This week's work has included sixty-six Department of Transportation (DOT) physicals. One of those necessitated some research and discussion that I think worthy of sharing here.
Drivers of commercial vehicles (large trucks, buses with more than thirty-five seats) must pass a basic physical exam to ascertain a minimal degree of health at regular intervals. The presence of diabetes is an important factor in determining a driver's fitness to drive.
Type I diabetes, in which the person is strictly insulin-dependent, is the variety that was once called "juvenile onset" diabetes, as it typically manifests itself early in life. People with Type I diabetes cannot drive commercial vehicles because insulin use is a disqualifier.
Type II diabetes is far more common today as it is linked to obesity, which is epidemic in America. Type II diabetes can be treated with diet, diet and oral medication, or in rare cases, diet with oral medication and insulin injections. The latter group cannot qualify for a commercial drivers' license, though, as insulin is the deal breaker for the DOT.
When Shirley came in Friday to renew her medical certificate for her commercial driver's license (CDL), I looked over her history carefully. She is 5'4" tall and weights 158 pounds. She had Type II diabetes under good control. There was no glucose in the urinalysis, and her blood glucose checks were in a good range. However, she had begun taking insulin injections the day before under the care of her physician at the Veterans Administration Medical Center in Atlanta. This was a definite and disappointing disqualifier for her DOT physical.
This led me to do some research for her. Because Shirley only has a few days to renew her license, she will have to lapse from her Class A CDL to a Class C drivers license that will still allow her to drive her personal vehicle. At some point in the future, should she not need the insulin, she can retake her physical exam. Upon passing the physical, she can take a written test and driving skill check, then reapply for her CDL.
The whole discussion hinges on Shirley achieving a degree of remission from her diabetes to make all this possible. She must get to a point at which she does not need insulin. Is this possible?
Indeed, it is possible. I had a discussion with Shirley that this setback is not necessarily the end of her driving career. Diabetes can be mastered. We have done it with our patients repeatedly.
First, some definitions are in order. The word "cure" in this context would mean that Shirley must maintain normal fasting blood glucose (less than 100 mg/deciliter) without any medication for five years. That time interval is fairly arbitrary, but if she achieved that, we could claim a cure. A party would be in order.
More realistic for her is a remission. Shirley is not hopelessly overweight, so 15-20 pounds may tip her into balance. If she attains fasting blood glucoses under 125 mg/deciliter without any medication for a year, she would have a partial remission. A return to normal fasting glucose levels (under 100 mg/deciliter) without medication would constitute a full remission. Either of these is realistic for Shirley, and a party would still be appropriate to celebrate her return to freedom.
How do you beat Type II diabetes? Simply drop and stabilize the blood glucose at sustained lower levels. Cut fat intake. Maintain metabolism by eating six small meals daily. Focus on low glycemic carbohydrates so that they burn completely instead of being stored as triglycerides and fat. We also use omega 3 and non-flushing niacin to knock down cholesterol and triglycerides, and it works well.
We accomplish this with our patients through our Take Shape for Life program, but we add a critical aspect: coaching. Our patients are supported and coached through the process. As we make changes in lifestyle and life choices, our patients learn new habits that will guide them into a long-term health.
This offers Shirley hope of returning to her career. The path to health for her is not in oral medication and insulin, but in weight reduction to remove the cause of the problem. With coaching, she can turn this around. It will not likely be a long process.
Ironically, beating diabetes is truly sweet.