Trucker MD
A common concern of truckers: Am I at risk for diabetes?

By John McElligot, MD

Most drivers are aware that there is an FMCSA waiver for truckers with insulin-treated diabetes to operate a commercial vehicle in interstate commerce. While there is always some confusion as to who can drive, there’s even more confusion about the disease itself.

The National Diabetes Clearinghouse provides us with a good definition of diabetes, describing it as a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action or both. Diabetes can lead to serious complications and premature death, but steps can be taken to control the disease and lower the risk of complications.

There are two main forms of diabetes: Type 1, formerly called juvenile diabetes, and Type 2, the most common kind, formerly called adult-onset diabetes. What’s the difference? Simply said, in Type 1 your body is not producing insulin, while in Type 2 the body is resistant to insulin.

Here are some of the most frequently asked questions I hear from professional truck drivers.

Do Type 1 and Type 2 diabetes have anything in common?

Type I and Type 2 diabetes mellitus are very different and yet have a common thread. This thread is known as genetics and tends to be triggered by a predisposition that you have acquired over generations.

Here are some predisposing factors in Type I diabetes you may not know. One factor can include cold-weather, since diabetes occurs most often in colder environments. Consumption of certain foods at an early age may cause you to be predisposed to diabetes, and that includes children who are not breast-fed. Viral infections appear to be linked as a small but noticeable cause of Type 1 diabetes.

Type 1 diabetes tends to occur in younger individuals beginning at age 1 through late teens. That’s why it has been called “juvenile diabetes.”

If both parents have Type 1 diabetes, then the offspring have double the chance of developing this form of diabetes.

Type 2 diabetes, which is most common in adults, has an even stronger genetic tendency. The triggering mechanism appears to be most commonly associated with food intake. It has been reported that Type 2 diabetes will soon be labeled as a “food-borne” illness by CDC. With the American tendency for fast foods, the incidence of Type 2 diabetes in children is escalating at a very alarming rate. Although Type 2 diabetes can be seen in individuals of normal weight, it is not common.

Why is diabetes often slow to be diagnosed?

What makes diabetes so dangerous is the duration of symptoms prior to actual diagnosis. Type 1 diabetes is usually straightforward and often presents in an emergency room setting with the patient in a diabetic coma. It can also present to a pediatrician or family practitioner with symptoms of increased thirst, increased urination, and increased appetite in the face of aggressive weight loss and fatigue.

Type 2 diabetics offer a diagnostic challenge in that they likely have had the disease up to 10 years before being diagnosed.  Type 2 diabetics, by the time they are diagnosed, have burned up half of their pancreatic beta cells that produce insulin. It is paramount to begin treatment as soon as possible, especially if there is a family predisposition to diabetes.

What are some of the complications of diabetes?

Complications of diabetes are well known and include blindness, progressive dementia, hearing loss, strokes, silent heart attacks, gastroparesis (inability to empty the stomach of food), renal failure (a leading cause of kidney transplant) and peripheral neuropathies.

The process begins with “sugarcoating” of all the major organ systems. This sugarcoating causes premature breakdown of tissues, leading to the above listed complications. The most dreaded complication of diabetes is progressive weight gain, which leads to metabolic syndrome. This syndrome can develop into cardio-metabolic syndrome, which is often incapacitating and even fatal.

How do you control diabetes? Is it true that bariatric surgery can be a successful treatment?

The control options are many and can be very successful. However, the best treatment for any type of diabetes is education, education, education and diet. Medications are good, but give individuals a false sense of security. They tend to think that it’s OK to eat since they are on diabetic medications.

The other good form of treatment is exercise and then more exercise. Make sure that you are controlling your blood pressure and do not have sleep apnea. The latter is a leading cause of poorly controlled diabetes as well as hypertension.

The only “cure” that is now medically established for cardio-metabolic/metabolic syndrome is bariatric surgery. The type of surgery recommended is bypass since it does not allow patients addicted to eating a means of getting around the remedies the way banding and gastric stapling do. LL


John McElligott is an MD, Fellow of the American College of Physicians, and medical director of the St. Christopher Truckers Development and Relief Fund. This column is the opinion of the writer and does not necessarily reflect the opinions of Land Line Magazine or its publisher.