Diabetes Mellitus
Diabetes mellitus is a chronic life-long metabolic disorder affecting approximately five to ten percent of the population. Diabetes can develop at any age. Insulin, a pancreatic hormone which maintains normal metabolism of carbohydrates, fats, and protein, regulates how the body uses and stores food for energy. Insulin is the key to diabetes. Lack of insulin affects the body's ability to properly use glucose. In diabetes, the body either stops producing insulin or cannot properly use the insulin it makes. The three types of diabetes mellitus are: Type I diabetes: Insulin Dependent Diabetes Mellitus (IDDM) Type I diabetes is diagnosed in ten percent of the people with diabetes mellitus. In Type I diabetes, there is a defect in the person's immune system that triggers the body to destroy its own insulin-producing cells. The onset of Type I diabetes usually occurs before age 40. People with Type I diabetes always require insulin injections to regulate their blood glucose in order to survive. Type II diabetes: Non-Insulin Dependent Diabetes Mellitus (NIDDM) Type II diabetes affects approximately sixty percent of people diagnosed with diabetes mellitus. Most people who acquire Type II diabetes are overweight and are over age 40. In Type II diabetes, the pancreas may produce an insufficient amount of insulin or the body may become resistant to insulin, causing it to be less effective or not to be used properly in maintaining metabolic control. Most people with Type II diabetes manage their blood glucose by diet and/or oral diabetes medicine. In some cases, insulin injections are also prescribed for Type II diabetes. Gestational Diabetes Mellitus (GDM) which develops during some pregnancies. Gestational Diabetes develops in approximately five percent of pregnant women during t Continue reading >>
Diabetesvoicejune 2010 €¢ Volume 55 €¢ Issue 1 43
Hypoglycaemia at the wheel is the most common acute risk for drivers with diabetes, and a concern for public road safety. Drivers with diabetes worldwide are subject to special legislation, although the restrictions and requirements vary considerably from one country to another. but are drivers with diabetes really a danger? Are they more likely to provoke an accident than people without the condition? João Manuel Valente Nabais steers us through the related research and reports from Europe on the Eu’s latest laws on driving with diabetes. Since the 1960s, a number of stud- ies have looked at the issues around driving and diabetes. In terms of the possible safety risks from driving with diabetes, the findings are far from con- sensual. Overall, however, there ap- pears to be no clear evidence that a driver with diabetes is more likely to be involved in an accident than a driver without diabetes. Any increased safety risk has been found to be modest, and not sufficient to warrant major legal restrictions on drivers with diabetes.1,2,3 The available scientific evidence does not support a blanket restriction on all drivers with insulin-treated diabe- tes. Another interesting finding is that there is no significant difference in the rate of citations and law violations (such as speeding, careless driving, alcohol and drug violation) for driv- Diabetes at the wheel – the need for safety and fairness under the law João Manuel Valente Nabais ers with diabetes when compared with drivers without a medical condition. Although the immediate effects of mild hypoglycaemia are unpleasant, it is un- likely to create a danger when driving a motor vehicle if treated quickly. This is because the signs of cognitive dys- function, and thus a negative impact on driving c Continue reading >>
Driving & Diabetes
Save for later Having diabetes does not mean that you need to give up driving, but it does mean that you need to plan in advance before you get behind the wheel. We have been campaigning for many years to ensure that you will be able to continue driving safely and without any unnecessary restrictions. This information can help you ensure that your driving is hazard-free. If you require further information, please see theDriver and Vehicle Licensing Agency (DVLA)website (or theDVAin Northern Ireland), or call ourHelpline. Group 1 driver (cars and motorbikes) If you are on insulin, you must tell the DVLA (in the UK) or DVA (Northern Ireland). Your licence will then be renewed every one, two, or three years. Any changes to your condition or treatment which occur between renewals (e.g complications which might affect your ability to drive safely) should be reported when they happen. Drivers who are under medical supervision by a doctor do not need to notify if insulin is used for a temporary period only (less than three months, or for gestational diabetes less than three months after delivery) unless they have problems with hypos/severe hypos/hypo unawareness. If you are a Group 1 driver on non-insulin medication for diabetes you do not need to notify unless: You have had two episodes of severe hypoglycaemia within the last 12 months (where you were completely dependent on another person to treat your hypo). You develop impaired awareness of hypoglycaemia (where you are unable to recognise the hypo when it starts). You experience a disabling hypo whilst driving. You have other medical conditions or changes to existing medical conditions which could affect your ability to drive safely. Examples are: problems with vision (e.g. laser treatment/injections), circulation, or sens Continue reading >>
Commercial Truck Driving And Diabetes: Can You Become Truck Driver With Diabetes
In this article we will explore what it takes to get a commercial driver’s license with diabetes, and how to get an insulin waiver for Type 1 and Type 2 persons who use insulin. We will look at requirements for Type 1 vs. Type 2 diabetes. We will look at insulin vs. non-insulin users. We will look at state vs. interstate CDL requirements. We will also look at the Federal Motor Carrier Safety Administration (FMCSA) diabetes waiver program, and how you can be evaluated to drive a commercial vehicle across state lines when you have diabetes and use insulin. Intrastate guidelines for CDL with diabetes If you want to work in the trucking industry only within your state, and you do not plan to cross any state lines, you can get approved to drive a commercial vehicle in your state. For drivers driving within state lines, you do not need to apply for the Federal Diabetes Exemption. Likewise, you would not need to apply for the Federal Diabetes Exemption if you do not use insulin. Whatever rules and regulations your state has for holding a CDL with diabetes is what you have to follow for intrastate or interstate trucking. It is important to know that most commercial driving will be considered interstate, not intrastate driving, even if you do not cross state lines. If you are carrying cargo or passengers to or from another state, this is also considered as interstate commercial driving. For information on intrastate commercial driving, check with your home state for CDL requirements and see if they are applicable to you. They vary from state to state, with each state having its own regulations. You can look up the laws governing your state by visiting this page at the American Diabetes Association website, You can type your home state in the search for laws and requirements fo Continue reading >>
Diabetes And Driving
You can be fined up to £1,000 if you don’t tell DVLA about a medical condition that affects your driving. You may be prosecuted if you’re involved in an accident as a result. Check with your nurse or doctor if you don’t know what type of medication you’re on. Read leaflet INF188/2 for more information about driving a car or motorbike with diabetes. Diabetes treated by insulin Car or motorbike licence You must tell DVLA if your diabetes is treated with insulin. You can also fill in form DIAB1 and send it to DVLA. The address is on the form. Bus, coach or lorry licence You must tell DVLA if your diabetes is treated with insulin. Fill in form VDIAB1I and send it to DVLA. The address is on the form. Read leaflet INS186 if you want to apply for vocational entitlement to drive larger vehicles (C1, C1E, D1, DIE, C, CE, D or DE). Diabetes treated by tablets or non-insulin injections Car or motorbike licence Check with your doctor or nurse to find out if your treatment means you need to tell DVLA. If you do need to tell DVLA, fill in form DIAB1 and send it to the address on the form. Bus, coach or lorry licence You must tell DVLA if your diabetes is treated by tablets or non-insulin injections. You must fill in: form VDIAB1SG if your diabetes is treated by sulphonylurea or glinide tablets form VDIAB1GEN if your diabetes is treated by any other tablets or non-insulin injections Send the form to DVLA. The address is on the form. Diabetes treated by diet Car or motorbike licence You don’t need to tell DVLA. Bus, coach or lorry licence You don’t need to tell DVLA. Continue reading >>
How To Cope With Diabetes And Driving
Having a driver’s license is a significant responsibility because it impacts your safety and the safety of other drivers around you. Each state has specific laws about driving and diabetes. Find out why risks could be higher for drivers with diabetes and what you can do to maintain your driving privileges. Basics about Driving and Diabetes Most people need to drive to accomplish certain things in a day such as getting to work, school, medical appointments, shopping for food and other important things. There are certain organizations dedicated to representing all people with diabetes that state “laws make it harder for drivers with the condition” which may be discriminatory. Each state has laws related to driving with diabetes, whether you want to get a non-commercial or commercial driver’s license. Some have restrictions and others do not. It is important to find out the laws in the state where you reside. Many people have “diabetes” noted on their license for added protection. In some states, your license can be taken away if you experience severe hypoglycemia or low blood glucose that requires treatment. Low blood sugars often mimic the symptoms of drinking too much alcohol so police like to know if diabetes may be a factor. A person must maintain healthy blood sugar levels for a designated period or prove it will not occur again. The good news is hypoglycemia can usually be prevented by testing frequently and having a glucose source with you. Accidents State laws regarding diabetes and driving exist because of the possible increased risk. According to published research, people with diabetes have an approximate 12-19% increased risk of having an accident. Other study results are mixed. Factors such as the location, meals eaten, your exercise schedule, and Continue reading >>
Driving With Diabetes
Has diabetes affected your experience of driving? It can. How about getting licensed to drive? In some states, diabetes can make obtaining a driver license much harder. The biggest risk in driving with diabetes is low blood glucose. Our brains run on glucose, and when glucose gets low, it’s very hard to think or react. This is why authorities can be suspicious of people’s ability to drive with diabetes. One of the largest studies on safe driving with diabetes was published by University of Virginia researchers in 2003. At diabetes specialty clinics in seven US and four European cities, about 1,000 adults with Type 1 diabetes, Type 2 diabetes, and without diabetes completed an anonymous questionnaire concerning diabetes and driving. The results showed that drivers with Type 1 reported significantly more crashes and moving violations. Drivers with Type 2 did not, even when they were on insulin. Nearly all the accidents were related to hypoglycemic (low blood glucose) episodes. People who injected insulin were more likely to crash than those who used an insulin pump. Fewer than half of people with either type had discussed driving with their doctor. The researchers found that not checking glucose before driving was a big risk factor for accidents, and “encouraged [all physicians] to talk to their type 1 diabetic patients about hypoglycemia and driving.” There may not be studies, but on many Internet bulletin boards, people with Type 2 have reported difficulty driving from either high or low blood glucose. People talk about “brain fog” as a symptom that can come from lows or highs. Some commented that for people who typically run high, getting down to “normal” can feel like having a low and fog your thinking. If you ever feel fuzzy while driving, the America Continue reading >>
Driving And Diabetes
Individuals with diabetes who have a driver’s license must: Have regular checkups by a physician (to assess potential diabetes complications and blood glucose (sugar) control); Have a good understanding of their disease and follow the recommendations of health care professionals; Take certain precautions when driving (primarily people at risk of hypoglycemia). Precautions for individuals being treated with insulin or an insulin secretagogue* You must measure your blood glucose (sugar) levels before taking the wheel, then every 4 hours thereafter on long trips. Your blood glucose (sugar) levels should be: Above 4 mmol/L if you are driving a car or motorcycle Above 6 mmol/L if you are driving a vehicle other than a car or motorcycle (classes 1, 2, 3, 4) If you have ever had severe hypoglycemia or hypoglycemic episodes with no warning signs, caution is advised. You should measure your blood glucose (sugar) levels before you depart and every hour thereafter. In this case, your blood glucose (sugar) level should be above 6 mmol/L before taking the wheel of a car or motorcycle. *Gliclazide (Diamicron® and Diamicron MR®), Glimepiride (Amaryl®), Glyburide (Diabeta®, Euglucon®), Nateglinide (Starlix®), Repaglinide (GlucoNorm®). Research and text: Cynthia Chaput, Dt.P., Dietitian June 2014 Reference: Association des Specialistes en Medecine Interne du Quebec. (2012). Document produit à l’intention des patients. (Downloadable PDF; French only.) (Consulted May 15, 2014). Continue reading >>
Diabetes And Driving (factsheet 16)
This factsheet provides information for drivers with diabetes. It gives advice on some of the risks and precautions for diabetic drivers and outlines limitations and conditions which may apply to your licence when you are driving. Check our driver licence section for this information Continue reading >>
Driving
The guidelines for diabetes and driving have recently been updated. This page and resources are currently under review. Please visit the Austroads website for more information. In March 2012, new medical standards came into effect for drivers of both private and commercial vehicles. The new standards are contained in the Austroads document Assessing Fitness to Drive 2012, which replaces the previous standards (Assessing Fitness to Drive 2003). The new standards include the following: Private vehicle drivers treated by glucose-lowering agents other than insulin may generally drive without licence restriction but should be required to have five-yearly reviews. In addition to the sections on hypoglycaemia, there is now a new section on hyperglycaemia for commercial drivers whose diabetes is treated by either insulin or other glucose lowering agents and for private drivers whose diabetes is treated with insulin. The new medical standards address ‘satisfactory control’ of diabetes and state that satisfactory control “will generally be defined as a glycated haemoglobin (HbA1c) level of less than 9.0% measured within the preceding three months”. The use of the term ‘generally’ is intended to allow medical practitioners to make their own clinical judgements on the ‘satisfactory control’ of diabetes on a case-by-case basis. ‘Satisfactory control’ of diabetes is required for a conditional licence to be considered by the driver licence authority. If you take medication for diabetes and you are a commercial driver, you must have an annual review by a specialist in endocrinology or diabetes to ensure you meet the specific criteria to hold a conditional licence. If you are a private driver and your diabetes is treated with insulin you must have a review at least e Continue reading >>
Truck Drivers With Diabetes Dot Regulations
The Department of Transportation (DOT) and the Federal Motor Carrier Safety Administration (FMCSA) adapted medical guidelines that diabetic truck drivers must meet. They are part of the requirements for obtaining an interstate Commercial Driver’s License (CDL). At one point in time, a truck driver with diabetes had to prove they have had diabetic episodes for three years to qualify for the diabetic exemption program. Since the diabetic exemption program was revised, this qualification no longer applies. Read below to find out what the new DOT regulations mean for prospective truck drivers with diabetes. Changing DOT regulations for diabetic truck drivers The first diabetic exemption program was established in 2003. It contained a long list of stipulations that made it hard for diabetic truck drivers to qualify for their CDL. This kept many capable truck drivers from employment with interstate trucking companies. One of the main DOT regulations hindering diabetic drivers from qualifying for the exemption program was the three-year rule. The three-year rule stated truck drivers with diabetes must have a record of driving for three years without a diabetic episode, and must have been on insulin for that time. It prevented nearly all potential drivers with diabetes from meeting the old DOT regulations. Between 2003 and 2005, only four exemptions were granted to diabetic truck drivers. On November 8, 2005, the FMCSA overturned some of the rules stated in the 2003 diabetic exemption program. The agency made vital changes, opening the road to more diabetic truck drivers. The FMCSA started accepting applications for the revised diabetic exemption program on September 22, 2005. Implementing changes in the DOT program for diabetic truck drivers The 2005 DOT regulations for the Continue reading >>
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Diabetes And Driving
Of the nearly 19 million people in the U.S. with diagnosed diabetes (1), a large percentage will seek or currently hold a license to drive. For many, a driver's license is essential to work; taking care of family; securing access to public and private facilities, services, and institutions; interacting with friends; attending classes; and/or performing many other functions of daily life. Indeed, in many communities and areas of the U.S. the use of an automobile is the only (or the only feasible or affordable) means of transportation available. There has been considerable debate whether, and the extent to which, diabetes may be a relevant factor in determining driver ability and eligibility for a license. This position statement addresses such issues in light of current scientific and medical evidence. Sometimes people with a strong interest in road safety, including motor vehicle administrators, pedestrians, drivers, other road users, and employers, associate all diabetes with unsafe driving when in fact most people with diabetes safely operate motor vehicles without creating any meaningful risk of injury to themselves or others. When legitimate questions arise about the medical fitness of a person with diabetes to drive, an individual assessment of that person's diabetes management—with particular emphasis on demonstrated ability to detect and appropriately treat potential hypoglycemia—is necessary in order to determine any appropriate restrictions. The diagnosis of diabetes is not sufficient to make any judgments about individual driver capacity. This document provides an overview of existing licensing rules for people with diabetes, addresses the factors that impact driving for this population, and identifies general guidelines for assessing driver fitness and de Continue reading >>
Insulin-dependent Diabetic Requirements
Before an applicant for waiver for diabetes will be approved, the applicant must attend a meeting of the Motor Carrier Safety Appeal Board. An applicant will be scheduled to attend the next available board meeting after a completed packet is received. Packets are due no later than two weeks before the meeting date and must include: MC-027 - Application for Intrastate Medical Waiver. MC-028 - Physician's Statement of Examination. (Make sure box B, E and F is checked before printing.) A Medical Examination Report for Commercial Driver Fitness Determination (Form MCSA-5875) completed by a medical examiner familiar with the requirements of 49 CFR 391.41. (DOT Physical) Sixty days of blood sugar readings taken twice a day, including physician's recommended range. Application for employment for company applicant intends to drive for. A copy of the driver's official driving record. A copy of crash reports for any accidents applicant was involved in during the previous five years. Continue reading >>
Driving And Type 2 Diabetes
Having diabetes is not an issue for driving but if you are taking medications that leave you at risk of hypoglycaemia you must take extra precautions and you must inform the National Driver Licence Service. CHECK WITH YOUR PHARMACIST IF YOUR MEDICATIONS LEAVE YOU AT RISK OF HYPOGLYCEAMIA e.g. Insulin or Sulphonylureas such as Gliclazide (Diamicron®) or generic versions such as Diabrezide, Diaglyc, Diacronal MR, Diaclide MR, Gliclazide, Zycron MR.or the post prandial regular Nateglinide (Starlix®). If you are not at risk of hypoglycaemia you do not need to inform the National Driver Licence Service (NDLS). Medicine regimes change therefore remember to tell the NDLS if you start any of the medications that increase the risk of hypoglyceamia. Drivers at risk of hypoglycaemia are advised to take the following precautions: • You must always carry your glucose meter and blood glucose strips with you. You must check your blood glucose before the first journey and every two hours whilst you are driving. • In each case if your blood glucose is 5.0mmol/l or less, take a snack. If it is less than 4.0mmol/l or you feel hypoglycaemic, do not drive and take appropriate action to correct glucose level. • If hypoglycaemia develops while driving, stop the vehicle as soon as possible. • You must switch off the engine, remove the keys from the ignition and move from the driver’s seat. • You must not start driving until 45 minutes after blood glucose has returned to normal. It takes up to 45 minutes for the brain to recover fully. • Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets, lucozade or sweets within easy reach in the vehicle. • You should carry personal identification to show that you have diabetes in case of injury in a road tra Continue reading >>
Driving And Diabetes: Problems, Licensing Restrictions And Recommendations For Safe Driving
Abstract Driving is a complex process that places considerable demands on cognitive and physical functions. Many complications of diabetes can potentially impair driving performance, including those affecting vision, cognition and peripheral neural function. Hypoglycemia is a common side-effect of insulin and sulfonylurea therapy, impairing many cognitive domains necessary for safe driving performance. Driving simulator studies have demonstrated how driving performance deteriorates during hypoglycemia. Driving behavior that may predispose to hypoglycemia while driving is examined. Studies examining the risk of road traffic accidents in people with insulin-treated diabetes have produced conflicting results, but the potential risk of hypoglycemia-related road traffic accidents has led to many countries imposing restrictions on the type and duration of driving licenses that can be issued to drivers with diabetes. Guidance that promotes safe driving practice has been provided for drivers with insulin-treated diabetes, which is the group principally addressed in this review. Keywords DiabetesType 1 diabetesType 2 diabetesInsulin therapyHypoglycemiaAutomobile drivingDriving performanceDriving licenseRoad traffic accidentMotor vehicle accident Introduction Driving has important business and recreational roles for transport in most countries, allowing people to travel to and from work, pursue their employment, and undertake multiple social and domestic activities. Most people regard driving to be a fundamental part of daily life; especially those with limited access to public transport [1]. Safe driving requires complex psychomotor skills, rapid information processing, vigilance and sound judgment [2]. Driving is classified as a light physical activity [3] but has considerable Continue reading >>
