Diabetes Self-Management Blog

Inspirational stories about people with diabetes reaching for and achieving their dreams are published all the time. One of those stories recently took the form of a Reuters article on Douglas Cairns, a pilot with Type 1 diabetes who plans to fly an airplane solo to the North Pole later this month. The article notes that in most countries, such a solo flight would not be allowed; the Unites States is one of only five that allows people with diabetes who take insulin to fly private planes on their own. Cairns himself must be familiar with restrictions based on his condition, having been released from the British Royal Air Force upon his diabetes diagnosis in 1989.

Few people would argue that there should be no occupational restrictions at all for people with diabetes — especially when it comes to high-risk situations like military combat. But many people believe that existing restrictions are not narrow enough to be rational — and courts often agree, as we noted two years ago when a prospective FBI Special Agent with diabetes won a lawsuit after initially being rejected because of his condition.

One area of employment in the United States that people with diabetes cannot access at all is the military. As About.com notes in its section on the US Military, an official Army Regulation — which the other branches of the armed forces also recognize — lists medical conditions that disqualify individuals from military service. Diabetes is one of them, regardless of its form or whether the person relies on injected or infused insulin. Not quite as restrictive are Federal Aviation Administration guidelines, which focus on people with insulin-treated diabetes. These individuals are barred entirely from first- or second-class medical certification, which means that they cannot fly commercial aircraft. They may, however — on a case-by-case basis according to various medical markers (HbA1c level, hypoglycemic episodes) — obtain third-class certification to fly small private planes.

The rules governing commercial driving also focus on people with insulin-treated diabetes. As the American Diabetes Association notes on its Web site, longstanding federal law once prohibited these individuals from operating a vehicle involved in interstate commerce — which doesn’t mean that the vehicle has to cross state lines, only that it is part of an operation that transports people or goods from state to state. In 2003, however, the Federal Motor Carrier Safety Administration instituted its Diabetes Exemption Program, which allows some people with insulin-treated diabetes to apply for interstate-commerce certification. This program, however, is only open to people who already drive a commercial vehicle that is not involved in interstate commerce. But most states do not allow people who take insulin to operate commercial vehicles involved in state-based operations, or they have strict medical requirements for exemptions from the law. This is also the case for noncommercial state-based positions, such as school bus drivers.

What do you think — what kinds of restrictive rules for diabetes in specialized professions are acceptable? Should every person be judged on a case-by-case basis, or are there some situations in which it is acceptable to exclude categories of people? Is it wrong to single out insulin-treated diabetes for scrutiny? Would it be wrong to single out Type 1 diabetes over Type 2, or vice versa? Leave a comment below!

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Comments
  1. I was diagnosed with Type 2 in October 2006. At the time, I was a member of the NH Air National Guard, and had to admit that I had it. I worked with my unit commander and the base medical clinic, and I was able to obtain a waiver to stay in the Air Guard until 2009, when I was able to retire.

    Posted by Thomas Stanley |
  2. I certainly think it is necessary to restrict drivers or other operators of potentially dangerous machinery if they have a history of hypoglycemia, particularly hypoglycemic unawareness. But people with type 2 diabetes who take daily basal insulin even when it is very unlikely they will experience low blood sugars if it is dosed appropriately should be allowed to drive commercially in my view. We allow people who take oral meds that lower the blood sugar and have the potential to cause low blood sugars to drive. It has never made sense to me to restrict due to basal insulin use.

    Posted by BK CDE |
  3. As a commercial driver with type 2 diabetes, I think it is wrong to single out drivers who are insulin dependent. It might have been appropriate in the early days before the acceptance of pens for injections and before most drivers had coolers in their trucks. It isn’t difficult to determine how many units to use, as my husband proved when he was out on insulin for a short time at diagnosis. And the excuse that our blood sugar may crash is hot valid either, since I have had low blood sugar episodes on oral medicines. I keep glucose tablets within reach for emergencies, but have never had a time when I couldn’t feel such an episode coming on! Take away the no insulin clause, DOT! Drivers need to know they can take care of themselves without fear of losing their jobs!

    Posted by Jean Polk |
  4. I agree with these restrictions however upsetting it may be. Some people cannot detect a hypo until its too late. How can such a person fly a commercial plane? Its a serious risk to all involved, the individual concerned included.

    Posted by Pepprina |
  5. Not an acceptable restriction to me - I would agree to this IF it included ALL diabetes and gave the option of obtaining a waiver if a person could prove control of the diabetes, as does the government job of law enforcement in some national jobs. Some people are sensitive to the ups and downs - a year’s proof of care and control may be all needed, maybe the dotors would say two years would be the right amount of time. For the people who keep a close watch on diabetes there should be no punishment for a disease that can be treated and controlled so easily.

    Posted by Lina |
  6. The ironic part about the restrictions on commercial driving is the crap that most drivers eat and their lack of exercise. My driving, non-diabetic husband eats smart and takes walks but I’ve seen my share of drivers that must be within inches of being diabetics.
    Now that I’m an insulin dependent diabetic we’ve had to rethink our plans of “retiring” on the road. I’m well controlled and aware of (rare)lows. I can just as easily crash my car as a truck. I’d be happy to see the restrictions eased.

    Posted by Susan |
  7. I have been a diabetic since I was 18 months old (I am now 59, what a testimony to modern science!). My mom had to control me from watching the way I acted, as a blood sugar would be drawn and the results given maybe 45 minutes after the draw. She had to rely on her assessment, as mine at that age was not reliable. Well, we have come a long way guys and gals, we have our glucose meters readily available. The truth is though, when I get behind the wheel to drive I do forget to test. I do not condone nor support any diabetic doing that, but it does happen. I used to be very sensitive to my Blood Sugar, but no longer can I tell. I think I would be very dangerous on the road with low blood sugar levels, so in conclusion, I think unless there are rules to keep a hypoglycemic person off the road, we have the potential to cause bad things to happen. In a perfect world, before you get to turn the key to start the engine, you would have to indicate you have tested yourself and are ready to go. We are approaching that kind of standard for people who drink alcohol, why not those who take insulin? I don’t relish the idea of being kept from anything, but I also do not relish the idea of making a fatal or tragic decision to think about the rest of my life! Thanks for listening. Bill.

    Posted by William Hildebrandt |
  8. I am not a diabetic, but was informed that I am borderline. So I look at this from another POV.

    I am sorry, but I believe that there should still be a listing on the DOV’s Commercial list for diabetes…but should have different regulations. (please remember, this is off the top of my head).

    When first diagnosed, they should have a certain minimum timeframe (perhaps 6 months) that they are not allowed to drive. Perhaps the DOV can have a class that they are required to attend, with information on how to drive with diabetes, emergency kits, coolers, walking, etc.

    Perhaps after that, there is another type of waiting time. This is up to the Doctor, and the patient’s team. When the Doctor feels that the “spikes” are under control, and/or that the patient is aware, and is able to take the items correctly, and would be safe on the road, then they have a limited license. I do not know the current regulations, as far as length of drive, and how long they have to “sleep”…but perhaps during the trial period, they are required to take a break (1/2 hour or so) in the middle, for diabetes management (someone would figure out the correct timing), take their blood levels, write it down, and use the remainder for walking/etc (have to be on the honor system for that).

    Then, after they are on a “approved” list…they should have the same regulations, or similar, to epilepsy. If I remember right, when an epileptic has a seizure, and it’s reported to a doctor, they have to report to the DMV, and the driver is suspended for a year. I would feel that the diabetic should have a similar type…If they have an episode, they should go back on a trial basis…perhaps 1, then release by the doctor…2 episodes, they have to go 6 months, then released by the doctor…after that, who knows.

    Sorry for being long, and sorry for thinking that there should be regulations, but I do believe that there should be something to help the population as a whole. And perhaps if I were the driver, I would be on the other side.

    Thank you for letting me speak!
    Mary

    Posted by Mary |
  9. What a sad sad world of rules. Being a diabetic for 47 years the care and treatments have come a very long way. If you want to be a commercial driver be one and check your blood sugars at certain times each day. (If that means 4, 6, or 8 times then do it) you can adjust your intake of food to help keep you safe.

    To renew a drivers license in Illinois I have to have a doctor sign off that I my records show I will be a safe driver. Gee I dont know if others with other medically treated aliments have to do this. (Heart meds, depression, etc. I am not picking on any others.)

    What about those text messaging while driving. Oh yes that is not medical, but dangerous.

    I could go on and on. What it amounts to is being in control of your body. If you loose warning signs adjust to be incontrol.

    I do not believe in restricting.

    Posted by Robin |
  10. DOT drivers have no business driving big rigs and buses if those drivers have either type I or II diabetes. They are already behind the wheel of what could become a deadly weapon. People with diabetes should actually be checking their sugars before they get behind the wheel of their vehicles. And for heaven sakes have a can of pop or something else available-something that won’t so bad when left in the car. “Just in case”. Most of us know to carry a quick source of sugar. Not everyone does get a symptom of low sugar until it is too late.

    Posted by Patricia Pollard |
  11. There should be no restrictions period.
    As long as your health is in good control and your taking the necessary precautions like taking a second drink something if needed or monitor your sugar we should not be discriminated against. I am a heavy construction laborer involved in excavation, hazardous waste and wastewater treatement work.
    Hands on in the trenches literally! there are people without type 1 diabetes who cannot keep up with us. It upsets me deeply that the NYS DMV will not permit me to have a commercial drivers license to further me career or obtain new employment.

    Posted by vincent IDDM 35 years |

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