood glucose]."
And it's not just people taking insulin who concern employers. Because some type 2 pills, such as sulfonylureas, can cause low blood glucose, people on oral medication often face restrictions or discrimination, too. The good news: "That is becoming less and less a wall to knock down because (a) sulfonylureas are not used as much and (b) the prejudice against diabetes is mostly against insulin or the misunderstanding of what an A1C is," Griffin says.
Though many professions are catching up to the times and adjusting their policies regarding the hiring of people with diabetes, certain careers remain walled off. People with diabetes are able to pilot private airplanes, but they are prevented from operating commercial airlines. (Interestingly, Boeing has test pilots with type 1 who fly 747s without issue—a point that bolsters the ADA's case for equality for pilots with diabetes.)
But the most difficult occupation for people with diabetes to enter is the military, which doesn't operate under typical federal employment laws that make blanket bans illegal. People with diabetes cannot join any branch of the military. (If you're diagnosed with diabetes after you've been accepted by the military, though, you possibly may avoid discharge, depending on your medical history, your job, and other factors.) "The question should be: Can they be a good soldier?" says Griffin. "We believe there is a subset of young men and women with diabetes who would be excellent soldiers. They should not be denied that privilege because of their diabetes."
Despite the fact that blanket bans still exist for some careers, the job market on a whole is accepting. Even in occupations where everyone with diabetes was once banned, practices have changed in recent years, thanks in part to advocacy efforts by the ADA.
Instead of being denied outright, would-be cops, FBI agents, and Foreign Service officers undergo a medical evaluation that verifies diabetes control. "It's only a matter of time before the CIA joins the FBI and the State Department in thinking people with diabetes should be evaluated on how well they manage their diabetes," says Griffin.
The National Fire Protection Association has also dropped its blanket ban on firefighters with diabetes. Applicants now go through a similar medical evaluation as police officers, though regulations require them to have an A1C under 8 percent, in most cases, in order to be medically qualified.
Commercial truck driving is another occupation in which the thinking has changed about employees with diabetes. In the past, those who treated their diabetes with insulin were automatically banned from interstate truck driving. Now the federal Diabetes Exemption Program allows people with diabetes to apply for the right to be interstate truck drivers by releasing health information related to their diabetes. (Still, the process is rigorous—you must be on insulin for one to two months before applying—and approval can take a half a year or more.) Many states have their own waiver programs that let people with diabetes who take insulin drive commercial vehicles within the state, though obtaining a waiver can take months.
Even NASA, which has had stringent requirements for its astronauts, is more accepting. "Our stance has relaxed over time as well," says James Locke, MD, MS, a NASA flight surgeon at the Johnson Space Center's Flight Medicine Clinic. "Medical science has improved, and the ability to keep [people] healthy has improved." Astronaut applicants are evaluated on a case-by-case basis, and people with diabetes aren't automatically turned away. Instead, Locke and his team consider a person's blood glucose control, frequency of hypoglycemia, and any complications—from diabetes or otherwise—he or she may have.
However, there have been no astronauts with diabetes in space, and Locke says a few issues still exist. For instance, because there are no refrigerators in spacecraft, it's unclear whether insulin could be stored for long periods of time. And because the United States works with international partners, other countries may be hesitant to allow someone with diabetes in space, especially if there is more of a stigma surrounding diabetes in another nation. Of course, that shouldn't deter you from applying. "We really want to encourage people with medical conditions to work through them," Locke says.
Looking to the Future
In school, they like to say that you can be anything you want to be as long as you work hard enough.
Just ask Anna Balogh, James Allman-Gulino, and Shane Siegel, who challenged the State Department when diabetes barred them from becoming Foreign Service officers. Ask the two men who fought UPS to keep their jobs or the factory worker who went up against a giant corporation to prove his type 2 diabetes didn't affect his job performance.
"Well-motivated young men and women with insulin-treated diabetes are opening doors every day," says Griffin. "If you ask them, they'll say, 'I didn't want my children or my younger brothers or sisters to be barred where I have been.' Is it worth it? Yes."
And the ADA is actively fighting for equal rights for people with diabetes, regardless of the job. "Evolution is sometimes slow, and the path to civil rights for people with diabetes is one that has some rocks in the road," says Griffin. That said, great strides have been made in recent years, and the fight will continue until people with diabetes aren't banned outright from any job.
"What we need to do is say anybody with diabetes should be able to do any job they are qualified to do," says Lorber. "In my opinion, there are no jobs people with diabetes can't do."