Type 2, Occupational Health, and reasonable adjustments

[Amyfaith]

Hi all, long time no see (been busy, lemme tell you). Just had a fascinatingly straight-forward conversation with my line manager regarding diabetic-related reasonable adjustments without even having to go to OH. I asked for a timetable change so I wasn't teaching 12-3 with no break for lunch and they were immediately like 'yep, that's bonkers, you need to be able to eat at consistent times. If Timetabling has an issue, then tough for them'. And just - I didn't expect the blood sugar fairy to bequeath the ability to override the timetabling team, but she has. The bonuses are rare, but they're there!

Any other suggestions for useful reasonable adjustments? I'm an academic and diet/exercise managed (and in remission), and my GP is on campus so I don't need a lot of time off for any check ups, so it's really just being sure I can get food in me at predictable intervals (dashing across campus for teaching sessions takes care of the exercise). But if anyone has anything useful they've requested, particularly with office-based jobs, or if there's a sort of 'master list' of ideas somewhere, that'd be super helpful for myself, and probably loads of others.

 

[Leadinglights]

I was in technician and skills demonstrator so the day was often 8am for preparation work then in the lab for 3 sessions ending at 6pm with clearing up after and I just grabbed a few minutes at some point for a drink but I never even thought of asking for any specific time for lunch. Things varied so much from day to day.
Good that you have a supportive manager.

 

[Amyfaith]

I was in technician and skills demonstrator so the day was often 8am for preparation work then in the lab for 3 sessions ending at 6pm with clearing up after and I just grabbed a few minutes at some point for a drink but I never even thought of asking for any specific time for lunch. Things varied so much from day to day.
Good that you have a supportive manager.

It helps that the slot that they popped this seminar in also shouldn’t exist, I think! (We have specific slots for types of sessions - so a three hour seminar ought to be either 9-12 or 2-5, so not sure what happened here). I can’t imagine teaching 8-6 without a break, though, even in the Before Times. I did that sort of shift when I worked retail, but despite being an indoor job with no heavy lifting, academic work is exhausting in a very different way and I’d need a day to recover from 10 hours of teaching! I think my max in a row is 5, and that was ill-advised and only done as I was precarious and hourly paid at the time and had no clout to use. (Note for non academic types - this is just ‘contact time’, eg lectures/seminars. I work 8-9 and sometimes 12 hour days like your normal person; my job is more than teaching.)

 

[Lucyr]

I asked for a timetable change so I wasn't teaching 12-3 with no break for lunch and they were immediately like 'yep, that's bonkers, you need to be able to eat at consistent times.

Why do you need to eat at consistent times? Diabetes shouldn’t require that. If it’s because you’re on mixed insulin ask for a change to basal bolus and get flexibility back in your life. You say you’re diet managed though so there should be absolutely no requirement to eat at set times. Even things like deliberately intermittent fasting should be fine with diet managed type 2.

Any other suggestions for useful reasonable adjustments? I'm an academic and diet/exercise managed (and in remission), and my GP is on campus so I don't need a lot of time off for any check ups, so it's really just being sure I can get food in me at predictable intervals

Why would you need to eat at predictable times? I can’t imagine why you would need any reasonable adjustments at all other than adjusting hours to fit in annual diabetes check if needed?

 

[JimmyBlue]

@Lucyr it often depends on the individual and type of diabetes. I am also type 2 and try to eat every 3 to 4 hours. The following is a summary from a Mayo clinic report on diabetes type 2 eating habits:

people with type 2 diabetes generally need to eat regularly, ideally at consistent times throughout the day. This helps maintain stable blood sugar levels and prevents dangerous fluctuations. Eating at regular intervals is also important for managing hunger and avoiding overeating later in the day.

Snacking can mean that the body is pushing out BG all the time and therefore managing hunger is key step in reducing snacks.

 

[Amyfaith]

@Lucyr it often depends on the individual and type of diabetes. I am also type 2 and try to eat every 3 to 4 hours. The following is a summary from a Mayo clinic report on diabetes type 2 eating habits:

people with type 2 diabetes generally need to eat regularly, ideally at consistent times throughout the day. This helps maintain stable blood sugar levels and prevents dangerous fluctuations. Eating at regular intervals is also important for managing hunger and avoiding overeating later in the day.

Snacking can mean that the body is pushing out BG all the time and therefore managing hunger is key step in reducing snacks.

This. With the original timetabling, it would involve a very short period between breakfast and lunch of about 3 hours and then a massive gap of about 8 hours between lunch and dinner, OR a massive gap between breakfast and lunch and a tiny one between lunch and dinner (I’d be unlikely to actually get to eating lunch till almost 4 if I ate after). Type two is easier to regulate with consistent mealtimes even if you’re just diet controlled - gives things time to come down a bit if you can space meals out reasonably well.

 

[Amyfaith]

Also, at least for me, consistency across all days is important. So if on a Monday I’ve got wild gaps between meals and then have a super late dinner and then I have an 8am start on Tuesday (and I do), that would throw me way off. My body has learned the rhythm and the spacing and it seems to manage itself accordingly. (It took me three weeks for fasting numbers to resemble something even close to my normal numbers when I was in the US and five hours behind - my body was chucking out glucose like crazy, and I was eating and moving identically, or near enough.)

 

[silver minion]

@Lucyr I also need to stick to fairly regular meal times to keep my BG levels in a reasonable range. I take my gliclazide morning and evening but if my midday meal is delayed by more than an hour I will drop to below 4mmol/l and need to treat hypo symptoms. Fortunately this doesn't happen very often and I have good hypo awareness without needing a CGM. I would certainly ask for similar adjustments if I was still working and not retired.

 

[Lucyr]

I also need to stick to fairly regular meal times to keep my BG levels in a reasonable range. I take my gliclazide morning and evening but if my midday meal is delayed by more than an hour I will drop to below 4mmol/l and need to treat hypo symptoms.

The OP is diet controlled so this is irrelevant. T2 diet controlled won’t have hypos with a longer gap between meals. The break from digestion is actually good for the body.

 

[Lucyr]

Type two is easier to regulate with consistent mealtimes even if you’re just diet controlled

You say “easier to regulate” but what does that actually mean. What actual blood sugar readings are you getting with different gaps between meals? Bgs under 4 are not dangerous when you aren’t on medication. Spikes can be regulated with the type of food you eat. Unless you’ve got some actual numerical blood sugar evidence of needing this then you’re just making assumptions and not evidence based actual medical needs.

 

[JimmyBlue]

Having consistent meal times helps regulate insulin release in T2D patients. Thus improving their overall BG management, keeping BG levels stable and reducing the risk of high post prandial spikes. The following is a research paper that looked a the frequency of food consumption: Chrono-nutrition for the prevention and treatment of obesity and type 2 diabetes: from mice to men
While T2Ds do have the ability to manage BG through food it is not a guarantee. If I leave it too long between meals (normally > 4 hours) then my BG before dinner will be high 7s or even 8 resulting in a post prandial high of 9-10 and above.
Just because T2Ds don't face the risks of T1D sufferers does not mean that employers should not build in time for us to eat at a reasonable time. Being hungry creates all types of complications from mood issues to increased stress and it is in the employer's interest to ensure that people have the time to eat food in line with their bodily needs. It also reduces the risks for T2Ds of being tempted to snack or over eat come meal times.

 

[Lucyr]

Just because T2Ds don't face the risks of T1D sufferers does not mean that employers should not build in time for us to eat at a reasonable time

I know loads of T1s in real life. Not one of them has adjustments at work to eat at set times.

 

[JimmyBlue]

Hi @Lucyr having worked across a range of industries I can understand why that might be the case, academia and public sector are fare more likely to ensure that employees are given the options to ensure that they are able to manage their condition in an appropriate manner. Private companies are bit hit and miss. The last employer I had in the UK was certainly one that would be happy to provide an adjustment to eat at set times (or more specifically to ensure the employee had the opportunity to eat when they needed to) but others you'd be lucky if they gave you the time to run to the sandwich shop whilst making sure you ate at your desk and continued working.
The other side of the equation is whether people have asked for the adjustment but again, this is a tricky issue as a lack of knowledge or understanding of not only diabetes in general but type 1 and 2 specifically on the employers part could cause people to lose their jobs. Equally, some employers may be willing to give the adjustment but never think to ask whether people need it.
It is a difficult situation all round for a lot of people.

 

[Lucyr]

Hi @Lucyr having worked across a range of industries I can understand why that might be the case, academia and public sector are fare more likely to ensure that employees are given the options to ensure that they are able to manage their condition in an appropriate manner.

That isn’t why it’s the case. The reason it’s the case is that diabetics don’t have to eat at set times unless on mixed insulin. If I needed to eat at set times I’d put it on my reasonable adjustments form and it would be sorted, but it’s simply not medically required. So no T1 or T2 I know (I don’t know any T3s in real life) has ever needed to ask for set meal times as an adjustment. You’d struggle to find a doctor that advised you that as a T2 diet controlled diabetic you medically need to eat at set times either.