KRISS S. HALPERN
Law Offices of Kriss Halpern
1021 Fifth Street, Suite 209
Santa Monica, California 90403
(310) 458-9340
fax (310) 395-4786

January 21st, 2006

Re: Your Employee

 

Human Resources Manager
Employer
City, California Zip Code

Dear H.R. Manager:

I am writing on behalf of Your Employee in response to your letter to her dated January 11, 2006, and your prior meeting with her pertaining to her Type One Diabetes and her employment with Employer.

As you know, Your Employee loves her job and has been a highly competent employee for many years. Her recent incident of hypoglycemia while working is something she is grateful the Employer would like to assist her with so that her job duties will not suffer in any way. As you also know, the Employer’s assistance is required under both federal law, pursuant to the Americans with Disabilities Act (“ADA”), and California law, pursuant to Government Code Section 12921, et. seq. (specifically including Section 12926.1(c) which explicitly protects persons suffering from diabetes in their right to “hold employment without discrimination because of…physical disability… [or] medical condition….”]

Your Employee is particularly grateful that the Employer is seeking to assist her as she is well aware that without the good faith efforts of her employer the promise of fair treatment is meaningless.

To that end, it is my hope to assist Employee in explaining to Employer what reasonable accommodations will facilitate her fulfillment of her job duties; and to provide a helpful dialogue between her and Employer so that this can be accomplished as easily as possible. I would be more than happy to talk or meet with you and Employee or anyone else associated with Employer at any time you feel that would be helpful to your efforts.

Like Employee, I also have Type One Diabetes, so it may be possible for me to explain reasonable accommodations a bit more easily. But I do not mean to be rude in this correspondence so please forgive me if you are already familiar with the medical issues discussed here.

Employee is a very highly controlled diabetic who uses an insulin pump and maintains an average blood sugar level nearly the same as that of a person without diabetes. A clinical trial sponsored by the National Institutes of Health known as the Diabetes Control and Complications Trial (“the DCCT”) definitively proved that the closer a person with diabetes maintains their blood sugar levels to normal, the less likely it is that the dangerous long terms complications of the disease will occur. This blood sugar level is most effectively measured by a test known as the Hemoglobin A1C blood glucose test which determines the average blood sugar level of the person’s blood over an 8-10 week period of time. A non-diabetic can be expected to have an A1C test showing blood glucose levels under 6%. The closer a person with diabetes maintains her blood glucose at that level, the less likely it is that long term complications will occur. However, as the average blood glucose level is decreased, the likelihood of sometimes falling too low and suffering from hypoglycemia – as occurred in the recent incident with Employee - increases. Thus, managing blood glucose levels is an ongoing and constant dilemma that takes a good deal of effort and knowledge to handle properly. Moreover, it is not possible to prevent occasional errors that result in low blood sugar and still keep blood glucose levels near the recommended range for improved long term health.

Employee has maintained a high level of effort and demonstrable success at properly managing her blood glucose levels for many years. She uses an insulin pump which allows her to adjust her blood glucose levels constantly and is well trained in doing so properly. When one works as hard as Employee to mimic the blood glucose levels of a person without this illness, there is a risk of hypoglycemia occurring with greater frequency. While this has not been an ongoing problem of great severity, we understand that Employee’s Boss and your office have some concerns and Employee has therefore met with her health care providers to discuss the issue in order to avoid any further hypoglycemic events of significance.

The recent incident at work has caused Employee to review her insulin regimen with her endocrinologist, a Certified Diabetes Educator, and a psychotherapist specializing in the concerns of persons with diabetes. As a result of these efforts, Employee has made three changes to her blood glucose regimen in order to avoid a recurrence of a severe hypoglycemic event.

First, she has lowered the amount of insulin she takes through her pump from a level of 1 unit of insulin for every 15 grams of carbohydrates to 1 unit of insulin for every 16 grams of carbohydrates. This change will slightly decrease the amount of insulin in her body at any given time and thereby decrease the likelihood of a hypoglycemic incident.

Second, Employee has recognized that the recent incident occurred as the result of her taking too much insulin for a snack she ate on that occasion and that she has had other, less significant, low blood sugar incidents as the result of not finishing meals after taking the proper amount of insulin based on the meal before her. In other words, if one orders a tuna sandwich and takes 5 units of insulin for it, but then only eats half the sandwich, there is a significant likelihood of a low sugar incident after the insulin is absorbed. Therefore, at the suggestion of her health care team, Employee will now be taking only half the required insulin for a given meal when she begins eating and then the remainder only after she has finished the meal. This way, if she chooses not to finish the meal, she will not already have the insulin in her system for the full meal. Persons without diabetes have these issues resolved for them automatically by their pancreas which instantly recognizes how much insulin is required and provides the proper amount. Those of us with insulin dependent diabetes do not have a pancreas that can produce insulin so we have to make these decisions ourselves. Unfortunately, however well-trained and diligent we may be, we do not have the ability to operate with the perfection of a properly functioning pancreas. But, with the changes Employee and her health care team have made, we believe that the likelihood of a future significant low blood sugar incident will be greatly diminished.

Third, her insulin pump has been reset to raise her target blood glucose level from 120 to 130; this adjustment has decreased the insulin in her system and reduced the likelihood of a low blood sugar event.

It is not possible for any person taking insulin to eliminate the possibility of severe hypoglycemia. Indeed, most of us feel symptoms of hypoglycemia several times each week. But these incidents are rarely severe and typically not noticed by anyone other than the individual with diabetes. Employee needs to be permitted to test her blood sugar levels with a meter she takes to work and be allowed to treat any low blood sugar event that occurs. She keeps orange drink with 40 grams carbohydrate with her at her desk, another in a nearby refrigerator, as well as carbohydrate bars and candy in her purse, so that she can do so easily and quickly. Also, the nearby soda machine provides yet another source of carbohydrates to handle a hypoglycemic incident. She keeps change in the top drawer of her desk to purchase a soda with sugar if her blood glucose falls too law. Employee’s Boss or any other person in the office should be advised about these items so that, if necessary, they can assist her to ingest them and increase her blood sugar level back to normal if they ever see her going too low again.

It is easy to raise a blood sugar level back to normal – it just requires ingesting something with sugar or carbohydrates and waiting a short period of time. Typically, the recovery period for a minor hypoglycemic event is short and Employee can get back to a full resumption of her duties within fifteen minutes even on those very rare occasions when her symptoms become elevated. Although highly unlikely, it is conceivable she might again suffer from a more severe incident, but on those rare occasions she can also recover by checking her blood sugar level and treating the symptoms with juice, a beverage with sugar, or some form of food that contains quick absorbing carbohydrates or sugar. On those very rare occasions when the incident is severe, she may need to rest briefly before resuming her full level of duties, but Employee is well trained to avoid and handle this properly. Finally, in the case of a very severe hypoglycemic incident in which Employee is unable to help herself and needs some assistance – this has occurred precisely once in her career and that was the recent incident – Employee will now keep a vial of glucagon in her desk which can be used to give her a shot and bring her back to normal immediately. If Employee’s Boss or anyone else is willing to learn how to provide glucagon properly it can take a couple minutes to learn and Employee can easily demonstrate how to use it.

The fact that Employee’s Boss and other persons who work nearby Employee are aware of her illness should be helpful. The symptoms of severe hypoglycemia are fairly easy to recognize once one witnesses them and is made aware of them. Nervousness, sweatiness, confusion, paleness and hunger are all common symptoms. As Employee’s Boss previously pointed out, the diabetic suffering from hypoglycemia looks like “a deer caught in headlights”. His description is apt and points to his ability to recognize the symptoms. If these symptoms persist without treatment, more severe symptoms may occur and the diabetic can stop functioning at a competent level, eventually becoming extremely confused and even falling into shock or coma. But those symptoms of severe hypoglycemia are very rare and can almost always be avoided by frequent blood sugar testing, regular eating, and snacking when the symptoms are beginning. If Employee’s Boss or anyone else notices a change in Employee that causes concern, it is easy enough to ask her how she is feeling and if she needs anything or thinks she might need to test her blood sugar. While a person suffering from severe hypoglycemia may be slow in reacting, it is typically only a momentary delay before one is able to react and treat the incident adequately. Employee carries a blood glucose meter with her at all times that can tell instantly what her precise blood glucose level is so she can make any necessary adjustments to bring her blood glucose back to normal and avoid a severe incident.

With the tools and efforts described in this letter, the support of Employer, and the ongoing diligence and efforts of Employee, there is no reason that she cannot continue to work at the same high level of professionalism she has maintained throughout her career.

Thank you again for your assistance in addressing this matter. Please let me know if there is anything at all I can do to assist you and Employer to make certain that Employee is able to function as highly in the future as she has in the past.

Very truly yours,

Kriss Halpern

cc Employee