Most doctors prefer not to prescribe medicines for Type 2 diabetes if it can be controlled in other ways like with diet and exercise

Most doctors prefer not to prescribe medicines for Type 2 diabetes if it can be controlled in other ways, like with diet and exercise.

Truck drivers suffer from diabetes 50% more than rest of America

Doctor offers some tips on how to get a little healthier on the road

A truck driver's life is a recipe for diabetes, and the statistics prove it. In the U.S., about 9.4% of the population has diabetes according to the Centers for Disease Control. For truckers, that number is 14%.

Why do truckers suffer from diabetes at a rate almost 50% higher than the rest of Americans? They have more risk factors, physicians say. Drivers smoke more – about half of truck drivers smoke compared to 19% of other adults – they rarely exercise and their diet is high in calories and fat. Also, almost 70% of truck drivers are obese, which is more than twice the nation average. See: Obesity and other risk factors: the national survey of U.S. long-haul truck driver health and injury.

The American Diabetes Association recommends aiming for a blood sugar level between 70 to 130 mg/dl (milligrams per deciliter) before meals and less than 180 mg/dl one to two hours after a meal. Fasting before a blood test gives the most accurate reading.

Physicians like Dr. Albert Osbahr who treat truck drivers among other patients, say they’re taken aback when drivers are surprised when they're disqualified.  "They have numbers that are high and wonder why we might give them short cards or might actually, in some cases, disqualify them when their numbers are 450 or 500. They'll look at me in disbelief and say: 'Why would you do that?' I say, 'This is not stable. This is not safe.'"

"If we don't find ways to improve this we'll have more guys with eye problems, heart problems, kidney problems, stroke-like symptoms or sensation problems because of diabetes," noted Osbahr, who is the medical director of occupational health services at Spartanburg (SC) Regional Healthcare System and a Board of Trustees Member of the American Medical Association.

"Weight loss is very crucial to diabetes control,” he added. “I've seen dramatic control of diabetes Type 2 when people lose weight. The two key issues in terms of weight – as long as there's not something else in the way like another disease such as thyroid or a medication that is causing extra weight – are exercise and diet."

About 90 to 95% of people with diabetes have Type 2, a condition in which your body doesn't use insulin properly, a malady also known as 'insulin resistance.'  Insulin is a hormone made by the pancreas that allows your body to produce sugar from carbohydrates in food. This sugar (glucose) gives you energy which is why one of the first signs of diabetes is fatigue. Type 1 diabetes is rarer and usually presents itself in children as the pancreas may be dysfunctional from birth and not produce any insulin.  People with Type 1 diabetes must take insulin every day, usually by injection. Contrary to what some people believe, Type 2 diabetes cannot become Type 1 diabetes. They are different diseases. 

Because of how well medications work on Type 1 diabetes, The Federal Motor Carrier Safety Administration has proposed that drivers who use insulin may no longer need a medical waiver to drive but instead can get certified annually by their health care provider that their diabetes is well controlled by insulin.

Tips for drivers

Osbahr repeats what he says to every trucker with diabetes. "When I see guys in the office and they raise the issue [of how to lose weight] I say, 'Add a little extra to your regular activities. Any little bit of extra exercise, walking, even doing some flexibility calisthenics for 15 minutes while you're getting ready to sleep or getting up in the morning can help. Probably the biggest thing is parking farther away from the truck stop [building], making that walk in and out and do that [extra walking] with any other kind of activity."

The other thing I say is 'you guys have to inspect your trucks. Why don't you make multiple trips around your truck in your inspection, but make it like a walk? You don't need a gym or a running track. You can add some jumping jacks if you can. You can do some knee-ups if you can. You can do some running in place if you want to, but everybody is probably able to at least walk and that does not require any additional equipment.'"

As for diet, Osbahr concedes that truckers have fewer healthy options on the road than most workers. "The foods that are offered on the road are not very good; they're also high caloric. You have to work to find the right ones. And I tell a lot of the guys, 'How many fat vegetarians have you seen?' Most of the guys will laugh and say, 'You're right; there are not too many of them.'  I tell them, 'Yeah I've seen a few, but  not that often.' There is something [healthier] about eating vegetables and fewer starches, breads, and meats, even though I love them. There's something to be said for eating more vegetarian foods. You probably would lose more weight, but we don't always see those options on the road….  In general, the lifestyle of a trucker does not lend itself well to losing weight. There's no question about that."

Dr. Adrian Vella, who studies Type 2 diabetes at the Mayo Clinic and sees patients about 40% of his time, said that if he had to choose one thing for truckers to do that would prevent or handle diabetes it would be diet. "To me, the most important thing is the amount of calories you eat compared to the amount of energy expended during the day. The second most important thing is what those calories consist of. In general, it would be a good idea to avoid high-fat, calorie-dense foods."

"Nine times out of 10 they [patients] are doing bad things,” he added. “They are not compliant or following recommendations, and I understand that this is difficult for truck drivers. The other issue is what physicians face when they're trying to choose medications for their patients. They want to avoid hypoglycemia at all costs for obvious reasons."

Some diabetes medicines cause hypoglycemia or low blood sugar which is deadly for drivers as it can cause blurry vision, poor coordination, tiredness and confusion. 

Both Vella and Osbahr say that most doctors would prefer not to prescribe medicines for diabetes if it can be controlled in other ways, but often they have no choice as many patients are non-compliant when it comes to diet and exercise.

Osbahr knows that treating diabetes, especially in truckers, is an uphill battle. "The biggest problem I find is a lot of guys not taking care of themselves… It is hard for us as humans to stay disciplined in a way to take care of ourselves and truckers are no different than the rest of us non-truckers. Motivation seems to come only when bad things happen to our health. Plus, most of the truckers are men and we, as men, do not keep up on our health like we should."

Unfortunately, he sees truck drivers and diabetes as indicative of our nation's future. "We're not talking about just truckers who are a window into what our culture is doing. Our culture has gotten heavier and truckers are at the extreme." 

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