When an employee with diabetes is working in a safety-sensitive role experiences severely low blood sugar, what are the ramifications for employers?
This question was addressed at Benefits Canada’s 2019 Chronic Disease at Work conference in Toronto in June. “For you, as an employer, what if this was your employee on their way to meet a client? What would that mean to you as a company?” asked Suzanne Lepage, a private health plan strategist, speaking about a case study where a person with type 1 diabetes lost consciousness behind the wheel due to low blood sugar and killed three people.
While the definition of type 1 diabetes sounds concise — the pancreas doesn’t produce insulin — the disease is anything but, said Lisa Geelen, a type 1 diabetes caregiver who also spoke during the event.
When insulin is injected into the body, it has to be balanced out with carbohydrates and exercise. This is called the diabetes triangle, said Geelen. But other elements have to be factored into achieving target blood levels, including stress, sickness, weather changes, hormones and the glycemic index in food. “It’s nearly impossible to be in that target, safe zone,” she said. “Diabetes is more of an art than a science to manage.”
People who are insulin-dependent are also at risk of hypoglycemia, a low blood sugar emergency that can lead to confusion, disorientation, loss of consciousness, seizure, coma or even death. People with diabetes on medication have an average of 2.4 to 2.5 severe hypoglycemic events annually, said Dr. Donna Mojdami, clinical research physician and endocrinologist, who also spoke at the event.
“Hypoglycemia costs an average of $815.22 per patient per year because of reduced workplace productivity, but this statistic doesn’t account for the impact on caregivers,” she said.
In a study highlighted by Lepage, 18 per cent of individuals who experienced a hypoglycemic event at work left early or missed a full day, resulting in 9.9 hours of lost work per month. For those who had a nocturnal hypoglycemic event, 23 per cent of individuals arrived late or missed a full work day, resulting in 14.7 hours of lost work per month.
Indeed, presenteeism is an issue that merits more discussion, as employees experiencing hypoglycemia may be physically present in their workplaces, but not necessarily working at full capacity.
Continuous glucose monitoring can reduce the risk of hypoglycemic events by 72 per cent, said Lepage, and reduction of these incidents can result in decreased absenteeism and increased productivity. CGM minimizes the fear of hypoglycemia by improving diabetes management since the devices have alarms that function, day or night, to warn patients of dangerous glucose levels, she added.
“For people on insulin, where the risk of hypoglycemia is a daily fear, this matters in order to make proper dosing decisions to get glucose levels back to a normal range.”