Wil Dubois

Got questions about navigating life with diabetes? Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1, diabetes author and specialist Wil Dubois. This week, Wil is tackling two tough questions related to workplace discrimination and the effect of stress on our blood sugar levels.


{Have diabetes-related questions of your own? Email us at AskDMine@diabetesmine.com} 

 

Norm, type 1 from New York writes: I recently had two bad cases of hypoglycemia while at work on overnight shifts at a FedEx Office. In the first I passed out, and in the second I accidently kicked a copy machine. I have been fired due to what they say is “bad conduct.” Can you help me with any information regarding any advocacy organization that could help me? I’m now in grievance process with FedEx plus I have upcoming hearing with NY labor court.

Wil@Ask D’Mine answers: The classic Warren Zevon song says it best:  ♪♫♪ I’m the innocent bystander, but somehow I got stuck between the rock and the hard place, and I’m down on my luck, yes, I’m down on my luck… Send lawyers, guns, and money… ♬♫♪

God, I love that song. :)

OK, so the guns aren’t really going to help in any case involving an organization engaged in mail carrying-like activities, and none of us have any money to spare. But lawyers are the best weapons for this kind of fight, and who are the Lawyers, Guns, and Money people (sans the Guns and Money) when it comes to diabetes? Yep! None other than the boys and girls in red: The American Diabetes Association. More specifically, the ADA’s Center for Information and Community Support, which you can contact here. But first, check out the ADA’s excellent info page on the whole subject of employment discrimination, and what to do if you experience it. 

Diabetes At Work

So will the ADA have your back in this case? The official ADA Position Statement on diabetes and employment says: “A single episode of severe hypoglycemia should not per se disqualify an individual from employment, but an individual with recurrent episodes of severe hypoglycemia may be unable to safely perform certain jobs, especially when those episodes cannot be explained.”

Do two incidents qualify as “recurrent"? I can’t speak for ADA, but two incidents don’t make up a recurrent pattern in my book. Besides, I bet most of us have accidently kicked a copy machine or two in our time, even without having a low blood sugar.

Anyway, Norm, I’m glad you came out of the corner fighting, but do get in touch with the ADA ASAP and see what they advise in your specific case. And get with your medical team, too! You need to find out why those lows happened, and modify your therapy so they don’t happen again—both for the employment fight and for yourself. Because the next time you have a serious low, it might be more than your job that you lose.

Meanwhile, these types of efforts on the part of the ADA are why all of us—every man, woman, child, and transgender person with diabetes—should join the ADA. Their strength comes from our numbers, and you never know when any of us might need their help.

Oh, that reminds me, I think I need to renew my membership… now, to find a copy machine to get my renewal paperwork in order.

 

Laura, type 1 from North Carolina writes: I have had type 1 diabetes for 28 years and been pretty well-controlled. Just recently, I noticed that sometimes I run high for a few days requiring me to increase my basal by as much as 125% and increasing my I:C (insulin to carb) ratio on my pump. Now I am good at figuring things out, but I can see no reason for this. I checked my pump site, insulin freshness, changed sites, etc. This past weekend I spiked high and remained there until I upped my basal and bolus amounts. Okay, so when I look into the reason I can only see (1) emotional stress, or (2) reduced exercise. I did very little exercise but I don’t normally exercise that much anyway. What I want to know is: what is the science behind these reasons? I mean, if exercised consistently then stopped I can see a spike, but I do not, and the spike is enough to almost double my normal insulin intake!! The other reason of stress makes no sense either… I cannot find much on the Internet to explain what is going on. 

Wil@Ask D’Mine answers: Well, don’t trust anything you read on the Internet. Except what you read here, of course. I agree with you that a change in exercise seems unlikely as the cause of your woes. Even if you were a gym rat and took a break, I doubt it would double your insulin needs. Stress, on the other hand, can have a profound effect on your diabetes carcass, and I think I can explain how.

The key to understanding stress and diabetes is to know that stress is not an emotional problem. The hard reality is that stress triggers a physical, or actually a chemical reaction in your body. To understand how and why this is, you need to take a walk with me back in time to the days of our ancient ancestors, whose stupid DNA we still have to deal with on a day-to-day basis. 

We evolved for thousands of generations in a very different environment from what we live in today. Stress today is no cell phone coverage, crashed computers, tax audits, traffic jams, declined credit cards at the end of the meal, and jerky bosses (not something I have to deal with of course, but I’ve heard other people have this issue). And if none of those things are happening to you right this moment, there’s always the fear it will happen in the next moment, which is almost as stressful as stress itself.

DiabetesStress

But what about the stresses of yesteryear when our species was evolving? Back then stress was worrying about being eaten by a saber tooth tiger, being eaten by a cave bear, being eaten by a lion, being eaten by a pack of hyenas, or being mauled by a jaguar. Seeing a theme here?

Can you spell, D-A-N-G-E-R?

Right. And how does the human body react to physical danger? By triggering the flight or fight response. If you are about to be eaten by a (   fill in the blank   ) your two best choices are to go on the defensive and run like hell, or go on the offensive and beat the ever-loving-shit out of whatever it is that’s threatening you and eat it for dinner. Ha! Take that you effin’ tiger-bear-lion-hyena-jaguar!

Of course, either response takes a lot more energy than you usually have at your disposal. No problem, your body is designed by nature for just such circumstances. The flight or fight response dumps hormones and sugar into your body for super-human strength. In primitive times you’d use up this extra fuel in short order by doing an Olympic-shaming sprint or by tearing the legs off a hyena.

We evolved in a world of physical stresses and our bodies are built to respond to stress in a physical way. All good and fine in Paleo times. But our modern stresses tend to be cerebral in nature, not physical, yet our bodies didn’t get the memo. They’re not up with the times and the human body doesn’t know the difference. To it, stress is stress. And to make matters worse, the response to today’s stress doesn’t have a physical component—there’s nothing to burn off that extra sugar. Also, unlike the brief stress of the past, today’s stresses tend to linger. Animal attack: Fast and over quickly. One way or the other. Tax audit? That takes a while.

Don’t underestimate the tiger-bear-lion-hyena-jaguar killing power of your body. The fuel to protect yourself in the wild can have a massive effect on your blood sugar in a traffic jam. 

OK, but what to do? Well, plan A is to relax. Remove the stress.

Yeah, riiiiiight.

Plan B is to do what you do. Accept the fact that you’ve got stress and you can’t easily rid yourself of it. That’s not good for you, but there’s no need to let it wreck your diabetes control either. All inulin pumps are set up for alternate basal patterns. Program a stress profile. Some pumps (and all of them should!) also have to ability to set up an alternate profile with different I:C rations and correction factors. When you get stressed out, you simply need to switch to your stress settings and ride it out.

So on one hand, we need to be grateful that the saber tooth tiger is no longer a problem. While we can be angry that our bodies are out of date in how they deal with stress, at least we have more than stone tools and bear skins to deploy in our favor. 

The modern insulin pump, used right, can trump our ancient DNA.

 

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.