Medical Letter for Work Position Change Request
Direct Recommendation
This patient with uncontrolled diabetes experiencing headache and chronic fatigue should receive a work position change away from heavy lifting duties, as federal and state laws require employers to provide reasonable accommodations to help employees with diabetes perform their work safely and effectively, and heavy lifting poses legitimate safety concerns in the context of uncontrolled diabetes. 1
Medical Justification for Work Accommodation
Safety Concerns with Heavy Lifting
Heavy lifting in the context of uncontrolled diabetes creates multiple legitimate safety risks:
Hypoglycemia risk during physical exertion: Exercise and physical labor lower the body's need for insulin and can speed up insulin absorption, particularly when the activity involves areas near injection sites, creating unpredictable blood glucose fluctuations that increase injury risk during heavy lifting. 2
Sudden incapacitation risk: Jobs requiring heavy lifting or operating dangerous machinery raise safety concerns about whether the employee could become suddenly disoriented or incapacitated from severe hypoglycemia, which occurs more frequently in patients with uncontrolled diabetes. 1
Increased energy expenditure: Working more than usual or exercising beyond typical levels is a documented cause of hypoglycemia, and heavy lifting represents exactly this type of increased physical demand. 2
Symptom-Related Functional Impairment
The patient's current symptoms directly impair safe performance of heavy lifting:
Chronic fatigue: Fatigue is a common and distressing complaint among people with diabetes that hinders the ability to perform daily tasks, and both work characteristics and diabetes-related factors contribute significantly to fatigue severity in diabetic employees. 3, 4
Headache: This symptom may indicate either hyperglycemia or hypoglycemia, both of which compromise the cognitive alertness and physical coordination required for safe heavy lifting.
Symptom burden with physical demands: Research shows that diabetic symptoms and the burden of adjusting insulin dosage are especially problematic when combined with high job demands, and heavy lifting represents exactly such a high physical demand. 4
Legal Framework for Accommodation
Federal and State Requirements
Employers are legally obligated to provide reasonable accommodations:
Federal and state laws require the provision of "reasonable accommodations" to help an employee with diabetes perform the essential functions of the job effectively and safely. 1
Most employers are required to provide accommodations unless those accommodations would create an undue burden, which a position change typically does not. 1
Accommodations must be assessed on an individualized basis, considering the specific job requirements and the individual's capacity to perform that job with or without reasonable accommodations. 1
Appropriate Accommodation Types
For this patient, the following accommodations are medically indicated:
Reduced physical demands: An employee with nerve pain or other complications may benefit from reduced walking distances or having the ability to sit down on the job; similarly, this patient requires reduced heavy lifting to prevent injury. 1
Work schedule flexibility: Certain types of work schedules can make it difficult for individuals to manage diabetes effectively, and accommodations should support both health and productivity. 1
Access to diabetes management: The patient needs breaks to test blood glucose levels, administer insulin, and access food/beverages to respond to low blood glucose levels or maintain hydration if glucose levels are high—all of which are more critical when performing physically demanding work. 1
Clinical Assessment Requirements
Documentation Needed
The medical evaluation supporting this accommodation request should include:
Blood glucose monitoring records: A series of self-monitored blood glucose measurements over time provides valuable information about diabetes control and hypoglycemia patterns, which is essential for assessing workplace safety. 1
History of hypoglycemic episodes: Documentation of any incidents of severe hypoglycemia is a key factor in assessing employment safety and risk, particularly for physically demanding jobs. 1
Symptom assessment: The presence and severity of headache, chronic fatigue, and other diabetes-related symptoms should be documented as they directly affect job performance and safety. 3, 4
Current treatment regimen: Details about insulin or other diabetes medications are relevant because hypoglycemia risk varies significantly based on treatment type, with insulin and sulfonylureas carrying the highest risk. 1
Complications Screening
The following should be evaluated to determine if complications contribute to work limitations:
Autonomic neuropathy: This increases the risk of exercise-induced injury through decreased cardiac responsiveness, postural hypotension, impaired thermoregulation, and greater susceptibility to hypoglycemia during physical activity. 1
Peripheral neuropathy: Nerve complications may affect balance and coordination, increasing injury risk during heavy lifting. 1
Cardiovascular complications: Diabetes-related heart disease may be exacerbated by the physical demands of heavy lifting. 1
Specific Recommendations for the Letter
Essential Elements to Include
The accommodation request letter should contain:
Clear diagnosis: State that the patient has uncontrolled diabetes mellitus requiring insulin or other glucose-lowering medications.
Specific symptoms: Document headache and chronic fatigue as current symptoms affecting work capacity.
Safety rationale: Explain that heavy lifting increases the risk of hypoglycemia-related injury and that the patient's uncontrolled diabetes creates legitimate safety concerns for physically demanding work. 1
Accommodation request: Specifically request reassignment to a position that does not require heavy lifting or physically strenuous activity.
Temporary vs. permanent: Indicate whether this accommodation is needed temporarily (until diabetes control improves) or permanently (if complications are present).
Management plan: Note that the patient is under active medical management to improve diabetes control, which may reduce accommodation needs over time.
Common Pitfalls to Avoid
When writing the accommodation letter, avoid these errors:
Do not use A1C alone: A1C test results reflect average glycemia over several months but do not provide information about hypoglycemia risk or daily glucose variability, which are the relevant safety concerns. 1
Do not speculate about future complications: Long-term complications become relevant only when they are established and interfere with current job performance, not based on speculation about what might occur in the future. 1
Do not suggest complete work disability: Most people with diabetes can manage their condition with minimal risk if appropriate accommodations are provided; the goal is modification, not exclusion from work. 1
Do not provide excessive medical detail: Only medical information relevant to evaluating the individual's current capacity for safe performance of the particular job should be included. 1
Prognosis and Follow-Up
Expected Outcomes with Accommodation
With appropriate work position change:
The patient can continue productive employment while managing diabetes more effectively without the added burden of heavy physical demands. 1
Risk of workplace injury from hypoglycemia during heavy lifting is eliminated. 1
The patient can focus on improving diabetes control through consistent medication adherence, blood glucose monitoring, and lifestyle modifications without the confounding variable of unpredictable physical exertion. 2
Ongoing Medical Management
The patient requires:
Regular follow-up with a diabetes specialist to optimize glucose control and reduce symptoms. 3
Frequent blood glucose monitoring, especially before and after any physical activity at work. 2
Education about recognizing and treating hypoglycemia symptoms to prevent severe episodes. 5
Reassessment of accommodation needs as diabetes control improves or if complications develop. 1