Diabetes and the Workplace

Diabetes and the Workplace

Table of Contents Diabetes and the Workplace... 1 Diabetes Mellitus and the Workplace... 1 What Is Diabetes?... 1 Diabetes in the Body... 3 Types of Diabetes... 4 Complications of Diabetes... 5 The Diabetic Worker and the Workplace... 6 Working the Night Shift- Your Circadian Rhythm. 7 Diabetes and Cold Weather... 9 Conclusions... 10 References... 12 Occupational Health Clinic for Ontario Workers - Sudbury

Diabetes Mellitus and the Workplace Diabetes is one of the oldest chronic conditions known to man. Diabetes was first discovered in 1552 B.C. Over time there has been much advancement made in the diagnosis and treatment of diabetes, however there is no cure for this condition. According to Statistics Canada, the number of Canadian citizens diagnosed with diabetes is increasing each year. Some factors influencing this are: Canada s ageing population Rising obesity rate Common lifestyle changes, including less active lifestyles As of September 2005, there were about 32 million people in Canada. Of this population, about 5 %, or over 2 million people, have diabetes. This number is expected to triple by the year 2025! What Is Diabetes? Diabetes is a condition that affects the body s natural ability to control its blood sugar level. Blood sugar levels, also known as glucose levels, must remain in a certain range for normal body functioning. The normal range for blood sugar is between 70 mg/dl (3.88mmol/L) and 100mg/dL (5.55 mmol/l). Occupational Health Clinic for Ontario Workers - Sudbury Page 1 of 13

Blood sugar in the body has several important roles. Sugar is used in the brain to maintain normal brain function, which has a direct effect on the rest of the body. Sugar is also used as energy for the cells in the body. When the sugar level is above 126 mg/dl, it is too high (hyperglycemic). When the sugar level is below 50 mg/dl, it is too low (hypoglycemic). If the blood sugar level falls into either one of these categories, there are serious consequences for the body. There are three common symptoms when the blood glucose level is too high (hyperglycemic). These symptoms are excessive hunger, excessive thirst and excessive urination. Other symptoms of high blood sugar can include: Blurred vision Fatigue/ Tiredness Weight loss Poor wound healing Dry mouth Dry or itchy skin Impotence in males Recurrent infections There are also common symptoms when the blood glucose level is too low (hypoglycemia). A state of low blood sugar, or hypoglycemia, is considered a medical emergency, and must be dealt with immediately. The symptoms of hypoglycemia include seizures, confusion, disorientation, and a loss of consciousness. Other symptoms of low blood sugar can include: Cold, clammy skin Headache Abdominal pain or nausea Fainting Occupational Health Clinic for Ontario Workers - Sudbury Page 2 of 13

Blurred vision and dizziness Nervousness Extreme irritability Lack of coordination Difficulty concentrating Diabetes in the Body The control of blood sugar in the body is maintained by a chemical called insulin, which comes from the pancreas. (The pancreas is a 12cm to 15cm long gland in the body, which sits between the stomach and intestine). In a normal pancreas, insulin is automatically released into the blood stream when the body s glucose becomes too high, thus controlling blood sugar. Let s Review Diabetes changes the body s ability to control it s sugar level Diabetics can have a sugar level that is too high (hyperglycemia) or too low (hypoglycemia) Blood sugar is controlled by insulin Insulin comes from the pancreas Occupational Health Clinic for Ontario Workers - Sudbury Page 3 of 13

Types of Diabetes There are three different types of diabetes: Type 1, or insulin dependent diabetes mellitus (IDDM); Type 2, or non-insulin dependent diabetes mellitus (NIDDM); Gestational diabetes mellitus (GDM). Type 1 Diabetes Type 1 diabetes is also known as insulin dependent diabetes. In this condition the pancreas makes very little or does not produce any insulin for the body to use. This results in no blood sugar control. With type 1 diabetes, insulin must be injected into the body on a daily basis. Because the body cannot control its blood sugar level, diet must be strictly controlled. It is recommended that a dietician be consulted when making meal plans. Because there is no insulin production, type 1 diabetics are more likely to suffer from too high (hyperglycemia) or too low (hypoglycemia) blood sugar, Type 2 Diabetes Type 2 diabetes is also known as non-insulin dependent diabetes. In this condition the pancreas produces insulin; however the body is unable to use this insulin properly. Daily injections of insulin are not usually necessary. Control of type 2 diabetes often comes from a combination of strict diet and exercise. Occupational Health Clinic for Ontario Workers - Sudbury Page 4 of 13

Gestational Diabetes Gestational diabetes is a temporary condition. This type of diabetes can occur at any time during pregnancy. This condition is similar to type 2 diabetes. Control must come from diet and exercise. Risk factors for developing gestational diabetes include: A history of diabetes in the family Obesity Age over 35 years old Excessive body and facial hair The ethnic group at high risk is Aboriginal, Hispanic, South Asian or African descent Gestational diabetes is a cause of concern for both mother and the fetus, and as such must be diagnosed as early as possible. The Canadian Diabetes Association recommends that all pregnant women be screened for gestational diabetes at between 24 and 28 weeks of the pregnancy. Let s Review Three categories of diabetes: Type 1: the pancreas does not produce insulin: must have daily injections Type 2: the pancreas produces insulin, however the insulin is not properly used by the body; may require insulin injections Gestational: happens during pregnancy: concern for mom and baby Complications of Diabetes Having type 1 or type 2 diabetes places you at greater risk for developing other conditions. High blood pressure can be Occupational Health Clinic for Ontario Workers - Sudbury Page 5 of 13

a problem in itself. When high blood pressure happens with diabetes, both of these conditions make each other worse. STRICT blood pressure control must be maintained. Exercise and diet are the main ways to do this. Along with high blood pressure, diabetes has a long-term effect on most of the body s organs, and diabetics are more at risk to develop: Circulation trouble, which can lead to foot and healing problems Eye and vision trouble Kidney disease Nerve damage Erectile problems Depression and mood disorders (These are only some of the more common side-effects of diabetes) The Diabetic Worker and the Workplace Personal medical records in Canada are strictly confidential. This means that unless you are applying for a safety sensitive position, you are not required to tell your employer that you have diabetes. This means that discrimination in the workplace against workers with diabetes should not occur. The Canadian Diabetes Association officially states that a person with diabetes should be eligible, and has the right to be assessed for specific job duties that he or she is qualified for. Under human rights law, all employers in the province of Ontario must follow a duty to accommodate. This law means that reasonable steps must be taken to accommodate workers individual needs. Occupational Health Clinic for Ontario Workers - Sudbury Page 6 of 13

Safety Sensitive Positions There are certain jobs, called safety sensitive positions, that require a potential employee to disclose a diabetes condition. A safety sensitive position is defined as a duty which could endanger fellow workers or the safety of the public. Some examples of safety sensitive positions are: Airline pilot Fire-fighter Police officer Truck driver Railway engineer The reason for this policy is to maintain a safe work environment. The problem with diabetes is if a worker s blood sugar fell too low or became too high while at work, the safety of others may be in jeopardy. This emphasizes the fact that strict control over diabetes, mainly from diet, exercise and blood sugar levels, must occur. Let s Review Personal medical information is strictly confidential: you DO NOT have to disclose your diabetes to the employer UNLESS: You are applying for a Safety Sensitive Position: where you are responsible for the safety of others Working the Night Shift- Your Circadian Rhythm The body has a natural clock inside the brain, known as the circadian rhythm. The circadian rhythm takes place during a 24 hour time frame. This time frame allows normal body functions to occur at specific times during the Occupational Health Clinic for Ontario Workers - Sudbury Page 7 of 13

day and night. One of the normal functions the circadian rhythm helps to regulate is the body s control of blood sugar. This natural clock is regulated by hormones and sleep patterns inside the body. It is also regulated by daylight outside the body. When a person is awake during the day and sleeping at night, this circadian rhythm works in its normal way. However, when a person stays awake all night and sleeps during the day, the circadian rhythm becomes confused, and the body does not understand this change. To make up for being confused, the circadian rhythm will change the time on its clock. When the circadian rhythm is changed, natural occurring body processes will also change. One of these body processes is blood sugar control. When working in shifts, specifically the night shift, your diabetes must be carefully monitored. If you have type 1 diabetes, it is VERY important that attention is paid to your blood sugar level. Type 1 diabetics are more prone to having a hypoglycemic episode during shift work, which is a potential medical emergency. If you have type 2 diabetes and are controlling it through diet and exercise, planning meals for your shift is very important. Again, consulting a registered dietitian to help you plan meals for your shift work is a good idea. There is research evidence that shows a link between cardiovascular conditions and the circadian rhythm. Workers that have worked the night shift for a long time are at higher Occupational Health Clinic for Ontario Workers - Sudbury Page 8 of 13

risk of having a heart attack or stroke. Since diabetes is also a risk factor for developing cardiovascular conditions, a combination of diabetes and changing the circadian rhythm may be a very dangerous mix. Let s Review The body has a natural clock: the circadian rhythm The circadian rhythm produces hormones in the body; it helps the body to regulate blood sugar levels The circadian rhythm follows a 24 hour time period, and is naturally occurring The circadian rhythm follows the day and night time of the environment Working shift work changes the circadian rhythm This change can greatly impact diabetes Diabetes and Cold Weather There are many jobs that require working in cold weather for long periods of time (especially in Northern Ontario!!). Working in cold weather is a concern for diabetics. Studies have shown that working in cold weather for three consecutive months has a general increase on blood sugar levels in the body. Why this happens is unknown. We know that diabetes affects blood circulation. Long periods of exposure to cold weather also affect s blood flow in the body. When the body is cold, blood vessels get smaller and do not carry as much blood to the arms, legs, hands and feet. This combination of cold weather and diabetes can increase the risk of developing poor circulation problems. Some examples of these problems are: High blood pressure High cholesterol levels Occupational Health Clinic for Ontario Workers - Sudbury Page 9 of 13

Pain Poor blood flow to the feet (causing long-term problems) Poor healing time for wounds Diabetes and the Workplace It is also important to remember that many personal blood sugar monitors will not function if the temperature is below 10 Celsius. This is a factor to keep in mind when planning a spot to test your blood level. Let s Review Long periods of exposure to cold weather increases blood sugar levels Cold weather affect s the circulation system in the body Diabetics are at risk to develop circulation problems Personal blood sugar monitors will not work in the cold Conclusions Diabetes is a chronic condition affecting more and more Canadians each year Diabetes requires strict control, and can cause serious body problems In the workplace, discrimination against diabetes should NOT occur Working in shifts has a serious affect on diabetes Working in the cold weather also has a serious affect on diabetes With carefully monitoring and strict control, your diabetes is manageable!! This condition should not affect your ability to function in the workplace. Occupational Health Clinic for Ontario Workers - Sudbury Page 10 of 13

Notes Occupational Health Clinic for Ontario Workers - Sudbury Page 11 of 13

References A.D.A.M. http://www.adam.com/, 2005 American Diabetes Association. www.diabetes.org/., 2005. Ancient Egypt. http://www.misticismo.blogger.com.br/pyramid_and_sphinx.j pg, 2005. Canadian Diabetes Association. http://www.diabetes.ca/section_main/welcome.asp., 2005. Cartoon Stock. http://www.cartoonstock.com/directory/w/worker.asp., 2005. Dewar, K. J., (2001). Diabetes and shiftwork: maintaining healthy diabetes control. Diabetes Dialogue. Endocrine Disorders. http://www.endocrineweb.com/diabetes/hyperglycemia.html, 2005 Health Finder. http://www.healthfinder.gov/, 2005. Human Rights of Canada. http://www.chrc-ccdp.ca/, 2005. Knutsson, A. (2003). Health disorders of shift workers. Retrieved November 4, 2005 from Occupational Medicine, 53 pp. 103-108. Mamas Health. http://www.mamashealth.com/diabetes3.asp, 2005. Occupational Health Clinic for Ontario Workers - Sudbury Page 12 of 13

Medline plus. http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm, 2005. Ostenson, C. G. (2001). The pathophysiology of type 2 diabetes mellitus: an overview. Scandinavian Physiological Society, 171 pp. 241-247. Statistics Canada. http://www.statcan.ca/., 2003. Created July 2005 Occupational Health Clinic for Ontario Workers - Sudbury Page 13 of 13

If you need further assistance, call the Occupational Health Clinic for Ontario Workers Inc. Closest to you. HAMILTON 848 Main Street East Hamilton, ON L8M 1L9 (905) 549-2552 Toll Free: 1-800-263-2129 Fax: (905) 549-7993 E-mail: hamilton@ohcow.on.ca SUDBURY 84 Cedar Street 2 nd Floor Sudbury, ON P3E 1A5 (705) 523-2330 Toll Free: 1-800-461-7120 Fax: (705) 523-2606 E-mail: sudbury@ohcow.on.ca WINDSOR 3129 Marentette Avenue Unit #1 Windsor, ON N8X 4G1 (519) 973-4800 Toll Free: 1-800-565-3185 Fax: (519) 973-1906 E-mail: windsor@ohcow.on.ca SARNIA-LAMBTON 171 Kendall Street Point Edward, ON N7V 4G6 (519) 337-4627 Fax: (519) 337-9442 E-mail: sarnia@ohcow.on.ca TORONTO 970 Lawrence Ave. West Main Floor Toronto, ON M6A 3B6 (416) 449-0009 Toll Free: 1-888-596-3800 Fax: (416) 449-7772 E-mail: toronto@ohcow.on.ca PROVINCIAL OFFICE 15 Gervais Drive Suite 601 Don Mills, ON M3C 1Y8 (416) 510-8713 Fax: (416) 443-9132 Toll Free: 1-877-817-0336 E-mail: info@ohcow.on.ca Website: http://www.ohcow.on.ca Every effort has been made to ensure the accuracy of the information in this workbook. OHCOW assumes no responsibility for how this information is used.