Chapter 19

Knowing Your Rights

IN THIS CHAPTER

check Managing diabetes in the workplace

check Looking out for your child with diabetes at school

check Keeping an eye on your health while on vacation

check Staying safe on the road

You may spend a big chunk of your day at work, or your child may spend most of her days at school. So, it’s important to consider diabetes management in these situations and make sure you create the best environment for success. You have certain rights as a person with diabetes, and we detail them in this chapter. We also talk about how to keep those rights in mind when starting a new job, telling your co-workers or boss about your diabetes, or designing a safe and successful learning plan for your child with diabetes.

Travel is another activity that you can plan for in terms of your diabetes supplies, medications, and management of your blood glucose. In this chapter, find out about Transportation Security Administration (TSA) regulations, as well as tips for taking road trips or other types of vacations.

remember The American Diabetes Association is dedicated to helping you understand and advocate for your rights as a person with diabetes. People with diabetes have many legal protections, but there is still more work to be done. Keep in mind that ignorance may be one of the most common affronts you experience as a person with diabetes or as a parent of a child with diabetes. Knowing your rights can help you navigate (and perhaps defuse) these situations so you can educate other people about diabetes and, ultimately, create a successful work or learning environment. It’s not always easy or fair to have a chronic condition such as diabetes. We have tips to help you manage your diabetes and talk to others about it — whether you’re on the job, in school, or at the airport.

Diabetes in the Workplace

Whether you’re starting a new job or you’ve been at your company for years, you’ll want to consider your diabetes management at your workplace. Some things to think about include who (if anyone) to tell about your diabetes and how to communicate and educate others. You’ll want to know your rights and responsibilities as someone with diabetes.

Deciding whether to tell others

Your first question about diabetes at work is probably: Should I tell anyone? Well, it’s generally up to you.

You may want to tell people about your diabetes for various reasons. For example, you may have a rigorous job that makes it difficult to take sudden breaks for blood glucose checks or to give an insulin injection. Telling your co-workers and boss could make those self-care breaks go more smoothly. Or you may be concerned about low blood glucose emergencies. In this case, you can tell co-workers how to help in an emergency if they volunteer, including information about where you keep your glucagon and the importance of calling 911.

Some people with diabetes don’t feel comfortable sharing personal information about their health. Others may work from home or have a flexible environment that makes self-care more private and relaxed.

tip Sometimes a potential employer will make a conditional job offer that requires the employee to complete a pre-employment physical. In this situation, you’d be required to disclose that you have diabetes. And the employer could withdraw the offer if you don’t comply. It’s important to note that an employer may not request any disability-related information or give any medical examinations prior to making a job offer to the applicant.

Talking about your diabetes in the workplace really is a personal decision that’s up to you. In the following section, find out about your rights so you can make an informed decision about talking about diabetes on the job.

Knowing your rights

People with diabetes are protected against discrimination by disability laws. It may seem strange to think of yourself as someone with a disability, but your diabetes is a disability because it limits the endocrine system. You probably manage your diabetes with medications or lifestyle changes or both. However, your diabetes still qualifies as a disability because the law considers how a person would be if he stopped managing or treating his diabetes.

Several federal, state, and local laws protect people with disabilities, including people with diabetes. Usually federal and state protections are similar, but in states where disability laws are stronger, those state protections supersede any federal protections. And in states where the federal law is stronger than the state law, the federal law applies. Call 800-DIABETES (800-342-2383) for more information on your state’s anti-discrimination laws.

Here’s a rundown of the federal anti-discrimination laws you should be aware of:

  • Americans with Disabilities Act: Protects employees against discrimination by private employers, labor unions, employment agencies, and state and local governments.
  • Rehabilitation Act of 1973: Protects employees against discrimination in federal employment, and in the employment practices of federal contractors and employers that receive federal money.
  • Americans with Disabilities Act Amendments Act of 2008: Amends the Americans with Disabilities Act and the Rehabilitation Act of 1973 by expanding the definition of the term disability, making it clear that people with diabetes are protected from discrimination in the workplace.
  • Congressional Accountability Act: Protects employees of Congress and its Legislative Branch agencies.

remember The Family Medical Leave Act (FMLA) allows you up to 12 weeks of time off work (unpaid) to care for your own serious health condition, such as diabetes, or to care for a family member with diabetes. You can take this leave in small blocks of time such as 1-hour increments.

Not all employers are covered under the FMLA. The act applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees. Also, it can only be used to care for an immediate family member (spouse, child, or parent).

What are my protections?

Under disability laws (see the preceding section), your employer can’t discriminate against you because of your diabetes. You may experience discrimination in any number of circumstances such as hiring, while on the job, in training, promotions, tenure, and leaves of absence. If you have questions or think you may have experienced discrimination, call the American Diabetes Association at 800-DIABETES (800-342-2383). The American Diabetes Association can provide information and assistance to better understand your rights.

remember Some key protections under the law:

  • Your employer can’t refuse to hire or promote you because of your diabetes.
  • Your employer can’t fire you because of your diabetes unless you pose a “direct threat” or can no longer perform the essential functions of your job with reasonable accommodations.
  • Your employer must provide reasonable accommodations that help you perform the essential functions of the job.
  • Your employer must not discriminate against you for health insurance offered in the workplace because of your diabetes.

tip For more specifics about these protections, visit www.diabetes.org or call the American Diabetes Association advocacy team at 800-DIABETES (800-342-2383).

Educating and communicating with others

If you decide to tell others about your diabetes, take a moment beforehand to think about what you want to say. You may want to be fairly succinct and straightforward, telling people that you have diabetes and that you manage it on your own. However, in an emergency during hypoglycemia, you may need their help finding your glucagon or calling 911.

tip Check out the Centers for Disease Control and Prevention’s program Diabetes at Work by visiting www.cdc.gov/diabetes/diabetesatwork. It has resources about the prevention and management of diabetes in the workplace, including wellness programs, fact sheets, and best practices for helping employees manage their diabetes at work.

tip Consider keeping an extra supply of glucagon at your desk or workplace so you’ll have it on hand if you have a low.

Staying healthy on the job

Many companies now offer wellness programs for employees, so take advantage of these benefits. Your employer may offer discounts for gym memberships or offer in-house exercise programs such as yoga classes. Some health insurance plans reward policyholders for exercise if they meet fitness goals while wearing their fitness trackers.

Stress is an all too common component of the workplace, and stress can affect blood glucose. Check your blood glucose if you’re concerned about it for any reason, and keep in mind that your mental health is important on the job, too. Check out Chapter 14 for more strategies to manage stress.

If you have a desk job, remember to stand up and take breaks throughout the day. The American Diabetes Association recommends that people with type 2 diabetes get up every 30 minutes for 3–4 minutes of activity such as arm stretches or walking in place. Take a walk down the hall, or better yet, take the stairs down and walk around the building before taking the stairs back up to your desk. (Flip to Chapter 13 for more information about sitting less and moving more.)

Your Child with Diabetes at School

Your child will spend the majority of her day at school, so you’ll need to work together with school administrators, the school nurse, and other school staff to ensure he is safe and successful. Your school may not be familiar with caring for and supporting preteens and teens with type 2 diabetes. After all, the increase of type 2 diabetes in young people is a fairly recent health concern. Don’t be discouraged. Take the opportunity to educate others about diabetes and advocate for your child. He may need special accommodations during the school day so he can be a safe, healthy, and successful student.

Knowing and advocating for your child’s rights

Children with diabetes are protected against discrimination by disability laws. It may be hard to think of your child as having a disability, but diabetes is a disability because it limits the function of the endocrine system. Students with diabetes have the right to enroll and participate in school just like any other students. They have the right to take care of their diabetes and be safe, as well as have the opportunity to learn.

Federal laws protect children with diabetes at school, and some state laws give further protections and clarification about which school staff are allowed to provide diabetes care. Go to www.diabetes.org/kidswin to find specific information on your state’s laws and read on for information on federal laws.

Section 504 of the federal Rehabilitation Act of 1973 is a federal anti-discrimination law that protects children in public schools and private and religious schools that receive federal funding. It requires schools to provide needed diabetes care and services and to treat children with diabetes fairly, so they may participate in all school-sponsored activities. Students who are able to self-manage should be allowed to do so anywhere, anytime. Having written accommodations plans like a 504 Plan helps ensure that your child’s diabetes needs are met in school (see the following section for details on 504 Plans).

The Americans with Disabilities Act also protects people with disabilities such as diabetes, and applies to public schools, private schools, camps, and other programs (except those run by religious institutions).

The Individuals with Disabilities Education Act is another federal law that gives states money to help provide education and services for children with disabilities like diabetes. Children whose diabetes or other disability interferes with learning and academic progress are eligible for services under this law.

remember The FMLA allows you up to 12 weeks of time off work (unpaid) to care for an immediate family member such as a child with diabetes, if your employer is a public entity or has 50 or more employees. For example, you could take this time to respond to a diabetes-related emergency at school or if your child is newly diagnosed or hospitalized. You can take this leave in small blocks of time, even as small as 1-hour increments.

Putting care plans in writing

A Diabetes Medical Management Plan (DMMP) can help your child receive the care she needs at school or camp. You work with your doctor to detail your child’s diabetes care needs at school, such as times to check blood glucose, following a diabetes meal plan, physical activity, and how to handle emergencies.

tip Templates for a DMMP can be found online at www.diabetes.org/dmmp, but your child’s provider may need to tweak it based on your child’s specific needs and health.

A written accommodations plan, like a 504 Plan, is different. It details how your child can stay safe by receiving needed care, self-managing his diabetes, and participating fully in school. It may include provisions such as permission to make extra trips to the bathroom or offering non-food rewards and providing healthy foods for class parties. It may outline training for staff to understand diabetes. It may set aside alternate arrangements for making up missed assignments and exams, time missed for medical appointments, or other issues related to diabetes. You can find sample 504 Plans online at www.diabetes.org/504plan.

tip Educate yourself before you take action. Visit www.diabetes.org/safeatschool or call 800-DIABETES (800-342-2383) to find out more about your child’s rights at school and how to make sure your child gets needed care at school.

Planning Ahead for Travel

Your diabetes shouldn’t slow you down from traveling, whether you’re off for a long weekend or a month-long European vacation. You’ll want to plan ahead by talking to your physician, bringing extra medication, preparing for airport security if needed, and thinking about snacks and meals.

Talking to your physician

If you’re planning a longer vacation, talk to your healthcare provider about what you’ll need to take care of your diabetes while you’re away from home. Ask about precautions to take before you leave or considerations while you’re on your trip.

Your physician may recommend that you bring extra medication on your travels. Determine whether you have enough or whether you’ll need new prescriptions before you hit the road.

remember If you use insulin, you’ll want to plan ahead for how you’ll store your insulin safely and in a cool place during your travels. Also, plan ahead for a portable way to dispose of syringes. You can find handy insulin storage and syringe disposal tools online.

Preparing for airport security

Going through security at the airport is sometimes a hassle, but it shouldn’t be more of a hassle because of diabetes. Here’s the skinny on how to get through the checkpoint with minimal hiccups.

The American Diabetes Association works with the Transportation Security Administration (TSA) to make sure people with diabetes have access to their supplies and equipment as they go through security checkpoints and board their plane. It’s always a good idea to arrive 2–3 hours early, pack diabetes supplies and medication in a clear plastic bag, and make sure to bring extra supplies. Most people can bring 3.4 ounces or less of liquids through security. However, people with diabetes can exceed those limits with medications, including insulin and glucagon, or drinks for treating a low such as juice.

remember If you use insulin, take it through security instead of placing it in your checked bag where it’s subject to extreme temperatures and pressure (and could get delayed or lost if your bag doesn’t end up in the same place you do).

tip TSA Cares is a helpline designed to assist travelers with disabilities like diabetes. Travelers seeking assistance should call 855-787-2227 at least 72 hours in advance. An optional Disability Notification Card, which you can print out online at www.tsa.com is a quick (and discreet) way to inform screeners about your diabetes. More information can be found at www.diabetes.org/airtravel.

Considering snacks and meals out

Your travel may put you on a different meal schedule than normal, so you may want to pack snacks to avoid low blood glucose. Raisins, energy bars, or glucose tablets are easy to have on hand.

You may also eat out more if you’re on the road, and eating healthy foods may be more challenging because you’re not cooking in your own kitchen. Think ahead about healthy options such as a simple breakfast in your hotel room or fast-food restaurants that offer nutritious, low-sodium meals. (See Chapter 12 for more tips on eating out.)

tip You may want to check your blood glucose more often when you’re on vacation if you’re on an irregular eating schedule or you’re more active than usual.

Taking care of your feet and skin

Pay attention to your feet when you’re on vacation to prevent problems that could interfere later in the trip or when you return home. Your feet may swell when you fly, and compression socks can help. You may walk more than usual on vacation (a great thing!), so pack comfortable shoes and breathable socks. If you have foot problems, try not to go barefoot on the sand or riverbank. Hot sand, shells on the beach, or other sharp debris can create small cuts that may be hard to feel if you have neuropathy or may take a long time to heal. Instead, buy a pair of comfortable waterproof sandals or shoes.

Wear sunscreen and put on a hat if you’re traveling someplace sunny or at high elevation. Cracked or peeling skin may become infected, so it’s best to prevent sunburns in the first place. Also, some diabetes medications such as glipizide and glyburide can make you more sensitive to the sun. The sun’s rays can be powerful, and it’s easy to forget to reapply sunscreen if you haven’t been at the beach for a while.

Ensuring Safety while Driving

Generally, people with diabetes aren’t restricted when driving or getting a private driver’s license. There may be some restrictions for obtaining a commercial driver’s license. All states have special licensing rules about medical conditions. Some states apply these rules to all drivers with diabetes. Others apply them only to people with certain medications or symptoms (insulin use, loss of consciousness, low blood glucose, seizures, foot problems such as neuropathy, and vision problems such as retinopathy).

Follow the same safety guidelines as others when driving your car, such as not drinking alcohol or using drugs while driving. Consider your blood glucose if you’re feeling low or experiencing more lows than usual. Carry your blood glucose meter and glucose tablets or gels. Be aware of warning signs of low blood glucose (see Chapter 8), and pull over if you feel a low coming on.

Some people with diabetes may have complications such as vision problems or sensation problems related to nerves or blood vessels in their hands or feet. Talk with your healthcare provider about whether these complications may affect your driving, and ask for a referral to a driving specialist who can evaluate your driving.