Category Archives: Work and Diabetes

What’s in your pigeonhole?

There’s always been a kind of up and down about my diabetes. Not just when it comes to blood glucose levels, but with everything. Work has been one of those things. Sorry that this is so long. Hope you’re still there at the end.

When I was first diagnosed, all the way through my first 15 years or so with diabetes, I didn’t really experience any clashes between my diabetes and my jobs. Later on, I had a few uncomfortable moments here and there, and for the last few years everything has been absolutely great. There are certainly reasons for all of this, and the reasons are probably not everything you would think of right away.

I should also mention that my A1cs were coming in pretty high during these years, when I was actually seeing doctors. I rarely tested my BGs. And I was on MDI (multiple daily injections); I didn’t start pumping until much later. So as long as I wasn’t running to the restroom every five seconds, there weren’t many outward signs of my diabetes at all.

Then I started the job I have today. That was around 16½ years ago. My A1cs were still in the 9s, but shortly after I started seeing a new endocrinologist who started me on Lantus. Now, my knowledge of diabetes was still practically nothing at this point, so I injected as prescribed, which was once per day. That’s it. The lantus did its thing, which was okay for a while. But my A1cs were still in the 8-9 range. And then, the lows started coming. Terrible lows. Lows that gave a new definition to hypoglycemia for me. Including a couple of bad ones at work.

After a couple of those events, I had to deal with internal conversations with my bosses. I have a hard time describing this, and after all this time I’m still not sure I can do a good job of it. I was called in, behind closed doors in one instance, and was asked “What are we going to do to make sure this doesn’t happen again?”. How do you answer that? Especially when your knowledge of your own diabetes is practically zero, but you think it’s not. Another conversation included a directive that because these lows seemed to be happening just prior to my normal lunchtime (not true, but they weren’t always aware of the other times), I was going to be required to go to lunch 45 minutes earlier than I had normally been going to lunch. Great… Let’s take the lunchtime issue out of the equation and add 45 minutes to the time I eat between lunch and dinner; I might go low right after work, but no one there will know about it because I won’t be there. Problem out of sight, out of mind. This was something no one else in my organization was required to do, and I was pretty unhappy about it, but what could I do? I had a really good job and people who depended on me. Plus, I was working with (and for) people who otherwise were very good, very nice people. I felt like I was running out of options, but didn’t know where to turn.

I muddled through a little longer. Okay, a few more years longer, before things began to change, and I think my co-workers started to see diabetes in a different way. Part of that involved a hypoglycemic event involving a co-worker who, until then, I was unaware had been living with diabetes. My boss came to me asking how I could help this person at that moment, while they were still trying to come out of it. I’m pretty sure they shouldn’t have shared the diabetes thing with me, but since they did, I shared what I felt during those times. I just started talking.

I told her about how hypoglycemia is a near-death experience, and how you can get this violent mental and physical swing between just wanting to survive, then feeling horrified that you’ve been such a bother to people who up to that point don’t know your diabetes and can’t hope to understand it on such a level, then wanting to prove how strong you are by going right back to work and performing like a superstar, all while feeling so physically weak that you just want to curl up in the corner and sleep for the rest of the day. This was the reward for coming back from the brink of extinction. And, oh, by the way, it might happen again tomorrow. You never know for sure.

I think that helped changed the perspective of how people at work viewed hypoglycemia, at least. My outward attitude started to change too. I started caring more about my personal survival and less about whether someone thought diabetes was a mark of personal weakness, or weirdness, for that matter.

Five years ago, I began to see a new endocrinologist, who for the first time, started to explain carb counts and blousing and updating basal rates based on exercise and eating habits. I started to check my BGs at regular intervals each day. I got off of the Lantus and started on Novolog. I started on an insulin pump, and my A1c started to come down.

Still, I felt pretty alone with my diabetes. Then my wife heard an interview on local public radio with someone who talked about an “artificial pancreas” and made me listen to it. I said, “Great, what do you want me to do about it?”. She said, “Find out about it. Someone online should be blogging about diabetes. Why don’t you do a Google search?”.

I did, and for the first time, I had that “Holy crap, I’m not alone… Holy crap, me too” moment. I began to learn even more, and talking to people living with and not living with diabetes. I remember having conversations with people at work and finding out that almost all of them were touched by chronic illnesses in one way or another. I had a conversation with one of my bosses where I was able to explain, and have understood, I think for the first time, that diabetes isn’t as easy as take a set amount of insulin, eat a set amount of food, exercise a set amount, and everything will be perfect. You can do everything the same every day for a month and have 30 different days’ worth of results. I learned how to say that from the diabetes online community.

I’m not sure what the moral of this story is. Sometimes I just need to write things to get them out of my head, you know? If there is a moral for me, it’s maybe that people act differently given different circumstances, and those circumstances are often influenced by things we’re unaware of at the time. I know I can’t influence every situation the way I want to. But I know that knowledge helps me deal with situations better, and I know that acting with empathy for all and perseverance through the difficult times can help me hold my head high even when the going is tough.

I read something recently about a workshop where a speaker was talking about acting with integrity in everything you do, and he mentioned that everyone gets pigeonholed at one point or another. His advice was, when you do, make sure your pigeonhole isn’t full of shit. The workshop was for new National Football League coaches and executives. Maybe the workshop should have been for existing coaches and executives. I don’t know. My question to you is:

What’s in your pigeonhole?

C’mon, CVS!

From the wonderful relationship that exists between employers and employees in the United States these days comes this little nugget. Go ahead, read it. I’ll wait.

Does this bother you a bit? It bothers me a lot.

I’m not bothered by the fact that an employer wants to try to help their workforce get healthier. My employer does many of the same things that CVS is talking about here. In fact, I’ve written about it. Done correctly, these initiatives are a win-win: employees get help identifying and taking action against illnesses they might not have known about before screening. And employers, helping employees get healthier, mitigate some of their risk against future insurance claims. This is especially true if, like a lot of large employers, they are self-insured: meaning, they pay their own claims, but pay the insurance companies to leverage networks of doctors and handle claims processing and other administrative functions.

But that’s about the extent of the good stuff in what CVS is doing here.

If I were to ask questions of the CVS/Caremark CEO, and their benefits manager, the first question I would ask is: Why do you want to penalize employees for non-compliance with a policy, when you could be incentivizing employees to get healthy?

How much that might cost would be in the details of how and what kind of incentives you would deliver, but let’s be honest. The cost would be miniscule. How do I know this? Oh, why don’t you ask the thousands of employers who have been delivering incentives to employees for completing smoking cessation classes, weight loss programs, and medical/bio screenings for decades here in the USA?

Second, I would simply ask if they understood that by forcing their employees to comply (and they are forcing them—when you earn the kind of money the people at the retail store level are earning, you’re forcing them to comply), they are destroying their workforce?

Knowing what we know now about this issue, even if you’re 100 percent healthy… let’s see a show of hands: Who wants to go to work for CVS right now? Anyone? Bueller? That’s what I thought.

Certainly, if you’re a person with good skills and an ability to land a job elsewhere, CVS/Caremark is immediately going to the bottom of your list of prospects. Which means that the new employees they will be landing in the future will be bottom of the barrel talent who can’t get a job anywhere else. And existing employees who might have other choices (like maybe Walgreens or Rite-Aid or, oh… anyone else) are going to bolt the first chance they get too, even if it’s for no increase in pay. Which means the employees that remain after a couple of years under this program are again, bottom of the barrel talent. So, CVS/Caremark: What do you hope to gain here? And have you considered how much it will really cost you? Because it will cost you. You will not save money with this plan.

And you, dear reader, may ask, after 500 words or so, “Hey Stephen… what’s this got to do with Diabetes?”.

I don’t know. I guess I’m saying that I don’t trust a company that will force you to do these things. Because if they’ll do this, what’s next? Will they start denying coverage to people who are diagnosed with diabetes? Thankfully, under the Affordable Care Act, they won’t be able to. But will they try to cut back on what they cover? That, I think, is a very real possibility.

Their new policy says: “Going forward, you’ll be expected not just to know your numbers – but to manage them”. By who’s measure? Will they pay less in claims if a PWDs Hemoglobin A1c isn’t within range (and we all know how difficult that can be)? Will they (for example) try to push someone with diabetes, in their 50s, like me, toward the exit so they can avoid paying what they think will be larger and larger claims until the person is eligible for Medicare? And in doing so, try to justify their decision by pointing at this policy?

Maybe that seems far-fetched. But is it? I mean, they’re already willing to coerce their employees into complying with their demands or risk giving some of their pay back to their employer. Does this sound Anti-American to you? It does to me.

That’s the crux of the thing right there. CVS is portraying this as a wellness initiative, designed to keep employees as healthy as possible. I’m viewing this as being too heavy handed. Mostly, I see what they’re trying to accomplish, at least from their public statements, as possible– if they would just put a different spin on it and act like they actually cared about whether their employees are healthy. And happy. And if they did it without docking employees’ pay or using the information to penalize employees that they are trying to keep healthy in the first place.

By the way, I have a choice of major drugstore chains in my area. And guess what? CVS is not my retailer of choice anymore. They just don’t get it. And geez, these people are running a multi-billion dollar company.

Do you feel the same? Different? Feel free to let me know how you’re thinking.

Yay Co-Workers!

From time to time, I’ve alluded to the fact that there’s been a somewhat tenuous relationship between my work and my diabetes over the years. In the early years of living with this disease, there weren’t really any issues. If diabetes got in the way at all, it was due to my A1Cs being high more than anything else. I might have been a little more sluggish during those times, but I was still able to function at a pretty high level.

Since those first few years, I’ve had an on and off, good and bad relationship between work and diabetes. At times, things were difficult. Tensions were occasionally strained.

So, what’s my point? Where am I going with all of this?

Over the weekend, I celebrated my 15 year anniversary at the company where I work. I thought about it a little in the last month or so. Whenever someone hits a milestone anniversary, the department gets together and does a thank you, gives a plaque, and then you go back to work. That’s great, but five minutes of feel-good doesn’t always wash away things that bother you for five years or more.

The good news is that in the last couple years, things have seemed to thaw a bit in this relationship. I don’t know exactly when things changed, although I think I know, and at any rate, I’m glad they’ve changed. I’d like to think that I’m a bit less sensitive these days too, and that helps.

Still, I felt a little… nervous about reaching this milestone at work. Kind of like some old demons were left that I couldn’t get rid of. So how do I take this thing that feels so uncomfortable, and turn it into something that feels good? The thought gnawed at me for a few weeks.

Then it hit me. Blue Fridays. Since my anniversary was on a Sunday, I would ask everyone to wear blue on the Friday before. I would also ask them to make a donation to the Diabetes Community Advocacy Foundation. You know… the organization behind the Diabetes Social Media Advocacy website, the DSMA Live and DSMA en Vivo podcasts, and the weekly #DSMA Twitter chat. I took the idea to my bosses, and they were all for it. Instantly. So I sent an e-mail to my colleagues in Baltimore, New York, and Connecticut, and marked it on my calendar.

The Baltimore crew.  I'm in the back ( I thought I was tall)

The Baltimore crew. I’m in the back ( I thought I was tall)

When I got into work, and later as I watched people arrive, I would look around and see a sea of blue. To think that my co-workers would care enough to do this for me… it almost made me break down and cry. A co-worker shared with me that they were recently diagnosed with Type 2, and they were appreciative of an effort to elicit support for those who have to live with diabetes. That almost made me cry. Not everyone who donated online told me how much they contributed. But what I know of the contributions puts the total dollar amount into the hundreds.

That’s my work anniversary and Blue Fridays story. I never really thought about what marrying these two ideas would really mean. It went beyond what I could have imagined. I’m so glad we were able to do this. And I’m so grateful for the people I work with, who made my cause their cause for a day. Today, I feel really lucky to be part of their team.

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