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LAK76

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Relationship to Diabetes
Type 1.5 LADA
I have been diagnosed with LADA for 12 months and I am still in the honeymoon phase. Having had a length of time off work as a community nurse I returned in September. Occupational health put forward recommendations of a prolonged phased return and working from home for 3 months with occasional going into the office. Management have now demanded I attend the office 50% of my working week and also do face to face clinic. In summary I now have support from occupational health and the union and have a meeting next week. My question is what reasonable adjustments should I be requesting? I have no issue going into the office for team meetings etc but my driving has to be in accordance with the dvla guidelines. I cannot see the benefit of office working when the service is rarely manned due to home visits and clinics. I love my job but realistically I cannot see how I can remain in my substantive post. Advise would be welcome. Thank you
 
My role involved a lot of UK travel although having only just learnt to drive I tended to go by train. As part of my phased return (which was more about the surgery than diabetes) we did discuss travel and trips to the office. I explained that because of the need to carb count and timings for insulin travel and overnights would be difficult at least until I got the hang of things. That was seen as a reasonable adjustment and accepted by my employer with a review in 12 months time. Trips to the office were left a bit more vague and I was asked to go into the office 'occasionally' and when team meetings were held in that location. We're geographically dispersed team so that probably won't be that often.

If they're insistent on office working I think all you can do is lay the groundwork on why some days you're not going to be able to do it - unsafe to drive, lack of sleep, energy, challenges over food? Does your manager understand what your particular version of diabetes involves? With the best of intentions I've had colleagues tell me I just need to eat more healthily and send me lots of low carb recipes. A bit of background and explaining what's actually involved saw a lot more understanding and no expectations to see me in person.
 
What issues are you having @LAK76 ? It’s very unusual to be off work for any length of time after a Type 1/LADA diagnosis. Is it the mental/emotional aspect of it all? Or do you have additional physical issues? Or is it some aspect of the job itself that doesn’t work?
 
What are the issues that prevent you from attending the office @LAK76?
A new diagnosis takes some time to get used to and to develop the new routine for managing our diabetes. This can impact us both physically and emotionally.

For driving I find it useful to make sure that I checked my levels 1 hr before I needed to leave to ensure that I could treat a hypo and recover. The sensors that are available now make life a lot easier as this not only shows your levels but also whether you are rising or falling. Do you have a sensor such as Libre?

In the office it would be useful if your colleagues are aware of your diabetes and the possibility of a hypo. It is worth having a stash of quick carbs there, along with those that you carry with you.

I had a phased return to teaching which ran over three months after diagnosis and then back to full time work. The only adjustments that I needed was to ensure that my colleagues were aware of my T1/LADA and would be on call in an emergency if I had a hypo. I was in secondary school so this was not a problem. I also had a stash of quick carbs in various places around the school for an emergency.
 
While I love working from home, mainly as it's quiet so I can get so much more work done in a day (and I can avoid sitting in traffic to boot), my blood sugar control is much better when I do travel into work (whether I ride a bike the 20km or simply drive it) - simply needing to move around more and do stuff (that isn't just sitting at a desk) at work does wonders for my insulin sensitivity even without any additional exercise.

Do you need to drive to do home visits for your role? I don't understand how travelling to work for meetings is different from travelling to do face to face clinic work from the point of view of travel, or perhaps I misunderstood? Certainly for face to face work it will take some adaptation time to work out what your BG does.

For example when I used to run courses (teaching ~3h sessions, two-per day, all week long), I tended to run low so would generally bolus less than usual for meals and ensure I had snacks on hand and would treat early and aggressively to avoid a 30min window of being useless while low/recovering from being low. Long meetings can be similar. CGMs make this so much easier than it was in the past though.
 
I wonder if this is a problem with lack of support and education to manage your diabetes well, if you haven't been able to attend work since diagnosis a year ago. Have you been offered and done a DAFNE (Dose Adjustment For Normal Eating) or whatever your local equivalent is? This is an intensive 5 day course either over the course of a week or 5 separate days over the course of several weeks. Yes, we all understand that the honeymoon period can be tricky for some people and smooths the edges off for others, making it a little easier, but the technology we have available now with CGMs should help a lot. Do you adjust your own basal and bolus doses according to exercise/activity and what you eat? Do you have half unit pens so that you can fine tune those doses?

It sounds like hypos are a main cause of concern for you with regard to your job. Do you have a lot of hypos? What have you done to minimize them? What do you have your low alarm set at on your CGM? Have you considered raising it to give you more advance warning of impending hypos. Mine is set at 4.5 but some people set it at 5.0 or even the maximum 5.6 (Dexcom can be set even higher I believe). Maybe you have not adjusted it at all and perhaps didn't know it can be adjusted and just that simple step will help you.
I can understand being concerned that you might let people down if you hypo and are unable to drive but if you can take steps to mostly prevent that I am sure that work will understand on the odd occasion that it does happen. As @SB2015 suggests, planning an hour in advance of driving is important, so that you don't get caught out.
Is there a time of day when you are less likely to hypo? perhaps the morning when levels are generally higher, which happens for most of us? Maybe ask to do home visits for half days in the morning and office work in the afternoon, if levels are more tricky after lunch.

If you can explain in more detail what the problems are and what you have tried to overcome them, then perhaps we can suggest other things that you may not have thought of. Diabetes can be tricky and particularly during the honeymoon phase but you have to learn to manage these situations and not let them stop you from living life, including work and play.
 
I realised I didn’t answer your question @LAK76 The reasonable adjustments I have and have had over the years are time to test my blood sugar and eat at my desk if and when needed; permission to keep my meter/Dexcom receiver, hypo treatments, etc with me, and my phone too; permission for a break from work when I needed to change a cannula - that kind of thing.

I see from your earlier thread that you were understandably stressed after diagnosis - it’s a massive shock. I found it took me some months to get my head round things, then a year or two to fully take it on board emotionally. If your problems are largely emotional, then counselling might help, or posting here. I find it helps enormously being amongst people who really understand and have ‘walked the walk’. I’ve had Type 1 30+ years but I still find this forum invaluable - for advice, opinions, suggestions and emotional support.
 
I have been diagnosed with LADA for 12 months and I am still in the honeymoon phase. Having had a length of time off work as a community nurse I returned in September. Occupational health put forward recommendations of a prolonged phased return and working from home for 3 months with occasional going into the office. Management have now demanded I attend the office 50% of my working week and also do face to face clinic. In summary I now have support from occupational health and the union and have a meeting next week. My question is what reasonable adjustments should I be requesting? I have no issue going into the office for team meetings etc but my driving has to be in accordance with the dvla guidelines. I cannot see the benefit of office working when the service is rarely manned due to home visits and clinics. I love my job but realistically I cannot see how I can remain in my substantive post. Advise would be welcome. Thank you
Hi LAK,
Similar to others you seem to have good support but what are the specific challenges to managing your diabetes in terms of your role moving forward.
After my diagnosis I took a few weeks to readjust but I had a very supportive employer plus backing of Occupational Health and they were happy for me to build up working from home over that time all at my own pace.
The only thing I cancelled was a Conference in Spain 5 weeks after my diagnosis as I thought I would have little control over timing when and what I would eat and that it would be better spending that extra week getting stable.
I can drive a lot in my job so up to 1k mikes a week and was unsure about how I would manage my BG but I do have a lot of control over if I need to stop etc.
I found once I had the confidence of knowing how to manage my diabetes it has proved fine and not a worry at all and apart from the occasional issue easily remedied by responding to my Libre alarm it really is not a problem.
I really do believe it is a confidence thing that prevents many of us from living as normal a life as possible and as usual the fear is much worse than the reality.
GL moving forward
 
My job has always been very desk based so I have never needed to make any special requests.
But the main things would be time and space for testing, eating and injecting. While there should be no need to eat at a specific time, we need the understanding that there are times (when we have or are nearing hypo) when we must eat.
I sometimes travel for work and, if driving, I need to test beforehand with an understanding of the consequences if my BG is too low.
Most of my travel is overseas and, when on MDI, I had to explain to my manager the challenges on basal dosing and timing of large time zone changes with little notice. However, I still found a way to travel to Seattle for less than 48 hours with even less notice.

I think a lot of this is my attitude to diabetes - I won’t let it control my life which includes the job i chose to do. I also don’t want it to impact my colleagues. In fact, I had a colleague sitting opposite me for more than a year and, although I tested and injected at my desk, he didn’t know I had diabetes.

As others say, it is about confidence which, taking so much time away from
“normal” work when first diagnosed, would not help me. To me, it means diabetes is in control.
 
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I can’t see the need for any reasonable adjustments, personally I went back to work in person on the very same day I started insulin. How else would I get used to what insulin requirements my normal life required, and how to manage diabetes at work, if I wasn’t doing my normal life?

Of course if you have a hypo and can’t drive you might need to start work at home and go in later when you can drive, or if you drive HGV for a living you might need to change roles for a while. But I’d see getting to work as my responsibility, if I know what time I need to drive then an hour beforehand I’m making sure my bg is in the right place.

Hope this doesn’t come across too harshly but I do make my own insulin as well as injecting it, so am in a similarish position. Maybe expand on why you’ve been off so long and why you can’t go back yet?
 
Also to add, I do have experience of the process of arranging reasonable adjustment as I had to request some for my ME/CFS as I was at the point of not seeing how I could continue my role otherwise. If there were any I required for diabetes I would have put them in at the same time but I genuinely couldn’t think of a single adjustment I’d need for diabetes. You just have to fit it in with your life.
 
Sorry to hear you feel your diabetes would prevent you from carrying out your work role @LAK76 :(

Are you having a lot of hypos? At unpredictable times? I may be misinterpreting your post and reading too much’ between the lines, but I’m trying to work out how driving to work and/or meetings would be too difficult within DVLA guidelines.

If it’s unpredictable hypoglycaemia that you are experiencing, forum members may be able to help you with strategies for that?

I was diagnosed in the final year of my degree, so my whole working life was spent accommodating my diabetes.

I’ve been employed in small and medium sized companies, I’ve been a freelancer, I’ve worked in offices, and worked from home, I’ve run my own business, and I’ve been employed by a large national charity(!).

There have always been ways to fit diabetes into my working life. And the only ‘reasonable adjustments’ I’ve really relied upon have been for clinic visits, and occasional 15 minute recovery periods.

Ket us know what problems you are having with your diabetes, and hopefully we can help you find ways to reduce them?
 
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