Last reviewed 7 April 2016
This year’s World Health Day on 7 April 2016 focused on diabetes, as awareness of the condition continues to grow with its increasing prevalence worldwide. Vicky Powell examines diabetes in the context of the workplace, considering how managers can best support the health of workers with diabetes and the relevant work and safety related issues.
What is diabetes?
Diabetes is a chronic condition where the body is unable to regulate its glucose levels. According to the charity Diabetes UK, this can be the result of the pancreas failing to produce insulin, or not enough insulin to help glucose enter the body’s cells. Alternatively, the insulin that is produced does not work properly (known as insulin resistance (IR)). These are the two main types of diabetes.
Type 1 is a less common condition, usually developing in children and young adults. With this type of diabetes, the body is unable to produce insulin to manage glucose levels in the blood.
Type 2 diabetes is far more common and mainly appears in adulthood (although there has been a recent surge in children, possibly connected to the global rise in obesity). In this type of diabetes, the body does not produce enough insulin or the body’s cells do not react to insulin.
Genetics certainly increase the chances of getting both type 1 and type 2 diabetes, but it is accepted that certain factors, particularly overeating and a sedentary lifestyle increase the risk of type 2 diabetes. Other factors include age, being overweight or obese, body fat distribution, family history and ethnicity.
Diabetes can lead to heart disease, stroke, kidney disease, vision problems and lower limb amputation if it is not properly controlled.
Why is diabetes increasing?
The World Health Organization (WHO) warns that the prevalence of diabetes is growing around the world and that diabetes will be the 7th leading cause of death by 2030.
According to the charity Diabetes UK, around 700 people a day are diagnosed with diabetes in the UK, equating to 1 person every 2 minutes. The charity says that as there are 3.9 million people living with diabetes in the UK, it is likely that many people work alongside someone with diabetes. Other workers may also be at risk of developing type 2 diabetes in the future.
The UK is facing a huge increase in the number of people with diabetes. By 2025, it is estimated that 5 million people will have the condition. Most of these cases will be type 2 diabetes, with the increase attributed by Diabetes UK to an ageing population and rapidly rising numbers of overweight and obese people.
Diabetes and safety in the workplace
Concerns about workplace safety in relation to diabetes tend to be associated with the development of hypoglycaemia — a state of low blood glucose. Symptoms of hypoglycaemia can include hunger and dizziness as well as confusion and unconsciousness. Hypoglycaemia is commonly perceived as a concern for people with type 1, rather than type 2, diabetes although hypoglycaemia is a potential risk for anyone using insulin and many people with type 2 diabetes are insulin-dependent.
In contrast, hyperglycaemia occurs when blood glucose is high because the body has too little insulin or is improperly using insulin, resulting in symptoms such as hunger, thirst and frequent urination. Left untreated, hyperglycaemia can lead to diabetic coma. However, the symptoms of hyperglycaemia generally develop over hours or days and do not occur suddenly. Therefore, hyperglycaemia does not pose an immediate risk of sudden incapacitation.
The Institution of Occupational Safety and Health (IOSH) points out that diabetes is a very common lifelong health condition that does not hinder people’s ability to get a job or to keep one. The law requires that people with diabetes be assessed on their individual ability to do a job and not to be discriminated against simply because they have the condition.
However, some safety critical jobs will have legitimate health requirements that may exclude people with certain medical conditions. There are some key areas of employment, such as driving long goods vehicles or those carrying passengers, where there are restrictions on people with insulin-dependent diabetes.
Supporting the health of workers with diabetes
One key consideration in relation to worker’s health and diabetes is shift work. According to Diabetes UK, 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 get in the way.
The Health and Safety Executive (HSE) has published a case study on a 55-year-old bakery worker whose job as a production operative involved rotational night shifts. Statutory health surveillance includes a health check for night workers and during this process, the employee was diagnosed with type 2 diabetes.
Symptoms of type 2 diabetes include an increased production of urine, unusual thirst, tiredness, loss of weight, increased appetite, feeling sick, blurred vision, increased infections and symptoms of feeling generally unwell, some of which the employee had been experiencing.
In view of the diagnosis, the bakery worker’s occupational health rehabilitation plan was updated and his line manager was informed that the employee needed to avoid rotational day and night shifts for a further three months, to allow his blood sugar levels to be better controlled.
Arrangements were also made for the employee to take regular breaks, increasing in regularity during spells of hot weather. In addition, first aiders were informed of his condition and he was included in the company’s flu vaccination programme since diabetics are at greater risk of contracting infections.
After three months, the employee was stabilised by diet and oral medication. The man’s GP stated he would be able to enjoy a normal life, including a normal working life that involved physical work with rotational day and night shifts.
Another interesting aspect to the night shift question is the conclusion of a recent large international research study which suggested that type 2 diabetes is more common in people who work shifts.
Commenting on the research, Dr Alasdair Rankin of Diabetes UK was quoted by the BBC as saying, “These findings suggest that shift workers need to be aware of their personal risk of developing type 2 diabetes. They can do this by taking a type 2 diabetes risk assessment, either online or in their local pharmacy. The best way to reduce your risk of type 2 is to maintain a healthy weight through regular physical activity and by eating a healthy balanced diet.”
Diabetes awareness at work
It is estimated that around half a million people in the UK have diabetes but are unaware that they have it, as in the case of the bakery worker featured in the HSE case study. Given that many of us may also be at risk of developing type 2 diabetes in the future, Diabetes UK says, that holding a diabetes awareness day could make a big difference to the health and wellbeing of staff (see Diabetes UK website for information in this regard).
Employers could of course also use their existing wellbeing programmes to raise awareness about the condition, including information about the value of keeping active, eating healthily and maintaining a healthy weight.
A source at Diabetes UK said, “Type 2 diabetes isn’t inevitable. Up to 80% of cases of Type 2 diabetes can be delayed or prevented. So it’s important that everyone understands their risk, so they can reduce their chances of ever developing the condition.”