Access to Work and Diabetes

Following on from our successful delivery of the previous iteration of Access to Work, 3SC currently work with RBLI on the newest version.

We asked one of our assessors, Rita, to talk a little about the challenges some of our customers living with Diabetes face.

Whilst most adults in the work-place have some awareness of diabetes there is less understanding of associated life-changing consequences.

One reason for this is that diabetes simply does not fit neatly into any one box: within the two identified types (Type 1 and Type 2) there lies a continuum of symptoms affected by various factors over time. A feature of diabetes is its uniqueness to the individual and its long-term nature.

What is Diabetes?

Normally the pancreas organ produces the hormone insulin which allows glucose to exit the blood stream into body cells where it can be used as energy (metabolism) or stored as fat. In short, diabetes is a disease where insufficient insulin results in abnormal metabolism. The glucose is not converted into energy, it stays in the blood.

Whilst both type 1 and type 2 diabetes are characterised by having higher than normal blood sugar levels, the cause and development of the conditions are different.

Type 1 Diabetes in the past was categorised exclusively by an early onset of impaired insulin production and early dependency upon synthetic insulin. This is less so now with some people presenting with Type 1 at age 40. There is no strong obesity link and insulin has to be injected or pumped directly into the body.

Management of blood sugars can be complicated for the Type 1 diabetic with extreme reactions to change including changes in the work-place. Indeed a period of early trauma can often be linked with Type 1.

Type 2  Diabetes covers 90% of the diabetic populace and has been associated with a later onset. Here the cells themselves have in most cases become misshapen or over-weight and the insulin can no longer access the cells. This is referred to as “insulin resistance”. There is an association with excess body weight and can be treated without regular medication. Moreover, there are many cases of people prescribed medication coming off the medication altogether.

Hyperglycaemia (high blood sugars) occurs when people with diabetes have too much sugar in their bloodstream. This can be caused by too little insulin, consuming foods of high glycaemic index, illness and stress.

Hypoglycaemia (low blood sugars) occurs when people with diabetes have too little sugar in their bloodstream. This is usually caused by too much insulin, metabolism changes or increased activity.

Visual Impairment:

Diabetes is the leading cause of blindness in the UK, mainly due to ‘Diabetes Retinopathy’ (high blood sugars causing damage to the retina at the back of the eye). Diabetics are regularly screened for Retinopathy as vision can deteriorate over a 12 month period. Also, it is possible for a sudden onset of high blood glucose to effect an instant reduction in vision which in the work-place will have repercussions.

Diabetes over time and unchecked causes the actual shape of the lens to change, hence causing blurred vision and a lack of focus. Regular, twelve monthly checks eye tests are essential.

Physical impairment:

Peripheral Neuropathy, nerve-end damage occurs in the hands, feet and arms. This is common in diabetics especially among those with poor long-term blood sugar control.

In the office some of the adjustments required are perhaps more obvious: footrests, ergo rests, pen grips. Looking at the wider working environment employees may be required to climb ladders/stairs and work in unsuitable temperatures escalating numbness (with cold) or swelling (if too warm).


Diabetes can be seen as an impairment of the energy system: the body simply cannot convert its resources into usable fuel.

Hyperglycaemia can cause tiredness and fatigue, lack of concentration and listlessness. Clients could benefit from training and strategies to aid their concentration during these times.

Mental Health

Diabetes can be very complex to manage and people with diabetes are constantly monitoring their food and life style and often feel judged. This can lead to feelings of anger, frustration and depression.

Type 2 diabetics in particular often feel responsible for their conditions and are aware of the Stigma around so it is important that as assessors we show compassion and are non-judgemental.

It is also important to note that Stress naturally increases the amount of glucose entering the blood stream. This is usually to help the individual cope in a ‘fight or flight’ situation but for Diabetics this can have a detrimental effect on their physical body due to the long term consequences of Hyperglycaemia.

People with Diabetes could benefit from talking therapies or groups and may be taking medication to help them cope with their issues. Mindfulness can be helpful for individuals would find it difficult to manage stress in the moment; putting situations into perspective and not ‘taking the problem on board’.