Tom Milam, CEO of health care provider TrueLifeCare, will tell you that there are three things motor carriers and their drivers need to know about diabetes and how it impacts the trucking industry:
- There's a 50% higher occurrence of diabetes in truck drivers than the national average;
- Drivers with diabetes can apply for a medical waiver with the Federal Motor Carrier Safety Administration (FMCSA) to allow them to operate a commercial vehicle, as long as they meet its specific criteria;
- Yet while the use of insulin is no longer a complete barrier to being able to operate a commercial vehicle on the road, a driver must be able to prove they are maintaining stable blood sugars; not an easy task.
“Managing diabetes on one's own is a daunting task. Add to that the high mobility of truck drivers and it's nearly impossible,” Milam explained to Fleet Owner.
“That’s where companies like ours come into play; developing diabetes management programs for employers who have high incidences of diabetes in their workforce,” he added. “We coach drivers – via telephone – about ways to manage their disease and stabilize blood sugars in order to keep them healthy and on the road.”
Milam said there are two key facts fleets need to keep in mind diabetes: First, that there is no cure and, second, diabetes is progressive, meaning that as symptoms worsen, the disease causes more harm to your body, especially without attentive personal management.
“The most immediate impact for drivers with diabetes is losing their jobs,” he stressed.
“Truck drivers can lose their ability to drive if they require insulin to manage their disease, an almost automatic ‘do not certify’ condition,” Milam said. “Today, nearly 20% of all people with diabetes use insulin therapy. While drivers who use insulin can apply for an exemption, it is a time-consuming and complicated process that can take up to 180 days, costing the driver his livelihood in the meantime.”
And while an insulin prescription isn’t necessarily a career-ending diagnosis, drivers can lose their certification to drive if they are diagnosed with peripheral neuropathy – the loss of sensation of touch in the hands or feet.
“About 70% of all people with diabetes develop some form of peripheral neuropathy because they fail to properly manage their disease,” Milam noted.
Another diabetic “side effect” that can potentially disqualify a driver is retinopathy, which is when diabetes causes fluids to “leak” into the eye, he explained.
“It can take 10 years from the onset of diabetes to start developing, but most people are diagnosed with diabetes five to seven years after the onset of the disease. So, in reality, a driver could start developing retinopathy soon after being diagnosed,” Milam emphasized. “The good news is, with personal management, a driver can keep this condition from developing and progressing.”
While other conditions can affect truck drivers with diabetes, those listed above can disqualify a driver from hitting the road because they impair the sensory skills necessary to safely operate a large truck, he pointed out.
Milam added, too, that proper medications are not only important for helping manage diabetes itself for driver so afflicted, but also its complications, such as hypertension and heart disease.
“Nationally, only 60% to 70% of people with diabetes are compliant with the medication regime. But, for truck drivers, it is closer to 50% to 60%t compliant,” he explained. “The demands of being on the road can hinder a truck driver with diabetes from taking his medication properly or on time. Problems such as failing to organize medications in advance of trips, leaving town without getting a refill or forgetting to pack them are frequent among truck drivers with diabetes.”
That’s where “personal coaching” comes into play
“A relationship with a personal and certified health coach can help a driver adhere to a medication schedule,” Milam said.
“Drivers with diabetes have all of the ‘normal’ challenges that every other driver has—marital and child relationships, families to feed, bills to pay, sick family or relatives—along with the added stress of responsibly managing their disease every day,” he pointed out. “But having a dedicated professional partner in their journey with diabetes can help them better deal with the stress while staying more compliant with both medications and behavior choices.”
Dietary education and support is another critical part of the coaching program because blood sugar levels are directly affected by food types and portion sizes.
“Our approach is to help the person with diabetes learn what happens to their blood sugar and for how long when they consume certain foods,” Milam noted. “Once a person understands what ‘the numbers’ are they are much more likely to engage with their disease and make adjustments to their food choices and quantities. Doing so will help keep their diabetes under control, allowing them to continue working for many more years.”
He stressed that the coaching element important as life with diabetes can be very complicated, especially out on the road
“Think about this: A driver with diabetes must learn to understand and know the actions he should take if he experiences a hyper- or hypoglycemic episode. He or she must self-monitor and analyze blood glucose readings, as well as develop medication management strategies, obtain regular HbA1c readings and develop action plans for improvement or maintenance,” Milam pointed out.
“Additionally, he must develop and implement nutrition and hydration strategies for work, and plan ahead to ensure productive clinical interactions, which normally occur four times per year,” he emphasized.
“Just as you provide drivers with a GPS to map their route, plus other communication devices to ‘see ahead’ and plan for detours, traffic snarls, construction, accidents, fleets need to provide similar guidance support for those of their drivers suffering from diabetes.”