Accommodating Employees with Diabetes

Accommodating Employees with Diabetes

The ADA requires employers to provide adjustments or modifications to enable people with disabilities to enjoy equal employment opportunities unless doing so would be an undue hardship (i.e., a significant difficulty or expense). Accommodations vary depending on the needs of the individual with a disability. Not all employees with diabetes will need an accommodation or require the same accommodation.

1. What types of reasonable accommodations may employees with diabetes need?

Some employees may need one or more of the following accommodations:

  • A private area to test blood sugar levels or to take insulin
  • A place to rest until blood sugar levels become normal
  • Breaks to eat or drink, take medication, or test blood sugar levels

Example: A manufacturing plant requires employees to work an eight-hour shift with just a one-hour break for lunch. An employee with diabetes needs to eat something several times a day to keep his blood sugar levels from dropping too low. Absent undue hardship, the employer could accommodate the employee by allowing him to take two 15-minute breaks each day and letting him make up the time by coming to work 15 minutes earlier and staying 15 minutes later.

  • Leave for treatment, recuperation, or training on managing diabetes
  • Modified work schedule or shift change
  • Example: A nurse with insulin-treated diabetes rotated from working the 6 a.m. to 2 p.m. shift to the midnight to 8 a.m. shift. Her doctor wrote a note indicating that interferences in the nurse's sleep, eating routine, and schedule of insulin shots were making it difficult for her to manage her diabetes. Her employer eliminated her midnight rotation.

  • Allowing a person with diabetic neuropathy (a nerve disorder caused by diabetes) to use a stool

Although these are some examples of the types of accommodations commonly requested by employees with diabetes, other employees may need different changes or adjustments. Employers should ask the particular employee requesting an accommodation because of his diabetes what he needs that will help him do his job. There also are extensive public and private resources to help employers identify reasonable accommodations. For example, the website for the Job Accommodation Network provides information about many types of accommodations for employees with diabetes.

2. How does an employee with diabetes request a reasonable accommodation?

There are no "magic words" that a person has to use when requesting a reasonable accommodation. A person simply has to tell the employer that she needs an adjustment or change at work because of her diabetes.

Example: A custodian tells his supervisor that he recently has been diagnosed with diabetes and needs three days off to attend a class on how to manage the condition. This is a request for reasonable accommodation.

A request for a reasonable accommodation also can come from a family member, friend, health professional, or other representative on behalf of a person with diabetes. If the employer does not already know that an employee has diabetes, the employer can ask the employee for verification from a health care professional.

3. Does an employer have to grant every request for a reasonable accommodation?

No. An employer does not have to provide a reasonable accommodation if doing so will be an undue hardship. Undue hardship means that providing the reasonable accommodation would result in significant difficulty or expense. If a requested accommodation is too difficult or expensive, an employer still would be required to determine whether there is another easier or less costly accommodation that would meet the employee's needs.

4. Is it a reasonable accommodation for an employer to make sure that an employee regularly checks her blood sugar levels and eats or takes insulin as prescribed?

No. Employers have no obligation to monitor an employee to make sure that she is keeping her diabetes under control. It may be a form of reasonable accommodation, however, to allow an employee sufficient breaks to check her blood sugar levels, eat a snack, or take medication.

Dealing with Safety Concerns on the Job

When it comes to safety concerns, an employer should be careful not to act on the basis of myths, fears, or stereotypes about diabetes. Instead, the employer should evaluate each individual on her skills, knowledge, experience, and how having diabetes affects her. In other words, an employer should determine whether a specific applicant or employee would pose a "direct threat" or significant risk of substantial harm to himself or others that cannot be reduced or eliminated through reasonable accommodation.

This assessment must be based on objective, factual evidence, including the best recent medical evidence and advances to treat and control diabetes.

5. May an employer ask an employee questions about his diabetes or send him for a medical exam if it has safety concerns?

An employer may ask an employee about his diabetes when it has a reason to believe that the employee may pose a "direct threat" to himself or others. An employer should make sure that its safety concerns are based on objective evidence and not general assumptions.

Example: An ironworker works at construction sites hoisting iron beams weighing several tons. A rigger on the ground helps him load the beams, and several other workers help him to position them. During a break, the supervisor becomes concerned because the ironworker is sweating and shaking. The employee explains that he has diabetes and that his blood sugar has dropped too low. The supervisor may require the ironworker to have a medical exam or submit documentation from his doctor indicating that he can safely perform his job.

Example: The owner of a daycare center knows that one of her teachers has diabetes. She becomes concerned that the teacher might lapse into a coma when she sees the teacher eat a piece of cake at a child's birthday party. Although many people believe that individuals with diabetes should never eat sugar or sweets, this is a myth. The owner, therefore, cannot ask the teacher any questions about her diabetes because she does not have a reasonable belief, based on objective evidence, that the teacher is posing a direct threat to the safety of herself or others.

6. May an employer require an employee who has been on leave because of diabetes to submit to a medical exam or provide medical documentation before allowing him to return to work?

Yes, but only if the employer has a reasonable belief that the employee may be unable to perform his job or may pose a direct threat to himself or others. Any inquiries or examination must be limited to obtaining only the information needed to make an assessment of the employee's present ability to safely perform his job.

Example: A telephone repairman had a hypoglycemic episode right before climbing a pole and was unable to do his job. When the repairman explained that he recently had begun a different insulin regime and that his blood sugar levels occasionally dropped too low, his supervisor sent him home. Given the safety risks associated with the repairman's job, his change in medication, and his hypoglycemic reaction, the employer may ask him to submit to a medical exam or provide medical documentation indicating that he can safely perform his job without posing a direct threat before allowing him to return to work.

Example: A filing clerk, who was recently diagnosed with type 2 diabetes, took a week of approved leave to attend a class on diabetes management. Under these circumstances, the employer may not require the clerk to have a medical exam or provide medical documentation before allowing her to return to work because there is no indication that the employee's diabetes will prevent her from doing her job or will pose a direct threat.

7. What should an employer do when another federal law prohibits it from hiring anyone who takes insulin?

If a federal law prohibits an employer from hiring a person who takes insulin, the employer would not be liable under the ADA. The employer should be certain, however, that compliance with the law actually is required, not voluntary. The employer also should be sure that the law does not contain any exceptions or waivers. For example, the Department of Transportation has issued exemptions to certain insulin-treated diabetic drivers of commercial motor vehicles.

Excerpted and Adapted from the EEOC Fact Sheet: The Americans with Disabilities Act and Diabetes by the U.S. Equal Employment Opportunity Commission.

Reviewed by Francine Kaufman, MD. 4/08

Last Modified Date: November 28, 2012

All content on is created and reviewed in compliance with our editorial policy.

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