Two more tough topics await in this week's edition of our "curiously strong" diabetes advice column, Ask D'Mine — hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Take a gander, and don't forget to send us YOUR queries related to life with diabetes. Not much is off-limits here! (except of course specific medical instructions for your own care; that's what doctors are for)

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Innovation 2015

Ed from Pennsylvania, type 1, writes: I'm getting ready to interview for jobs now and not sure if I should state upfront that I have type 1 diabetes. Some people have said that type 1 diabetes is a protected "disability." So should I mark that I am "disabled" on Human Resource questionnaires? In other words, is it better to tell or not to tell?

 

Wil@Ask D'Mine answers: First and foremost diabetes is not a disability. It's an inconvenience. So you should never label yourself as disabled or think of yourself as disabled. Ever. Period.

Well... OK... that's not quite true. Diabetes is, in fact, protected under the American with Disabilities Act, but it's not a "disability" in the way most Americans think of it — which is to say you cannot collect social security benefits or be covered under Medicaid simply because you have diabetes. We ran a guest post by diabetes lawyer Kriss Halpern a little while back that explains all the intricacies of the laws.

But for our purposes here: to tell, or not to tell, that is the question.

Oh dear. Was that the sound of Shakespeare rolling in his grave?

Don't tell. Not on the first date. You're not legally or morally obligated to tell a company about your diabetes when applying for a job. On top of that, doing so is probably a really bad idea.

Jumping into the legal end of the pool first: according to the American Diabetes Association, by law, you're not required to reveal your diabetes until after a job has been offered to you. Federal law protects us against employment discrimination, both in hiring, and on the job after we're hired. Well, in theory, anyway. But there's a reason the ADA has an entire battalion of lawyers on standby at all times. What the law dictates and what human nature fuels are not the same.

Now we're at the moral end of the pool: to tell or not to tell. Remember, there's a lot of bad info about diabetes out there in the world. Hell, even our loved ones don't "get it" half the time. I wouldn't expect more of a potential employer, who even if they (#1) totally "got" diabetes and (#2) knew the law, might find themselves worrying about how a type 1 on the company books might affect the already double-digit annual inflation on health insurance costs that are already draining the company coffers.

I would absolutely keep my lips sealed during application and interview process, unless I was trying to land a job with JDRF, or a diabetes clinic, or a Pharma company. In any of those cases, I would suspect that having diabetes would be an additional credential; otherwise, I wouldn't muddy the water with it.

A true story from the trenches: So I have a good friend who's type 1 like me. Let's call him Samuel. He's Mister High Tech. He originally came to me (and still does) as a diabetes education patient. Samuel told me that it made his day when he spotted a guy wearing an insulin pump and a stethoscope at the clinic. I mainly help him plow through the reams of data from his CGM, and help him fine tune his pump. He traveled a great deal, and that made for some fun biological and technical challenges. Later he became one of my gang of Diabetes Peer Educators.

Anyway, the economy being what it is, Samuel found himself out of work about a year ago. Just when things were getting really desperate for Samuel and his family, he finally got a lead on a job and was flown to another state for an interview. He asked if he could list me as a personal reference. I said sure thing.

A few weeks later I get a call from a vice president at the company Samuel was applying to. And this vice pres asks me how I know Samuel.

And without thinking I say something like I've been helping Samuel with his diabetes for years and he's one of our volunteer educators at the clinic.

And then there's a long silence on the phone and the guy says, "Oh. I didn't realize Samuel was diabetic. He didn't mention that."

And I'm like, fuuuuuu**!

Then the guy says, "He's a type 1?" And I say, "yeah."

Then the vice president of this company says, "Yeah, me too."

And Samuel got the job. Whew!

Juanita from Arizona, type 3, asks: Does diabetes effect dementia? My mother-in-law's Alzheimer's seems worse when her blood sugar is high. Do you think her years of poorly controlled diabetes might have caused her dementia?

Wil@Ask D'Mine answers: Who gets dementia? Mainly old people. Who has the highest rates of diabetes? Old people. Are the two just associated, or does diabetes drive dementia?

What's needed is a study that separates the wheat from the chaff by looking not at the relative rates of dementia and diabetes in a population, but by looking at well-controlled older diabetes patients and poorly controlled older diabetes patients; and back in 2003 Dr. Yousef Mohammad at Ohio State did just that. He looked at older, poorly controlled diabetes patients, older nicely controlled diabetes patents, older pre-diabetes patients, and garden-variety old folks with no diabetes whatsoever.

And what did he find? The poorly controlled D-folk were the most demented. By a landslide. Fast forward to 2008. One study arm of ACCORD linked elevated A1C scores to lower "cognitive function."

But before you get too excited, consider the 2009 study that suggests that low blood sugar in people with diabetes is linked to dementia, too. Yet other studies poo-poo diabetes altogether and say that belly fat is the real culprit.

A few years ago research announced at the Alzheimer's Association annual meeting in Madrid, Spain, showed such a close association between Alzheimer's and diabetes that the press starting calling Alzheimer's a "third kind of diabetes."

Oh, and adding to this mess, some of the meds for dementia have an interesting side effect: they raise blood sugar.

Great.  So what're we to make of all this conflicting evidence?

Hold on a sec, it gets even more confusing.

I noticed that you said your mother-in-law has Alzheimer's. Alzheimer's is one of many kinds of dementia that can strike us in our older years. For the most part, the only way to really sort out what type of dementia you have is at your autopsy. Alzheimer's is characterized by plaque buildup in the brain, other types of dementia are more vascular in nature. Blood vessel stuff. The early studies linked diabetes to this vascular dementia. Logically this makes a lot of sense, as we know that long-term elevated blood sugars tend to trash-out the vascular system. High blood sugar tears up your kidneys, your eyes, your heart, and the capillaries in your feet. Why the hell not in your brain too? In fact, for many years it was believed that Alzheimer's didn't have any logical biological connection to diabetes. That's all changed. Now it turns out that the pancreas isn't the only game in town when it comes to insulin. The brain apparently produces it too, where it is used to help file and store memories. Who knew?

So bottom line: While the devil is in the details, it sure looks like elevated blood sugar screws with your mind, just like it screws with the rest of your body. At this point, would fixing your mother-in-law's blood sugar help? Or is it too late?

Sorry, I simply don't know. And I don't think anyone else does yet, either.

But that point may be moot, because where the rubber meets the road in the real world, it gets really, really, really difficult. Dementia can make diabetes uncontrollable in some circumstances. Just last week I had a really hard call to make. We have a dementia patient whose cognitive function is getting really bad. She recently attacked her daughter with a broom. She didn't recognize her daughter and mistook her for an intruder.

This patient, like many type 2's who've been in the club for a long time, is treated with insulin. Wonderful drug insulin. Unless you take five shots instead of one because your mind is so far gone you don't remember you just took a shot. The doc asked me to evaluate the patient and give a recommendation.

I'll spare you the details, agony, and second guessing I went through. I knew if we left her on the insulin, she might kill herself with it, and that if we took her off it, her blood sugars would shoot up and maybe make her dementia worse. And don't flame me with comments about why didn't we get a visiting nurse to give shots or whatever. It's too long and sad a story, but none of the resources you'd expect a civilized society to provide are available in this case.

My recommendation? Stop the insulin. It was the lesser of evils. But don't think I felt good about it or slept well that night. Or the next night.

Or the night after that.

Or the next.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.