Jeffrey Mather was a truck driver until last year, when he learned he had diabetes. A federal rule prevents drivers who take insulin from driving big rigs.
The Mather Family
In fifth grade, Mather wrote an essay about what he wanted to be when he grew up, a truck driver. Read the essay.
In fifth grade, Mather wrote an essay about what he wanted to be when he grew up, a truck driver. Read the essay. The Mather Family
How to Tell If a Diabetic Trucker is Safe
While diabetes advocates are pleased that it's now easier for truckers to keep their jobs when they go on insulin, they're not entirely happy with the way that the Federal Motor Carrier Safety Administration (FMSCSA) will decide whether a trucker is safe to drive.
At issue is how to use a blood test that indicates a person's average blood sugar level over the previous few months. The test is called HgA1c, and diabetics usually aim for a test result below seven. That score means blood sugar levels are close to normal.
But FMCSA recently announced that it wants to see a higher test result, between seven and 10. The agency's thinking is that people with lower scores, who are aggressively managing their diabetes with insulin, may be more likely to have periods of very low blood sugar, or hypoglycemia, that could make them pass out or feel woozy.
Diabetes expert Christopher Saudek, at Johns Hopkins Hospital, says the agency's reasoning is flawed. And he says it puts diabetics in a bind.
"Essentially what you're saying with this kind of a rule is that if you are controlling your diabetes at all well, if you get it to 6.8 or 6.5, then you're liable to lose your job," Saudek says. "So congratulations. Your A1c is in a good range, but you aren't going to be able to drive your truck anymore. That doesn't make any sense."
Mary Gunnels, chief of the Physical Qualifications Division of FMCSA, said that the agency's target is just a recommendation to help guide physicians who will be evaluating truckers.
"That is just one of many measurements that are examined when you look at the stability and control of diabetes," Gunnels says. "Each decision is a case-by-case, individual determination made by the endocrinologist."
The FMCSA paperwork that truckers give to their doctors does indicate that doctors should look for the higher test result. It does note, however, that a lower result would be acceptable if the trucker has "no history of severe hypoglycemic episodes."
Some experts think that a person's history of hypoglycemia — and not a single test score — is the best way to determine whether they'd be safe on the road.
In one study published earlier this year in the journal Diabetes Care, for example, researchers reported that they'd recently followed a group of diabetics for six months and found that two were killed while driving cars. Both had HgA1c levels over seven.
A more revealing test result was something that the study's researchers call the "low blood-glucose index," a composite score that reflects the frequency and extent of low blood glucose over a month of self-monitoring. Based on this test, the two drivers appeared prone to problems. In fact, one of the drivers had four episodes of dangerously low blood sugar in the preceding three months, and the other had an episode in the week before his deadly collision.
Jeffrey Mather is standing outside one of his favorite truck stops, near Hagerstown, Md. His dad was a trucker, and Mather said he always wanted to follow in his father's footsteps. To prove it, he brought along an essay he wrote in the fifth grade.
"It says 'When I grow up, I want to be a truck driver,'" Mather reads. "You have to hear well. You have to see well. Truck drivers have to lift heavy things. You have to be 21 years old. You have to be good in math and other studies... ."
The essay contains a surprisingly comprehensive list of what it takes to be a trucker. But Mather's childhood list left out one thing: A trucker can't take insulin.
"Yeah, well, I didn't know about that then," he says.
He sure knows it now. Last September, at 37, Mather got really sick. The doctors said it was diabetes. In some cases, diabetics can just take pills, or watch what they eat. But Mather's doctors said he had to take insulin. So, under federal safety rules, after 10 years of trucking, Mather lost his federal license to drive a truck across state lines.
Many highway-safety advocates say stripping Mather of his trucker's license was a good move. They note that the federal government bars drivers who take insulin because the drug can cause episodes of low blood sugar, which can make a driver woozy or even pass out behind the wheel. And they note that trucks are involved in a disproportionate number of fatal accidents. All told, trucks play a role in 12 percent of all crash deaths.
A Second Chance
Now, though, a change in government policy should make it easier for Mather to get his license back. Under pressure from diabetes advocates, who say the ban on insulin amounts to discrimination that isn't supported by scientific evidence, Congress recently told federal regulators to change the rules. They'll now give diabetic truckers on insulin the opportunity to show that they can drive safely, and win a waiver from the ban. So far, Mather and thousands of other truckers have contacted the agency to ask for applications.
That's a big increase over the numbers that would have been eligible under an old waiver program, which was so restrictive that only a handful of diabetics could have applied. Before the recent rule change, diabetic drivers would have to show three years of safe driving within one state while using insulin before applying for a federal waiver. But because there's very little intrastate trucking, and few states had any kind of waiver program, diabetes advocates say this was a catch-22 that made the old waiver program impossible for most people. But now, the agency has done away with the requirement for three years of in-state driving, and diabetics can apply for the federal waiver the same day they go on insulin. If Mather's application is approved, he could be driving again within a year.
Health a Challenge for Any Trucker
Highway-safety advocates say this rule change is a big mistake.
"We think that insulin-dependent diabetic drivers should not be allowed to drive large trucks. Allowing them to drive represents a safety hazard," says Anne McCartt, a researcher at the Insurance Institute for Highway Safety. She's uneasy about opening up the waiver system, because it depends on truckers being truthful about how well they're controlling their blood sugar. And she says a trucker with low blood sugar, or hypoglycemia, is just too much of a risk to other drivers on the road.
"If there is a severe episode of hypoglycemia, that person may be incapacitated and unable to drive," McCartt says. "And this is a large vehicle maybe weighing 70,000 pounds, taking much longer to stop than other passenger vehicles. It's a risk that we don't think is worth taking."
It's true that diabetics drive cars all the time. But McCartt argues that a little car is not the same as a big truck. What's more, she says the life of a long-distance trucker is harder than most people realize. In her view, it's not the kind of life that makes it easy for people to carefully control their blood sugar.
"They're allowed to drive very long hours. They have difficulty getting good sleep. They are away from home for weeks, maybe even months at a time," she says, ticking off all the reasons she sees a potential problem. "Truck drivers have a difficult time finding time to exercise, finding a healthy diet."
Back at the truck-stop restaurant, Mather loads up a plate at the buffet. It's fried chicken, beans, and macaroni and cheese. Before he takes a bite, he takes out a small syringe that's shaped like a pen.
"I basically look at my meal and see how many carbs I've got on my plate, and I dose my self just by dialing it up with the amount of insulin," he explains.
He sticks the needle in his leg. It only takes a second.
Mather looks wistfully at all the big rigs in the parking lot outside. Losing his job has been very hard on him. He's gone from earning $60,000 a year to worrying about his family's unpaid bills. And he says looking for a new job is hard when the one job on your resume is the one job you can't do.
"I went into a depression when I found out I couldn't drive any more," he explains. "Here I am getting this career I've wanted to do my whole life and watching it going away from me... you know, I'll be driving down the road, I'll see trucks go down the road, and I'll start crying."
He says it seems so strange to him that he can't just get into one of these big trucks and drive away.
"They think that you're not able to function," he says. "Well, I feel better now than I have for years. I feel like a kid again."
Can he do it totally safely? "Oh yeah," Mather says, "Hands down." He says he's grateful that the new waiver program will give him a chance to prove it.
Singling Out High-Risk Drivers
The new program has won the support of diabetes experts like Christopher Saudek, a doctor at Johns Hopkins Hospital in Baltimore.
"Everyone ought to be evaluated on their own merits individually. I think there should not be blanket discrimination," says Saudek.
Over the years, there haven't been that many studies of insulin and driving. But Saudek says the evidence so far suggests that people who take insulin are no more likely to get into car crashes than anyone else.
He says a small percentage of diabetics do have problems with severe drops in blood sugar that could affect their driving. But, he says, "we can identify the people who are at high risk for low blood sugar and we can try to screen them out; we can effectively screen them out."
Saudek says that doctors can spot potentially high-risk drivers by looking at their medical records and past readings on their glucose monitors. If their condition is stable and they've had no problems in the past, they're unlikely to have any in the future.
As far as Saudek is concerned, the new waiver program will improve safety for everyone because it will encourage openness about the disease. "I certainly know people that are in trucking that are afraid of losing their jobs if they start insulin," Saudek says. "So they have two options. One is to take insulin secretly, and the other is to not take it and be in really poor diabetic control and put themselves at quite a risk" of diabetic complications, like eye and kidney disease.
The bottom line, he says, is if an insulin-dependent driver is as safe as anyone else, it's not fair to single them out just because they have a certain disease. And Saudek says that if the new waiver program is going to have any risks at all, they are going to be very small, and should be kept in perspective.
"There's never a perfect guarantee. There's never a zero risk to driving," he says. "And that would apply whether you're sleepy when you drive, whether you're coming home from a holiday party, whether you're a young teenager driving, any number of things."
Uncertain Future for Diabetic Truckers
Diabetic truckers like Mather are busy getting their medical exams and putting their applications together. But the future of this new rule is by no means certain, and both sides of this debate are going to have another chance to make their case in the coming months.
The Federal Motor Carrier Safety Administration has just announced a plan to rethink all of its rules on medical conditions. First up for consideration? Diabetes. The agency is going to be seeking advice on a long list of questions, like how to best monitor diabetic drivers, and whether they should be restricted to certain types of trucking, like only short-haul trips. Agency officials say it could be years before any new rules are finalized. And in the end, they could look very different from the rules in place today.