OBJECTIVE -Hypoglycemia was examined in regularly employed people with insulintreated diabetes to ascertain the frequency and consequences of this problem in the workplace. RESEARCH DESIGN AND METHODS-A prospective 12-month survey of 243 employed people (age range 20 -69 years) with insulin-treated diabetes was performed to record the frequency, severity, and morbidity of hypoglycemia occurring at work. Details of hypoglycemic episodes included time of day, place, activity, causation, blood glucose, treatment, and morbidity. Serial HbA 1c measurements were recorded.RESULTS -A total of 1,955 mild (self-treated) episodes of hypoglycemia (8 per person per annum) and 238 severe (requiring external help) episodes (0.98 per person per annum) were recorded. Of the severe hypoglycemic episodes, 148 (62%) occurred at home, 35 (15%) occurred at work in 27 (11%) people (0.14 episodes per person per annum), and 54 (23%) occurred elsewhere; 52% of severe episodes occurred during sleep. Of the severe hypoglycemic episodes reported, adverse events were described in 54 (23%), with 29 losing consciousness (14%), 21 having a seizure (9%), 4 (2%) sustaining a head injury, 5 (2%) suffering another injury, 3 (1%) injuring someone else, and 2 (1%) damaging property. Severe hypoglycemia in the workplace was associated with six episodes of minor soft-tissue injuries.CONCLUSIONS -In this cohort, severe hypoglycemia in the workplace was uncommon and seldom caused disruption or serious morbidity. On the basis of the frequency and severity of hypoglycemia observed in the present study, restriction of employment opportunities for most people with insulin-treated diabetes may be difficult to justify. Diabetes Care 28:1333-1338, 2005H ypoglycemia is a common side effect of insulin therapy (1) and is perceived to present a significant risk for certain occupations. Restrictions can be placed on prospective or current employees with diabetes, which limit their employment opportunities in Europe and North America (2-4). This may comply with health and safety legislation (5,6) but may not be compatible with employment legislation (7,8). Despite disability discrimination legislation, which now exists in many developed countries, employment opportunities in certain industries are restricted for people who have insulin-treated diabetes (2,3). In the U.K., recommendations for assessing medical fitness to drive (9) are sometimes used inappropriately by occupational physicians to restrict employment for people with insulin-treated diabetes, who are at risk of developing hypoglycemia in the workplace.This present prospective study sought to quantify the frequency with which mild and severe hypoglycemia occurs in the workplace in a group of people with insulin-treated diabetes who were in regular employment. The 12-month study aimed to evaluate the consequences of any adverse events associated with episodes of hypoglycemia, with particular reference to daily work. RESEARCH DESIGN AND METHODS -The study was conducted in a large diabetes center (6,000 patie...