Diabetes mellitus is a chronic life-long metabolic disorder affecting approximately five to ten percent of the population. Diabetes can develop at any age.
Insulin, a pancreatic hormone which maintains normal metabolism of carbohydrates, fats, and protein, regulates how the body uses and stores food for energy. Insulin is the key to diabetes. Lack of insulin affects the body's ability to properly use glucose. In diabetes, the body either stops producing insulin or cannot properly use the insulin it makes. The three types of diabetes mellitus are:
- Type I diabetes: Insulin Dependent Diabetes Mellitus (IDDM) Type I diabetes is diagnosed in ten percent of the people with diabetes mellitus. In Type I diabetes, there is a defect in the person's immune system that triggers the body to destroy its own insulin-producing cells. The onset of Type I diabetes usually occurs before age 40. People with Type I diabetes always require insulin injections to regulate their blood glucose in order to survive.
- Type II diabetes: Non-Insulin Dependent Diabetes Mellitus (NIDDM) Type II diabetes affects approximately sixty percent of people diagnosed with diabetes mellitus. Most people who acquire Type II diabetes are overweight and are over age 40. In Type II diabetes, the pancreas may produce an insufficient amount of insulin or the body may become resistant to insulin, causing it to be less effective or not to be used properly in maintaining metabolic control. Most people with Type II diabetes manage their blood glucose by diet and/or oral diabetes medicine. In some cases, insulin injections are also prescribed for Type II diabetes.
- Gestational Diabetes Mellitus (GDM) which develops during some pregnancies. Gestational Diabetes develops in approximately five percent of pregnant women during the second or third trimester. Once the pregnancy is over, the gestational diabetes goes away. However, a significant number of these women will eventually develop Type II diabetes later in life. Therapy for managing gestational diabetes is either a prescribed diet or insulin injections as determined by the health care team.
The Diabetes Consolidation Matrix and Glossary of Terms defines types of diabetes and provides information on management therapy. The matrix describes ranges of severity and lists possible complications and information on functional driving impairments; provides factors to consider when evaluating a driver; and provides a range of actions for both hypoglycemic and hyperglycemic diabetic reactions including physiological changes which include visual, kidney, nervous system and vascular changes. The matrix provides guidance in determining appropriate actions concerning the driving privilege of individuals diagnosed with diabetes.
Evaluating Drivers With Diabetes
The department may receive a report of a driver with diabetes from a variety of sources, including physicians, law enforcement agencies, and relatives of the driver. All drivers who have been referred to the department with a diabetic condition that may impair the ability to drive are scheduled for a driver safety reexamination. Depending upon the severity of physical or mental impairment and its effect on functional driving, further reexamination including written, vision and drive tests may be necessary. The evaluation of a driver with diabetes must include questioning that is sufficiently thorough to collect the specifics of his/her treatment regimen and its effectiveness.
Factors to Consider:
- Whether the driver understands the need to comply with treatment and is willing and motivated to maintain his/her treatment regimen.
- Whether there are difficulties the driver experiences in work hours, lifestyle, job duties, etc. that could interfere with compliance? For example, it may be easier for a person with sedentary desk job to be able to self-monitor blood glucose levels, make adjustments to insulin dosages, have access to emergency supplies (carbohydrates) and help, and to make appropriate meal choices than a person with odd hours who travels on the road long distances.
- The severity range of any complication that has developed as a result of the diabetes.
Imposing Licensing Actions:
The following matrix provides a range of licensing actions that can be taken for each diabetes complication. Since the driver may be experiencing more than one complication, and each complication may be at a different range of severity, it is important to factor all of these debilitations together. It is appropriate to take the recommended action based on the driver's worst complication, especially if that complication is moderate or severe. Immediate action will be taken against the driving privilege if evidence indicates that the condition renders the person unsafe to drive. The driver may request a hearing after receiving a notice of suspension or revocation.