Metabolic diseases are a group of conditions that disrupt the normal metabolism of nutrients usually contained in food. Among these are:
- Diseases of glucose metabolism (carbohydrates), such as hyperglycemia and diabetes.
- Diseases of lipid metabolism (fats), such as hypercholesterolemia
- Diseases of uric acid metabolism (gout)
Metabolic diseases also include diseases related to food excess (obesity and overweight)
Most people suffering from these conditions appear healthy for days, months, or even years. The onset of symptoms usually occurs when the body’s metabolism is put under stress, for example, after prolonged fasting or during a febrile illness.
There are many subtypes of metabolic disorders, and their symptoms, treatments, and prognoses vary widely.
Here we describe, by way of example, the case of diabetes.
The case of Diabetes
Age: 34 year old
Job: Blue-collar worker in a plastic factory
The case of Alex that suffers from diabetes
A few months ago, he was diagnosed with type 1 Diabetes. To manage his disease, he needs to follow a healthy diet, exercise regularly control his blood glucose levels and take medication insulin at certain times of the day, but sometimes he has no time to take food or follow his treatment properly. It is problematic for him to stop working to measure his glycaemia and if he needs to stop to eat something or take a pill, he cannot just walk away from the assembly line. Working in shifts makes following a regular meal pattern difficult. He also feels uncomfortable about taking more time off work for medical appointments. His work on the assembly line of the factory requires standing for long hours at his place, without much movement and this situation is becoming rather difficult for him due to his health.
Alex disclosed his condition to his director and colleagues, but he feels as if they fail to truly understand what having a chronic disease like diabetes means.
1 What is it
Diabetes is a metabolic disorder that occurs when the pancreas produces very little or no insulin (the hormone that regulates the way glucose is handled by the body to be transformed into energy), or when the body does not respond appropriately to insulin. As a result, blood glucose levels are higher than normal (hyperglycemia). High glucose levels are associated with damage to the body and the failure of various organs and tissues in the long-term.
There are three main types of diabetes:
- affects about 10% of people with diabetes
- usually occurs in infancy or adolescence but may affect people of any age
- the pancreas does not produce insulin or only in very low quantities
- autoimmune disease
- typically the disease manifests itself after 30-40 years of age
- is the most common form of diabetes (around 90% of cases of this disease)
- the pancreas produces insulin, but the cells of the organism are unable to use it
- risk factors: family history of diabetes, poor exercise, overweight or obesity
- Treatment options include diet and physical activity, drugs in tablet or injected format, and insulin injections.
- accounts for around 4% of pregnancies
- high level of blood glucose measured for the first time in pregnancy
- usually disappears after pregnancy but women and their children are at increased risk of developing type 2 diabetes later in life:
The main symptom of ischemic heart disease is angina: a pain or discomfort felt in the chest area. Angina often feels like a heaviness or tightness in the chest, which may also spread to the arms, neck, jaw, back or stomach. Some people describe a feeling of severe tightness, while others say it is more of a dull ache. Some people also experience shortness of breath, dizziness and nausea. Angina symptoms are often brought on by physical activity, an emotional upset, cold weather or after a meal.
Type 2: the symptomatology is more nuanced and usually does not allow a rapid diagnosis; hyperglycemia develops gradually, often without clear clinical signs.
Even when the symptoms are few or absent, there is often a risk of developing complications that are important to prevent. These consist in:
- Acute complications: hypoglycemia (low sugar in the blood) and ketoacidosis (a severe disease of metabolism).
- Diabetic ketoacidosis is a relatively rare but severe metabolic emergency. Symptoms include nausea and vomiting, excessive thirst, fatigue, shortness of breath, confusion, fruity-scented breath. Immediate medical care is required.
- Chronic complications: more or less serious damage in the nerves (neuropathy) or in the arteries (vasculopathy), which can lead to diabetic foot, damage in the eye (retinopathy), in the kidney (chronic kidney disease), and in the heart (heart disease), but also in other organs and tissues. Indeed, cardiovascular diseases are frequently associated to diabetes.
In the first instance, prevention of the development of ischemic heart disease by living a healthy lifestyle is of paramount importance. Emphasis is placed on an individual knowing their own risk factors for IHD and applying measures to manage these. The following will help to prevent IHD and also help those already diagnosed with IHD and/or angina in order to manage their condition and symptoms: avoiding or stopping smoking; getting plenty of exercise (minimum 150 minutes moderate intensity exercise per week); a healthy diet (rich in fruits, vegetables and whole grains and low in saturated/trans fats and salt); maintaining a healthy weight (losing weight to achieve this if necessary); reducing high blood pressure and high cholesterol; and managing diabetes.
Some people need operations such as coronary angioplasty with stents or heart bypass surgery to treat their IHD and angina.
Several medications are routinely prescribed for IHD and angina:
- Aspirin – an anti-platelet medication to prevent blood clots
- Statins – medication to lower cholesterol levels
- Nitrates – short or long acting (which contain nitroglycerin) to dilate the coronary arteries and increase oxygen-rich blood to the heart muscle
- Calcium channel blockers – to relax the walls of the coronary arteries and lower blood pressure
- Beta blockers- to slow the heart rate, reduce oxygen demand on the heart and reduce the frequency of angina attacks
Some of these medications may also be prescribed for individuals who are at significant risk of developing cardiovascular disease, to reduce the risk of heart attack or stroke in the future.
4 Psychosocial issues and impact of the disease on employment
For most workers with diabetes, simple accommodations to facilitate diabetes management on the job (e.g., allowing breaks for a worker to test blood glucose, take medication, or eat or granting a worker permission to keep diabetes supplies nearby and to treat diabetes wherever needed) have little to no associated costs.
For most types of employment, there is no reason to believe that diabetes will put the person with diabetes, other employees, or the public at risk.
When assessing whether a particular employee poses an unacceptable safety risk, context is important. The first step in evaluating safety concerns is to determine whether the concerns are reasonable in light of the job duties the individual must perform.
A truly individualized assessment is accomplished when a worker’s diabetes is evaluated in conjunction with an assessment of the essential functions of his or her job.
Moreover, since diabetes therapy implies a good therapeutic education of how to manage the disease, it’s essential that everyone at the workplace (human resources, managers, colleagues) become aware of the particular needs of the patient.
To manage workers with ischemic heart disease and help them continue working or return to work, employers can promote some interventions.
- When possible, it would be useful to make fruit and vegetables, whole grain cereal products, low-fat dairy products, and foods and beverages low in free sugars, added salt, and saturated fat available and to include sugar free food in the canteen. Moreover, it is suggested to promote physical activity, because an appropriate lifestyle, which includes nutritional aspects and physical exercise, is critical for the management and therapy of the disease itself.
- The work schedule should be flexible, as diabetic employees may need to be absent from work for medical examinations. Moreover, if recommended, they may also need to administer therapy (insulin), even when they are at work Thus they might need a space in the workplace for injecting the therapy.
- Support a free and frank flow of communication between the employer and the
employee with diabetes from diagnosis and throughout the whole process.
- Colleagues should be trained to face crises of employees with diabetes, in case, as when their blood sugar level becomes dangerously high or dangerously low, and they become drowsy or unconscious. Drowsiness and loss of consciousness in a diabetic require urgent medical attention. However, most individuals with diabetes know the warning signs and are able to take action. Nevertheless, a group of trained colleagues can be very helpful.
For further information, see:
International Diabetes Federation – Europe (IDF) – https://www.idf.org/our-network/regions-members/europe/welcome.html
European Association for the Study of Diabetes (EASD) – https://www.easd.org/