“Teetering On A Balance Beam”

The New York Times is at it again, with yet another in-depth and provocative feature story on what it means to live with diabetes.  This one focuses on discrimination on the job: “Diabetics Confront a Tangle of Workplace Laws.”

Besides the disturbing stories of people with diabetes who’ve lost jobs at everyplace from mortgage firms to UPS to a Texas baked bean plant, what really struck me was this statement:

“Diabetics can find themselves teetering on a balance beam, needing to prove they are disabled enough to fit under the law but not so impaired that they can’t do a job.”

Disrimination

I do not think of myself or anyone with diabetes as disabled, and it would pain me greatly to have to resort to conjuring up disability laws or special benefits just to succeed alongside non-diabetic colleagues in the workplace. But from this story, I can see that sometimes PWDs have no choice.

Consider the woman with diabetic neuropathy whose employer wouldn’t let her cut through a stockroom to reach her department (in order to reduce her walk), or the man fired from a Wisconsin candy company after asking where he could dispose of his insulin needles (!)

What’s the matter with these employers?  How do they figure “substantial risk” to their business, and/or to life and limb over stuff like this? 

Yes, a very small percentage of us run the risk of serious hypoglycemia.  But this is: 1) dangerous to no one but the PWD themselves in most jobs (think mortgage company), and 2) extremely rare in the sweeping population of people with diabetes.  Why make so many people suffer out of pure ignorance?

“But the companies say they are struggling, too, with confusion about whether diabetes is a legitimate disability and with concern about whether it is overly expensive, hazardous and disruptive to accommodate the illness,” the NY Times reports.

Hmm, definitely sounds like a case of the “I-word,” as in: “If I can get rid of ignorance, I can get rid of a lot of discrimination,” says Shereen Arent, the director of legal advocacy for the American Diabetes Association.

On the whole, however, I’d have to agree with Kelly Close that the sorriest part of this story is the quote from Fran Carpentier, senior editor at Parade magazine and a Type 1 diabetic herself.  She states: “Knowing what it’s like to live with the disease hour by hour, day by day, I wonder if I owned my own company if I would hire someone with diabetes…  I’m being bluntly honest. And it kills me to say this.”

I second Kelly’s assertion that “with quotes like that out there, I sure hope I’ll never be applying for another job.”  Three cheers for the golden days of independent consulting! 

25 Responses

  1. Kim
    Kim December 26, 2006 at 9:37 am | | Reply

    Wow, I am so totally in shock that a Type 1 diabetic would say that. She must harbor a lot of guilt about being a bad employee. Do you think Parade will be examining her performance more closely now? Gosh, this is really food for thought.

  2. Jo
    Jo December 26, 2006 at 9:50 am | | Reply

    Beat me to the punch, buy my post on this will go out tomorrow. With diabetes on the rise, these employers better get in gear and figure out the supposed “danger” we diabetics pose to them … they aren’t worried about the employee – they are worried about themselves only. Fortnuately I work where this isn’t an issue. Thank You God!

  3. Bonny C Damocles
    Bonny C Damocles December 26, 2006 at 10:09 am | | Reply

    Speaking only of type 2 diabetes, if what I have been learning about this disease since my diagnosis in July 1991 is applicable to all type 2s, then there is no problem at all for both the diabetics and the employers. The diabetics will be able to work and live like they have no diabetes.

  4. Adam Kaye
    Adam Kaye December 26, 2006 at 10:25 am | | Reply

    As for the disability thing: As a type 1, I’ve never considered myself “disabled” in any way, shape, or form. However, when I was signing up to take step 1 of the US Medical Licensing Exam, I was told that if I wanted to have my testing equipment and some sugar tabs with me in the testing room, I would have to qualify under the “Americans with Disabilities Act.” Furthermore, I now have to live with the fear that when residency programs see my score, it might have a dreaded asterisk next to it indicating my “disabled” or “special” status. How do people expect us to not ask for special consideration when they basically force it upon us for the most minute details? How hard would it be to just let me have a couple things with me in the test?

  5. Kathleen Weaver
    Kathleen Weaver December 26, 2006 at 10:38 am | | Reply

    I started posting about this two days ago when I saw this post http://www.kevinmd.com/blog/2006/12/diabetic-sues-over-nightclubs-syringe.html
    at Kevin, MD sites, and the poster was on the night club’s side.

  6. Lili
    Lili December 26, 2006 at 11:15 am | | Reply

    I can’t believe that quote, either. I am a very high maintenance diabetic, compared to others, and I don’t feel that way at all. I know that I can do an excellent job with only a few accommodations (like being able to eat and test at my desk). I don’t understand her attitude at all. And yes, thanks a lot! Everyone’s going to read that and get the wrong impression.

  7. Felix Kasza
    Felix Kasza December 26, 2006 at 4:35 pm | | Reply

    Regarding the specific example of the candy company: Would there have been sharps in the same room as candy or the ingredients thereto? In that case, I would also have placed the interest of all the potential consumers above the interest of one diabetic (and who came up with that retarded “PWD” moniker anyway?).

    Regarding Fran Carpentier: Brava! Finally, an honest answer. As my employer can attest, even diabetes under excellent control is expensive and time-consuming. If a meeting has to be stopped and postponed because I go low, I just wasted the time of three to ten people, not to mention delays until that event can get scheduled anew etc.

    Is this nothing?

    Cheers,
    Felix.
    T1

  8. Scott K. Johnson
    Scott K. Johnson December 26, 2006 at 6:29 pm | | Reply

    I was left feeling pretty frustrated and helpless after reading that article. There are valid points on both sides of the argument.

    But for a guy to have to choose between his health or his income, as the UPS mechanic had to here, is just a really sad thing.

    Teetering in a balance beam is a very good title for something like this.

  9. Sally Anderson
    Sally Anderson December 26, 2006 at 6:36 pm | | Reply

    This really scares me, but I’ve been disciplined over my diabetes before. I was working at one of the big retail stores and I kept going hypoglycemic. I left the floor to treat my low and I ended up being disciplined by one of the managers.

    It was a nightmare.

    Now I’m working hard on my computer science degree and I’m honestly not all that interested in telling anyone I have type 1 diabetes. I’m not ashamed or guilty for having it, but I’ve run into too much ignorance and too many myths.

  10. Michael Park
    Michael Park December 26, 2006 at 7:49 pm | | Reply

    I’d like to point out a slight bias… I’d venture to say that the whopping majority of people who comment here are of the “high maintenance” variety, generally under better control than the whopping majority of diabetics out there. A well managed type-one diabetic is definately a (whopping) minority amongst the world’s diabetes population (unfortunately).
    I have a question about the 13,000$ per annum cost… is that the cost to the individual, or to the company?!? I highly doubt that could be the cost to the company… could someone give me a rundown of exactly how diabetics cost their employers money… cause the website cited sure didn’t….

  11. Kevin
    Kevin December 27, 2006 at 3:56 am | | Reply

    I have worked in all aspects of a company. And I for one can see all of the different angles on this topic. I also belong to another website on Diabetes so some of my examples come from there.

    Diabetes can impose harm on a business. On that other website there was a member that worked for Progressive Insurance in their call center. He wanted advice on how to handle getting BG check breaks. He said he needed 5 minutes to do one and that his boss wouldn’t allow him “off the phone” that long. Now, to me, 5 minutes is too much time needed to do a BG check. I can do one in under a minute.

    This same poster then said he wanted 30 minutes to correct himself if he was low. He would need to take a break and then retest at 30 minutes. To me, if I were his boss, I’d definitely say no way. And that is what his boss said. There is a limit on what is reasonable. Working for a call center they plan on you working your complete 8 hour shift. Not working 7.5 hours. They may need to bring others in to answer the phone if you go absent. And you all know you hate being on hold calling 1-800 numbers.

    Now, do diabetics pose a substantial harm to others physically? I guess that depends on the job. Say you are a pilot and all of the sudden have a blackout, yup, you’re screwed and so are the 200 people sitting behind you. Granted, the chances are small in that, it’s significant enough that diabetics can’t get a commercial pilot’s license. Remember, it only takes ONE bad incident and the media to get involved to give ALL diabetics a bad name.

    As for financially hurting a company…it depends on how you look at it. Diabetes is either the #1 most expensive insurance claim or #2. Either way, it’s a huge driving factor in insurance rates for companies. So in a sense, we are driving costs to a company up. That is also why some companies just outright don’t offer insurance. If we work for a company that is willing to give us a 30 minute “diabetes break” every day, in a year that is 130 hours. At say $20 an hour, that is $2600 in lost profit for the company. Not small change for some companies.

    Now, you could say smokers cost a company money, and I agree, but that’s an issue we can’t change at this time, just one we can use for “equal” rights.

    Also, I for one work at a Police Department as a Police Clerk/Dispatcher and in the job interview I told them I was diabetic and that I needed no special treatment. So far I have not as I can test and eat when I need to. And they said if it ever gets to bad, they can bring in an officer off the road to sit for me for a bit. So far in 18 months I haven’t needed that.

    Just some thoughts to think about.

  12. Scott
    Scott December 27, 2006 at 6:06 am | | Reply

    The law specifies that “reasonable accommodation” must be made, and I think the same applies for patients themselves.

    For employers who are watching every minute, the solution may very well be that they must provide accommodations, but if the time required to do that eats into productivity time, then add a half hour onto their shift, problem is solved. As for the costs related to insurance, these are certainly real, and our country has serious issues with our healthcare delivery system that we have avoided addressing, but we cannot push them under the rug forever.

    But to claim that diabetes increases these costs disproportionately is denial; yes, proper care costs money, but the cost of ignoring the disease will be higher. Avoid paying for testing supplies and Rx, end up paying for trips to the ER for problems aggrivated by poorly managed DM. Small businesses are increasingly unable to offer healthcare insurance, whereas larger businesses are trying to manage the rise of costs. But what if there was a move to cover only employees, not their entire families? To blame patients with DM for costs is overlooking the bigger issue.

    The real issue with this article is whether they are making mountains out of molehills here; they cite a few worst case scenario articles and a few quotes, but considering there are ~17 million patients with diabetes, I would say the numbers of these incidence are VERY small.

  13. Anne
    Anne December 27, 2006 at 8:52 am | | Reply

    Maybe the JDRF and/or ADA should come out with recommendations for employers, so they can learn what reasonable requests might be from type 1 and type 2 diabetics. (Maybe they already do have something like that.)

    I felt a little bad that I was costing my insurance $$ until I saw an administrator of my insurance company driving a new luxury sports car. Then, I didn’t feel so bad anymore. This insurance company, at least, is doing just fine.

    It seems like we need a little more charity. Those who criticize diabetics for costing a lot to employers/insurance companies could easily find themselves on the other side in an instant.

  14. Melitta
    Melitta December 27, 2006 at 10:06 am | | Reply

    I have a number of reactions (and they are not hypos!) to this article. First, I think it is important to distinguish between Type 1 and Type 2 diabetes. They are two different diseases, and should be treated as such. Second, someone ought to string up that poor UPS mechanic’s doctor/endo by the toes–there is a high probability that the UPS mechanic has late onset/slow onset Type 1 diabetes, and he never should have been allowed to go off of insulin (and yes, I know that he is now on insulin). Third, I have known LOTS of Type 1′s who do not take good care of themselves, and yes their poor self-care has a profound impact on the people around them. Finally, I am grateful that I am able to really manage my Type 1 diabetes well. I have never had any problems at work, knock on wood, and I have not been discriminated against. (However, I do take my medic-alert bracelet off when going to a job interview.) Just my two cents.

  15. Felix Kasza
    Felix Kasza December 27, 2006 at 7:40 pm | | Reply

    Scott — you wrote:

    “But to claim that diabetes increases these costs disproportionately is denial; yes, proper care costs money, but the cost of ignoring the disease will be higher.”

    From an overall point of view, you are right. From an employer’s (or insurer’s) view, the costs mount disproportionately with the time and the lack of control.

    In other words, if the care now is crappy, someone else down the road will have to foot the really high bill.

    Michael Park –

    “I have a question about the 13,000$ per annum cost… is that the cost to the individual, or to the company?!?”

    I am on the pump. Consumables and pump cost (depreciated over four years) come to $5,000+ per year. For that money, I am alive; but I have not even seen my doctor. (Not even for the DME Rx.) Any complications? Perhaps even some expensive laser surgery?

    And don’t even think about the costs of a diabetic in ESRD and going on dialysis thrice weekly.

    I cannot give you a specific set of numbers that will add up to $13,000 — but the sum is definitely in the realm of the possible, and IMHO eminently plausible.

    Oh, and have we mentioned non-obvious costs, like extra sick time, loss of work time for tests and corrections, or wasting one’s co-workers’ time?

    Cheers,
    Felix.

  16. AmyT
    AmyT December 27, 2006 at 8:15 pm | | Reply

    Felix,
    It’s a bit unclear whether you’re trying to help or hinder the diabetic population here.

    In either case, you’ve so skillfully mastered the role of the Devil’s Advocate that you might consider starting a blog of your own. Really. You could call it “Diabetic Devil’s Advocate.” Kind of catchy, don’t you think? :)

  17. Vicki
    Vicki December 27, 2006 at 8:33 pm | | Reply

    I work for a hospital system, and when I was diagnosed with type 1 LADA 9 years ago there was another type 1 diabetic in my office who was really supportive. At the same time my supervisor was also diagnosed with type 2. Odd coincidence. There were no secrets about our diagnoses.

    No one I know who works for this hospital system has ever been discriminated against for having diabetes. IMHO, it would be really weird if they did. Oh, and I’ve never ever lost any time from work because of diabetes, either minutes for testing or time off for diabetes-connected illnesses. I got an excellent diabetes education and 9 years down the road, have no diabtees-related complications, either.

    Sad to say, the type 1 who helped me at the beginning of my diabetes career. has since had an amputation and is on dialysis now. I know she didn’t devote as much time and energy to her control as I do, and when we compared A1Cs hers was always a lot higher than mine.

  18. Michael Park
    Michael Park December 27, 2006 at 9:06 pm | | Reply

    Am I to gather from all of this that the entire cost of living with diabetes is covered by an employee’s insurance plan?
    (reminder I am from Canada and don’t understand US health Care).
    In Canada, everyone has the same basic coverage.. and the government seems to be prescribing glucose control ca. 1995 right now… Basic glucose control is covered and most insulins, but no pumping or CGM…

    Another comment, I agree that 5 minutes is excessive for a blood test- if you keep your glucometer with you, definately under a minute. And it shouldn’t be too difficult to multitask – how many times have you tested in your life?!?

    Can’t we all just have better control and avoid the hangups of diabetes?
    While I normally would say that phrase spewing with sarcasm, I think that in light of the world’s state of diabetes, we SHOULD feel more guilt for poor control.
    Those of us in N.A. have access at the very least to testing supplies and insulin. If I were in a developing nation, I would see us as having the tools to produce miracles. I would be disgusted at the idea that someone would let those tools go to waste.
    (I hope this doesn’t offend to many people, keep in mind I’m young and idealistic).

  19. Anne
    Anne December 27, 2006 at 10:09 pm | | Reply

    I think it is imperative that I take care of myself to the best of my ability, and help those around me who are seeking help. I think it is less helpful to judge others for what we perceive as “bad control.” Aside from cases of obvious, gross negligence, we can never know what another diabetic may be facing with respect to diabetes and any other life situation. What may be easy for me may not be so easy for someone else.

  20. Linda Blice
    Linda Blice December 29, 2006 at 1:55 am | | Reply

    I’m a type 1 diabetic, in all my jobs I have ever had I have always been up front about my diabetes and what I require or may need to keep with me in case of a low or a high. Earlier this year I resigned from my position with a major retailer here in the states because I was told I was not as productive as the other people in myposition. After explaining to the manager that Because of my diabetic complications that I have certain ways of doing things to make sure that the information I enter on the computer is accurate (for their benefit) and I could provide them with medical documentation of my limitations if they required it, I was bluntly told thet they did not care what I had to do but I needed to get it “fixed” so that I would be more profitable to them.
    For 28 years I have been living with this disease, To be told after 41/2 years of above standard work that I need to get “it ” fixed was devastating to me. People don’t seem to realize that if there was a magic pill, injection ,or surgery that I would have take that step Years ago?
    I did not choose this disease, but I have to live with it everyday and the consequences and realities of taking care and not taking care of myself can do to me and others around me. It’s very easy for people to criticize, but, with all these companies and businesses traing employees and management people on ethics and harassment and violence in the workplace, would it be to hard for them to have a session on handling workers with a valid medical condition? Whether its diabetes, cancer, mental or physical problems? None of these diseases seem to be going away in the near future, diabetes is increasing in the population, theres more cancer cases and heart disease and alot of other things. we are all still productive to society and can and do contribute valuable work and ideas to the world, companies need to start taking note of this, when that occurs maybe we will not have the worry anymore of will I still have a job or what will happen if I have to take 6 months for chemo or May need a few minutes to get my sugar back to a normal level so that I can perform my job correctly. nobody should have to have the fear in the back of their mind of will my low blood sugar at work cause me to lose my job/ it’s stressful enough living daily with a chronic disease without having to think about the consequences of something that might occur in the workplace.

  21. kassie
    kassie December 29, 2006 at 5:36 pm | | Reply

    How many of us have stopped an entire meeting because we are low? I’ve treated a reaction during a meeting and stepped out to test/treat lows, but I’ve never – in 20 years with diabetes (working full or part time for all of those) caused an entire business to grind to a halt over a low blood sugar. Fran’s comment (and Felix’s second) saddens me because so many of us manage the high maintenance needs of diabetes without interrupting our work day or adversely affecting our employer, it’s quite frustrating to have diabetes characterized as a problem in the workplace.

  22. AmyT
    AmyT December 29, 2006 at 8:58 pm | | Reply

    Thank you, Kassie. My sentiments exactly.

  23. shawn
    shawn December 31, 2006 at 7:00 am | | Reply

    another good artivle on front page of yesterday’s times too

  24. Dennis
    Dennis January 2, 2007 at 4:26 pm | | Reply

    After reading hundreds of comments on this subject.. I think it comes down to :
    A.You either learn to Work With IN the Systm Or
    B. You fight the system and more than likely-cause more damage to yourelf and everyone else

    Knowing your Limitations is The Key and then pursue what Careers you are going to be able to Do.. Not try to force society to change to suit you..

    Fact is? We ( IDDM’s) are a Very Small Minority (less than 1/2% of Population).. and our Disease is Progressive..it will get worse, not better.. this is the #1 issue Employers find out about ( even easier now with the internet)

    Yes, I run my own business, but No I can’t afford to hire a Insulin Diabetic..

    The sooner Parents of T1′s prepare their T1 Child of this, the better they will be able to plan their Life and not go into Shock when an employer tells them no..

    #1 Solution? Become Self Employed, as I did and many other T1′s I grew up with have..( Over 25% of Everyone working in the USA is Self Employed and growing)

    otherwise, work with-in the system, don’t try to be Aggitator..You create more Antimosity than sympathy…

  25. Steve
    Steve January 2, 2007 at 10:41 pm | | Reply

    I’m type 2. My employer is currently undergoing a transition from government to not-for-profit. I’ve always been very open about my diabetes, the various issues that could present, what to do if I pass out, etc. Well, that could bite me in the butt with this transition because now we all have to apply for our jobs in the new organization as if we are applying for a new job. What if the CEO of the new org decides I’m too expensive to keep around. $13,000 isn’t all that high. You have a quarterly blood work, time missed for the doctor appointment, prescriptions for medication, testing strips, meters, etc. Thank goodness I am not on insulin or the pump. My A1c is typically around 6.3, but it has been much higher, never under 6.1. I’ve been on medication for only 4 years. I’ve had a couple times where I’ve been sick, and I’ve had numerous occasions where my blood sugar spikes after lunch and I go to sleep for a while. How much is that work time worth? What about when I need insulin? Or something more serious such as an amputation?

    Think of it this way – I’m able to ask all these questions from a position of knowledge. How much more scary must it be for the CEO who doesn’t know much about our condition? How could they not be concerned about what it costs to keep us on board? Why shouldn’t they think twice about hiring me?

    Of course they do!

    Me? I’d take a disabled label any day. That way it would be much harder to discriminate against me and get away with it. As it is, I feel very vulnerable.

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