Type 1 diabetes must be managed around-the-clock, but many people, especially young people, tell us that they keep their diabetes to themselves at work. Generally, it’s up to you whether you disclose your diabetes, although if your diabetes affects your ability to do inherent aspects of the job, your safety at work, or if it could put the safety of co-workers at risk, then it is advisable to tell your workplace about it. Going beyond simply disclosing diabetes and having a more in-depth conversation about type 1 with your manager and co-workers can be a positive and valuable experience. If you decide to open up, be ready for people to say 'Wow, I had no idea you had to do that' - because talking about type 1 not only gives your colleagues the information they need to best support you, it also helps them to understand that living with diabetes requires tenacity, adaptability and resilience, which are immensely valuable qualities in any workplace.
It can be hard to find the right words to talk type 1. This Clinic Chat suggests some ways to approach talking about diabetes with your co-workers with some short scripts to help frame your conversations, capturing the details they need to know. Of course, it’s important to read the room and adjust what information you give your teammates, so that it’s both right for your workplace and comfortable for you – so take the scripts below and adjust them to suit your needs.
Type 1 basics: How to explain type 1 diabetes to your workmates
Firstly, no, you can’t catch it and no, I did not eat too much sugar as a child! Type 1 diabetes cannot be prevented and does not have a cure. I was born with genes that meant I could develop type 1 at some stage in my life. When I was [insert your age at diagnosis] I was exposed to a trigger in my environment that caused my immune system to suddenly destroy the cells in my pancreas that make insulin, leaving me dependent on injected/pumped insulin for the rest of my life. There are 125,000 people in Australia with type 1. It’s usually diagnosed in childhood, but it can be diagnosed at any age.
Insulin has a number of crucial jobs in the body, including metabolising the carbohydrates in the food that we eat. The carbohydrates from foods like bread, pasta, rice, fruit and starchy vegetables, as well as sugary and sweet foods, are turned into glucose by the body. Glucose accumulates in the blood, and insulin lowers blood glucose levels by allowing glucose to enter the cells to be used as energy. Without insulin, I can’t use energy from the carbohydrates I eat and the amount of glucose in my blood becomes unregulated. I also need to have insulin in my system even when I’m not eating, because it does other things in the background, like deal with the glucose my liver produces.
High blood glucose levels are dangerous, and over time can damage the body – especially the blood vessels in the eyes, the kidneys and nerves. Low blood glucose levels are also dangerous – they make me feel weak, shaky and confused, and can lead to unconsciousness if I don’t bring my glucose levels back up quickly by eating something sugary.
I need to try and keep my levels in a certain range, which is [insert your target range here]. This keeps me safe and healthy.
Optional extra point: It can be challenging to stay in range, because calculating my insulin doses is complicated. I need to be able to match how much insulin I take to the number of grams of carbohydrate I am about to eat, along with a number of other factors that influence my blood glucose levels, including how physically active I have been or am about to be, and how much protein and fat is also in my meal. In fact, 42 factors have been identified that impact blood glucose levels – can you do an equation with 42 factors? Probably not. I’m pretty good at the calculations, but it’s almost impossible to get it right all the time.
Insulin
Pumps: I give myself insulin via an insulin pump, which is a small device that is attached to me 24/7. It slowly drip feeds me insulin all the time. When I eat, I need deliver extra insulin to deal with the carbohydrates in the food, which is called a ‘bolus’. Pumps don’t ‘automate’ diabetes – I still have to adjust my insulin myself if I’m about to eat or exercise, so I'm still managing the mental load all day.
Injections: I give myself insulin using injections through an insulin pen/syringe. I need a long-acting insulin once or twice a day which provides me with the background insulin I need, and when I eat, I need to take a rapid-acting insulin for the carbohydrates. This means I might take up to [your number of injections] every day. Those jokes about me being a druggie because I use a needle? I’ve heard them all before - if someone you know makes one, tell them it's not cool on my behalf.
Blood glucose monitoring
With a meter: I need to test my blood glucose levels several times each day, which I do using a blood glucose meter. I prick my finger for a drop of blood and test it with the meter. I will need to do this before I eat, and at other times throughout the day to check my levels.
With CGM/Libre: My CGM/Libre is a device that shows me what my blood glucose levels are by sending information from a sensor that is inserted under my skin. The CGM/Libre tells me what my current glucose level is, and if it is heading up or down, which can help me act quickly to head off an impending low or high blood glucose level. CGM technology has real value but is not affordable for many people – it costs/will cost me [x] per year. I use it because I need it to optimise my health.
Low Blood Glucose – Hypoglycaemia
Low blood glucose happens if I take too much insulin. It can also happen if I’m physically active, because exercise uses up glucose from the blood, so I need to manage exercise carefully. I call having low blood glucose ‘having a hypo’ or ‘going low’. I am low when my level is below [your low threshold].
Mild hypos: The majority of the time I will notice that my blood glucose level is low because I feel shaky, sweaty, and weak [or your hypo symptoms]. I need something sugary to eat or drink to bring my level back up into range - I usually use [your usual hypo treatment]. If I ask you to get me something, sweet things like soft drink (not diet), juice, or lollies are what I need.
Severe hypos: It is possible – although very rare – that I may not feel my blood glucose falling if it drops very quickly. In this case, I may become disorientated or even pass out. This is when I will need your help.
If I am responsive, help me to test and get something sugary for me to eat or drink. Make sure I consume it, and stay with me until I am ok and my glucose level is above 4mmol/L on my meter.
If I am unconscious, call an ambulance straight away, and follow the usual first aid procedures for an unresponsive person.
Optional extra point if you want your workplace to learn about glucagon: If I am unconscious from low blood glucose, an injection of glucagon will raise my glucose levels rapidly. Call the ambulance first, and then grab my orange glucagon pen from [where it is stored]. I know it looks like a big needle, but it’s not hard to administer and it could really help me if you learn how. This is how you use it [demo glucagon injection].
High Blood Sugars – Hyperglycaemia
Sometimes my blood sugar runs higher than it should, which is caused by not having enough insulin in my system. This can be caused by missing an insulin injection, sickness, or even stress. When my blood glucose level is high it makes me feel [your hyper symptoms].
High blood glucose needs to be acted on, but not generally with the same level of urgency as low blood glucose. I'll need to take some extra insulin and my blood glucose will usually come down over a few hours - I can manage this on my own. However, if my levels stay high for more than a few hours, I may need medical attention.
Colds, flu, gastro and other bug may cause my levels to run high. If you send me home from work because I'm not well, it's important that a friend or family member knows to check in on me.
Healthcare appointments
Having type 1 diabetes is like having another full time job. To stay as healthy as possible, I need scheduled visits with my [healthcare providers]. I appreciate your support and flexibility with this.
Food
Dietary strategies for type 1 management can differ immensely from person to person. Here are some options to consider:
I eat what I choose just like you do, only I need to take insulin to cover the carbohydrates. I’m happy with my diet and management strategy, and I don’t want or need special food at work events.
OR
I choose a [low-carb/vegetarian/other approach] because I have found eating that way helps me manage my diabetes more effectively. I’d appreciate being given options around food choices at work events to fit in with my food preferences.
No matter what, you might like to consider also saying:
It doesn't feel great when people question whether I should be eating something. I have to carefully consider all my decisions around food and I can assure you, if I decide to eat something, I've thought about it!
After work drinks/work trips/team sports
Type 1 diabetes doesn’t stop me from doing anything! It helps to know about social or sporting events in advance so I can get my ducks in a row, but I love a night out or a casual netball/basketball game after work just like anyone else.
Conclusion
We hope some of these short scripts can help guide a conversation or two at work, because everyone deserves to feel safe and confident in the workplace, especially you. If you want to learn more about diabetes and your rights as an employee, here’s a great resource to read from Diabetes Victoria. Got questions or a specific workplace issue to discuss? The Family Centre team and our online communities are always here to help.