As of 10/1/2017, this manual has been retired. For current policies, procedures, and standards for the Texas Workforce Commission Vocational Rehabilitation Division, please refer to the following manuals:

In this manual, references to DARS now refer to TWC. The manual includes both links to public content and links to content available only to staff.

Chapter 13: Diabetes Self-Management Services

(Revised 06/14)

13.1 Diabetes Definition

Diabetes mellitus is a chronic disease affecting approximately 18 million Americans.

13.1.1 Type 1 Diabetes

Type 1 diabetes was previously called insulin-dependent diabetes mellitus, or juvenile-onset diabetes. With type 1 diabetes, the pancreas does not produce insulin. Insulin is a necessary hormone that allows blood sugar to enter the cells of the body and be used for energy.

13.1.2 Type 2 Diabetes

Type 2 diabetes, previously called non-insulin-dependent diabetes, accounts for 90 to 95 percent of all diagnosed cases of diabetes. With this type of diabetes, the pancreas can produce insulin, but there is less insulin available and/or a tendency for cells in the body to resist the action of the insulin. Gestational diabetes can occur during the second half of pregnancy. In this situation, a woman has a higher than normal level of glucose in the blood. Glucose levels return to normal after the pregnancy 95 percent of the time.

13.2 Considerations in Vocational Rehabilitation

When writing a plan for someone with diabetes, the vocational rehabilitation counselor (VRC) should consider several factors. First, it is important to maintain medical control of the diabetes through careful diet, exercise, weight management, and use of medications. Therefore, these factors could be a key piece of the rehabilitation plan.

A consumer may need a flexible work schedule with frequent breaks to accommodate snacks and meals, as well as insulin injections, that are necessary to maintain appropriate blood sugar levels. Frequent breaks also may be needed to accommodate common functional limitations, such as low stamina. When discussing job options, the VRC and consumer should not consider jobs with irregular hours, long hours of work without breaks, and irregular physical exertion. Also when discussing possible jobs, the VRC and consumer should remember that the long-term complications of diabetes may not be visible for many years. A good rehabilitation plan takes these factors into consideration.

When the consumer is deciding on a specific employment goal, the VRC should have him or her answer the following questions:

Being prepared for future complications and how they can affect employment will help consumers select appropriate vocational goals, as well as prepare them to have confidence, competence, and independence.

Consumers with diabetes may have functional limitations in the areas of

13.2.1 Treatment and Management Options

The goal of treatment is to keep blood glucose near normal levels at all times. Treatment may include following a carefully calculated diet, exercising, testing blood glucose levels, and having daily insulin injections. As the incidence of diabetes continues to grow, the US Department of Health and Human Services, American Diabetes Association, and other organizations are working toward a cure. Some research includes

13.2.2 Complications of Diabetes

Diabetes can have a number of complications including

13.3 Adaptive Diabetes Equipment and Supplies

The Division for Blind Services (DBS) does not require a prescription for adaptive diabetes equipment and supplies, but it is a requirement for insurance companies and Medicare because of reimbursement criteria.

To maintain consistency and to ensure that the VRC has a thorough working knowledge of (adaptive) diabetes equipment, the VRC must obtain a written recommendation before purchasing adaptive equipment. The recommendation also must include who is to provide training on the equipment.

The recommendation can be obtained from

13.4 Training on Blood Glucose Meter and Insulin Drawing Devices

The consumer can receive training on equipment from

13.5 Services Provided by Diabetes Educators

Diabetes educators have appropriate licensing as health professionals, including certified diabetes educator (CDE), registered nurse (RN), or dietician, preferably with specialization and certification in diabetes education. Diabetes educators are certified by the DBS diabetes program specialist.

Diabetes educators may provide services in

See the DBS Standards Manual for Consumer Services Contract Providers Chapter 5: Services, 5.9 Diabetes Self-Management - Education Services for contract requirements for diabetes educators.