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MICHELE NORRIS, Host:

From NPR News this is ALL THINGS CONSIDERED. I'm Michele Norris.

ROBERT SIEGEL, Host:

And I'm Robert Siegel. Every year around 5,000 people die in accidents involving big trucks. All told, big rigs play a role in 12 percent of all crash deaths. And that's why some safety advocates are upset about a recent change in the law that they say could lead to truckers being involved in more accidents.

NORRIS: For decades federal law made it nearly impossible for truckers to keep driving if they develop diabetes and started to take insulin. The fear was that insulin could put drivers at risk for a drop in blood sugar. That might make them woozy or pass out behind the wheel. Now, as NPR's Nell Boyce reports, a waiver program is making it much easier for diabetic truckers to get around this ban and stay on the road.

NELL BOYCE: When I first met Jeffrey Mather he suggested we go to one of his favorite truck stops near Hagerstown, Maryland. He'd brought along an essay he wrote in the fifth grade.

JEFFREY MATHER: It says, when I grow up, I want to be a truck driver. 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.

BOYCE: For a kid, he had a surprisingly adult view of what it takes to be a trucker. Maybe because his dad drove big rigs. But his list left out one thing, a trucker can't take insulin.

MATHER: Yeah, well I didn't know about that then.

BOYCE: He sure knows it now. Last September, at 37-years-old, he got really sick. It was diabetes. In some cases diabetics can just take pills or watch what they eat. But Jeffrey Mather's doctor said he had to take insulin. And after 10 years of trucking he lost his federal license to drive across state lines.

Mather used to earn $60,000 a year, now he worries about his family's unpaid bills. He says looking for a new job is hard when the one job on your résumé is the one job you can't do. Plus, he just misses the freedom he always felt on the highway.

MATHER: I went into a depression when I found out I couldn't drive no more, you know. It's like, here I'm getting this career I've wanted to do my whole life and it's just, watching it go away from me. So, you know, I'll be driving down a road and I'll see trucks go down the road, I'll start crying.

BOYCE: In the old days that would have been the end of the story, but just in the last few months things have changed in a major way. After years of lobbying from groups like the American Diabetes Association, Congress essentially forced the Federal Motor Carrier Safety Administration to put out a new rule.

There's still a ban on using insulin, but they've made it much easier for drivers to get a special waiver. If Jeff Mather's application is approved, he could be driving again within a year. And so could more than 2000 other diabetic drivers who have also contacted the agency. Highway safety advocates say this is a big mistake.

ANNE MCCARTT: We think that insulin dependent diabetic drivers should not be allowed to drive large trucks. Allowing them to drive represents a safety hazard.

BOYCE: Anne McCartt is a researcher at the Insurance Institute for Highway Safety. She's uneasy about the new 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.

MCCARTT: If there is a severe episode of hypoglycemia that person may be incapacitated and unable to drive, 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.

BOYCE: McCartt says, sure, diabetics drive cars all the time, but a little car is not the same as a big truck. And, she says, the life of a long distance trucker is hard. It's not the kind of a life that makes it easy for people to carefully control their blood sugar.

MCCARTT: They're allowed to drive very long hours. They have difficulty getting good sleep. They're away from home for weeks, maybe even months at a time. Truck drivers have a difficult time finding time to exercise, finding a healthy diet.

BOYCE: Back at the truck stop restaurant, Jeffrey Mather loads up a plate at the buffet, fried chicken, beans, macaroni and cheese. Before he takes a bite, he takes out a small syringe.

MATHER: So, I basically look at my meal and see how many carbs I've got on my plate, and I dose myself per just by dialing it up with the amount of insulin.

BOYCE: He sticks the needle in his leg. It only takes a second. Back outside Jeff Mather says he doesn't understand why he can't just get into one of these big trucks and drive away.

MATHER: They think that you're not able to function. Well, I feel better now than I have for years. I haven't felt this good, I feel like a kid again.

BOYCE: And you think you can do it totally safely

MATHER: Oh yeah. Hands down.

BOYCE: And the new waiver program will give him a chance to prove it. That's why it's won the support of diabetes experts like Christopher Saudek, a doctor at Johns Hopkins Hospital in Baltimore.

CHRISTOPHER SAUDEK: Everybody ought to be evaluated on their own merits individually. I think there should not be blanket discrimination.

BOYCE: Now, 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 anybody 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...

SAUDEK: 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.

BOYCE: He says 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, Saudek says they're unlikely to have any in the future. He also says this new waiver program will improve safety for everyone because it will encourage openness.

SAUDEK: I certainly know people that are in trucking that are afraid of losing their jobs if they start insulin. So they have two options. One is to take insulin secretly, and the other is to not take it but to be in really poor diabetic control and putting themselves at quite a risk.

BOYCE: The bottom line, he says, is if an insulin-dependent driver is safe, it's not fair to single them out just because they have a certain disease. And Saudek says, if this new waiver program is going to have any risks, they're going to be very small and should be kept in perspective.

SAUDEK: There's never a perfect guarantee, there's never a zero risk to driving. And that would apply to 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.

BOYCE: So diabetic truckers like Jeff Mather are busy getting their medical exams and putting their applications together. But the future of this new rule is by no means certain. Both sides of this debate are going to have another chance to weigh in. That's because the Federal Motor Carrier Safety Administration has just announced a new plan to totally rethink all of its rules on medical conditions. First up for consideration? Diabetes. Nell Boyce, NPR News.

SIEGEL: Advocates for diabetics are questioning the test that will be used to decide whether a trucker is safe to drive. You can read about that at our website, npr.org.

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