Rules and Routines for Truckers with Diabetes

Truck drivers often work long hours, travel great distances and are responsible for the safe operation of large trucks. Long haul truck drivers have more than twice the risk of diabetes due to high stress, a tremendous amount of sitting and unhealthy food options. A study published in 2010 stated, “88% of truck drivers suffered from at least one risk factor including smoking, hypertension or obesity. There is a rate of 28%, in long haul truck drivers, for risk of sleep apnea, a condition which limits proper sleep”.
Truck drivers may have been targeted about their health and driving because of these problems. Learn more about the rules and updates for truckers with diabetes.

What were the rules?

• Years ago, there was a ban that prevented truck drivers with diabetes who used insulin from driving commercial vehicles for interstate operation. In 2003, the Federal Motor Carrier Safety Administration (FMSCA) introduced the Diabetes Exemption Program. This permitted people with insulin treated diabetes to drive a commercial vehicle in interstate commerce. However, you needed three years of previous commercial driving experience to qualify. This transportation bill was changed in 2005. Even if you are on insulin, there is no need to show previous commercial driving experience.
• While the new law alleviated the need to have previous driving experience for individuals with diabetes who take insulin, there are 57 provisions, guidelines and screenings to pass in order to get a commercial driver’s license (CDL). Applicants also had to watch state requirements related to obtaining a commercial driver license. Drivers with insulin treated diabetes had to show they have control of the condition while on insulin. Those with type 1 diabetes must be on insulin for a minimum of 2 months before they can apply for the exemption. People with type 2 diabetes must be on insulin for at least 1 month.
• If you were taken off the road for a problem with diabetes, or your insulin, you were placed on the Family Medical Leave Act for 12 weeks. This bought you some time but usually the claim took more than 180 days and many times licenses and driving careers were lost.

Type 2 diabetes with no insulin

• If you had diabetes type 2, and did not use insulin to control it, there is no need to apply for a diabetes exemption. You did need to meet all of the other safety and licensing requirements in accordance with the state agency that issues your CDL. You would be checked for vision, hypertension and neurological function as well as cardiovascular disease. These annual checks generally come with a written re-certification.
• The purpose of regulations for truck drivers with diabetes is to prevent them from endangering other drivers or themselves on the road. Since the crash that nearly killed comedian Tracy Morgan, by a truck driver who had driven too many hours without proper rest, federal regulators have been closely watching truckers who violate these regulations and other safety regulations.

Intrastate Verses Interstate

Truck drivers who have a state waiver and do not drive commercial vehicles in interstate commerce do not need to do anything else. Interstate travel becomes Federal law. Staying in state covers each states rule. When driving, be aware of the differences per state.

New Rules Diabetes and Truck Driving

• On September 2018, the FMSCA announced a “final rule” with the message to people with insulin dependent diabetes that they can safely operate commercial motor vehicles.
• The final rule states, “it will be easier to operate a vehicle with a commercial driver’s license (CDL) in interstate commerce, with a stable insulin regimen and controlled blood sugars”. No longer is taking insulin a “blanket exclusion” for driving commercially interstate.
• This is the first complete update from the FMSCA since 1970.
• This new rule eliminates the “Federal Diabetes Exemption” to drive interstate for those taking insulin. It removes both financial and administrative burdens from the commercial driver, which had resulted in thousands of dollars spent and excess time and paperwork wasted.
• A certified medical examiner can grant an individual a medical examiners certificate stating, “they qualify for operating a commercial vehicle in interstate commerce when diabetes is controlled.”
• A specific A1C value of under 10% is not needed. Now the A1C is factored in to the total picture of diabetes control, not used as the sole factor.
• The certificate is valid for 12 months.
• You can’t continue to drive commercially if you suffer with , either non-proliferative or proliferative, whether on insulin or not.
• The medical examiner will look at all complications including peripheral neuropathy, kidney failure, stroke, congestive heart failure and peripheral vascular disease before making a final decision.

What about Food and Diabetes Supplies?

• Truckers often spend long hours on the road to complete a driving job on-schedule. Always have plenty of diabetes testing supplies on-hand in case you are on the road longer than you expect.
• Keep your supplies away from excessive heat or cold, or they may be ruined.
• Take medication as prescribed and do not miss any doses.
• Keep your blood pressure and cholesterol levels under control.
• Make time to eat your meals and snacks on a schedule to avoid blood sugar fluctuations.
• Do not skip meals.
• Try to avoid the temptation of fast, fried or processed foods at gas stations or truck stops.
• Order a salad, vegetables or grilled meats over salty, fatty foods on-the-go.
• Pick broiled, baked, steamed, and roasted or lightly sautéed foods.
• Avoid fried, cheesy, buttery, and creamy foods, or foods with heavy sauces.
• Learn to count carbohydrates.
• Keep a cooler in the truck and pack it with healthy choices for meals and snacks.
• Snack on small servings of nuts, fruit or cheese sticks/wedges with whole grain crackers.
• Avoid sugary drinks and carry diet iced tea, sparkling calorie-free water or plain water.
• Carry glucose tablets to treat hypoglycemia symptoms as soon as possible. They include weakness, dizziness, shakiness, headaches, hunger, blurry vision and facial tingling or numbness.

What can you do as the commercial operator for a better outcome?

• Wear sunglasses to protect your eyes and sunscreen when you are out of the truck.
• Make sure to get proper eye exams on schedule.
• Look on the Facebook page of the American Truck Drivers Diabetes Association for road food suggestions and other educational tips.
• Talk to your doctor about insulin schedule changes if you will be on the road for a long time.
• Consider using a CGM to help track blood sugars and show you trends before they occur.
• Get enough sleep to minimize diabetes-related complications such as fatigue that can play a role in safe driving. High cortisol levels can increase your blood sugars.
• Step out of the truck every 3-4 hours. Try walking around for 15-20 minutes to fit exercise and stretching into your day. This will help you both physically and mentally.
• Park further away when you are making deliveries to get in more fitness.
• Look for cab gym set ups to use on your truck during down time.
• Put a jump rope and resistance bands in your cab for some needed stretching.
• Ask about wearing compression stockings if you are prone to blood clots or leg swelling.
• Avoid smoking at all costs to improve your overall health.

Truck drivers do have an increased risk of diabetes due to their grueling work schedules as well as generally poor eating habits.

While the rules for truckers have become more realistic and reasonable over the past decade, it is important to follow state and federal regulations. Keep control of your diabetes through healthy lifestyle habits and proper administration of insulin and other medications. Talk to your doctor right away about blood sugar fluctuations and other health care concerns. Stay focused on you and your health.