Green light

New law lowers hurdles for insulin-dependent diabetics.

For many former and would-be truckers, the new highway funding bill grants a medical reprieve that will make it easier for them to get and keep a commercial driver’s license. Since the 1970s, drivers prescribed insulin to manage diabetes have been forced to give up their CDLs.

Despite several waiver programs, serious and often contradictory hurdles have remained for drivers wishing to return to the road. The most recent exemption allowed diabetics to drive if they could show safe operation of a commercial motor vehicle for three years while on insulin. To qualify, drivers had to operate intrastate, but not every state allowed insulin-dependent truckers to drive commercial vehicles.

Diabetics were also required to provide details of their medical histories, examinations, conditions and treatments from a diabetes specialist. If they received an exemption, they would have to submit to ongoing medical monitoring during the waiver period.

Of the 154 applications FMCSA received since the program began in 2003, the agency had gotten no further than planning to grant exemptions in five cases.

FMCSA announced Sept. 2 that four of the drivers received waivers. The fifth stopped using insulin and returned to the road.

“The denials tend to be grouped into three categories in which the applicants had limited driving experience, insufficient length of time documenting the medical condition or poor driving records,” says Bill McCloud, FMCSA spokesman.

Now that may change. After years of wrangling, Congress finally passed the Safe, Accountable, Flexible, Efficient Transportation Equity Act. The massive funding legislation includes provisions on insulin-dependent diabetes. While the act does not eliminate the requirement that insulin users receive an exemption, it makes doing so much easier.

FMCSA no longer will be able to require applicants to demonstrate a period of safe driving in a commercial vehicle while using insulin. “Insulin-treated individuals may not be held by the Secretary to a higher standard of physical qualification in order to operate a commercial motor vehicle in interstate commerce than other individuals applying to operate, or operating, a commercial motor vehicle in interstate commerce,” the new law says.

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Insulin-dependent diabetics will still have to show a minimum period of insulin use to “demonstrate stable control of diabetes,” the act says. What that demonstration will entail is still unknown.

L. Hunter Limbaugh, chairman of the American Diabetes Association’s National Advocacy Committee, said the bill “will prevent discrimination against people with insulin-treated diabetes while also providing additional commercial truck drivers.”

The act is also good news for many drivers with milder forms of diabetes. Traditionally, diabetics have been put into two categories: Type I diabetics usually contracted the disease as a juvenile and were dependent on insulin to manage blood sugar; Type II (or adult-onset) diabetics contracted the disease later in life and could manage the disease with diet, exercise and oral medications. But the treatment lines have been blurring. Many Type II diabetics are treated with insulin injections.

More than 18 million Americans have one or the other form of the disease, and that number is growing. Fewer than one-third of those with the disease are even aware they have it. Truckers, in particular, are considered a high-risk group to develop diabetes because of weight, diet and low levels of physical activity.

The insulin prohibition began in the 1970s after studies indicated insulin users had higher accident rates than other drivers, due to loss of consciousness or disorientation. A miscalculation during an insulin injection could put a driver and the public at risk, the studies showed.

But blood-sugar testing technology and treatment have improved dramatically since the restrictions were first put in place. Subsequent studies have shown no difference in performance between unaffected drivers and those who have well-managed diabetes.

A lot of diabetic drivers come by the American Business Medical Services clinic based in the Travel Centers of America facility in Baltimore, says Sharon Hansen, a licensed practical nurse who works there. Most drivers are aware of a diabetes problem because they were diagnosed at a biennial physical, or before they got their license, says Hansen, an ABMS vice president.

“But some people can start having problems between physicals,” she says. “So it’s a good idea to know the symptoms and watch for them.”

The main symptoms of diabetes are:

  • Increased thirst
  • Increased hunger (especially after eating)
  • Dry mouth
  • Frequent urination
  • Unexplained weight loss (even though you are eating and feel hungry)
  • Fatigue
  • Blurred vision
  • Headaches

Other symptoms include slow-healing sores or cuts, itching, yeast infections, recent weight gain, velvety dark skin changes of the neck, armpit and groin, numbness and tingling of the hands and feet, loss of consciousness, decreased vision and impotence.

See your doctor if you have any of these symptoms.

Diabetes is more common among Hispanics, African-Americans, Native Americans and Indians. Other risk factors include:

  • Family history
  • Obesity
  • Gestational diabetes
  • Polycystic ovary disease
  • Vascular disease
  • Hypertension
  • High cholesterol levels

MEDICAL. For more information on diabetes, consult the American Diabetes Association: (800) 342-2383 or this site.

REGULATORY. The Federal Motor Carrier Safety Administration will post updated information about exemption requirements at this site. To apply for an exemption, send a request and documentation to: FMCSA Diabetes Exemption Program, 400 Seventh St. S.W., Washington, D.C. 20590.