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CDL/DOT Physical Exam – Diabetes Mellitus

The complications of diabetes mellitus can lead to medical conditions severe enough to be disqualifying**,* such as neuropathy, retinopathy, and nephropathy. Accelerated atherosclerosis is a major complication of diabetes mellitus involving the coronary, cerebral, and peripheral vessels. Individuals with diabetes mellitus are at increased risk for coronary heart disease and have a higher incidence of painless myocardial infarction than individuals who do not have diabetes mellitus.

Preventing hypoglycemia is the most critical and challenging safety issue for any driver with diabetes mellitus. Hypoglycemia can occur in individuals with diabetes mellitus who both use and do not use insulin. Mild hypoglycemia causes rapid heart rate, sweating, weakness, and hunger. Severe hypoglycemia can cause symptoms that interfere with safe driving.

With Good Management A Driver With Diabetes Can Safely Operate A Commercial Motor Vehicle

The Center for Disease Control and Prevention (CDC) 2007 National Diabetes Fact Sheet reports the prevalence of diagnosed and undiagnosed diabetes mellitus in the United States, for all ages, as:

• Total: 23.6 million people, or 7.8% of the population, have diabetes.
• Diagnosed: 17.9 million people.
• Undiagnosed: 5.7 million people.

The most common form of diabetes mellitus is Type 2 (adult onset or non-insulin-dependent diabetes mellitus). Individuals with Type 2 diabetes mellitus:

• Can produce insulin and have intact blood glucose control counter-regulatory mechanisms.
• May preserve blood glucose control counter-regulatory mechanisms for many years with lifestyle changes and oral hypoglycemic medications.
• May, over time, have insulin production fail and require insulin replacement therapy.

While the detection and management of both hyperglycemia and hypoglycemia are important aspects of the overall medical management of a person with diabetes mellitus, the detection and management of hypoglycemia is more relevant to safety considerations, in the certification of the commercial motor vehicle (CMV) driver, with diabetes mellitus.

Blood Glucose Control

Some of the factors related to commercial driving that affect blood glucose control include:

• Fatigue.
• Lack of sleep.
• Poor diet.
• Missed meals.
• Emotional conditions.
• Stress.
• Concomitant illness.

These same factors may hasten the need for the driver with diabetes mellitus who does not use insulin to start insulin therapy. Poorly controlled diabetes mellitus can result in serious, life-threatening health consequences. However, with good management of the disease process, a driver with diabetes mellitus can safely operate a CMV.