Question
Under section §391.43 of the FMCSR, a driver who is diabetic is disqualified if they are required to use insulin. However, I understand that there is an inhaler that can be used to replace the insulin injection but is still in its experimental phase. If a diabetic who is required to use insulin can use the inhaler instead of a shot every day, can they then be qualified to operate a CMV?
Erik
Answer
That's a very good question, Erik...although I'm not sure that the medical people are prepared to give us a black and white answer on that just yet.
I have read up on the inhaler studies being done also. So much research is being done in the field of diabetes and that's great! I'm a diabetic also, but at this point mine is controlled by diet and an herbal supplement called "Glucosim". So far, my blood tests have been great. I do receive frowns from other medical doctors when I tell them that I am taking Glucosim for my diabetes, but when they see my test results .....they can't argue that it's working.
My guess though on this inhaler is that they are still going to argue the point that it IS still insulin, and as such.....disqualifies a driver from driving. But, we should remain hopeful.
Mary
Darn, I need a spell checker!
[This message has been edited by Mary (edited 03-10-99).]
Answer
Eric,
as Mary stated, this is a very good question. And I am sure the inhaler offers hope to a lot of diabetics. However, if the medication being inhaled is Insulin, I can almost guarantee that it will be a disqualifying factor.
I recently heard of a combination of medications ( in pill form) that is allowing SOME persons who have previously been controlled by Insulin to return to pill medications. The combination is Glyburide and Metformin HCL. Please check with your physician to see if this treatment would be appropriate for you. Everyone is different and any diabetic should be followed very closely by their physician.
I will watch for further info on the inhaler.
Keeping you safe, healthy, and on the road.
Nurse Red
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Answer
If anyone is interested in learning more about the new insulin inhaler or the new oral medication that are undergoing testing right now, you can refer to this site. It goes into depth about the new medications and supplies statistics concerning the studies so far.
http://endocrine.medscape.com/CPG/ClinReviews/1998/v08.n10/c0810.04.html
Mary
I made your link "hot" Mary .... but it says you must be a member to get there?
[This message has been edited by Trucker (edited 03-14-99).]
Answer
Thanks, Monty, for making it "hot". I came back in to do just that.
Darn! I wasn't even thinking about the membership requirement. I'll just have to go back and attempt to copy and paste it here.
Mary
Answer
Thanks, Monty, for making it
"hot". I came back in to do
just that.
Darn! I wasn't even thinking
about the membership
requirement. I'll just have
to go back and attempt to
copy and paste it here.
Mary
Answer
Here is the information presented in the link that I posted previously which is only password accessable.
New Insulin Delivery System Emerging.....
A handheld device resembling an asthma inhaler may one day make injected insulin obsolete. Phase III trials of inhaled insulin are scheduled to begin this fall, and results of earlier studies involving patients with both type 1 and type 2 diabetes are promising.
The new portable aerosol delivery system will be most attractive to patients who have resisted insulin treatment because of "the discomfort and inconvenience of injections," predicted Jay S. Skyler, MD, of the University of Miami in Florida. The mechanically operated device (see photo, right) delivers a dose of insulin in a dry powder through the mouth directly into the lungs, where it enters the blood circulation as rapid-acting insulin.
In one study conducted at 10 sites, 70 people with type 1 diabetes were randomized to continue with their normal insulin regimen of two to three daily subcutaneous injections, or to receive inhaled treatment. The inhaled group took one or two inhalations of insulin before each meal, as well as one injection of slow-acting insulin at bedtime to control blood glucose levels during the night. Over 3 months, the regimens performed comparably, Dr. Skyler said. Levels of HbA1c fell from 8.51% to 7.87% in the inhaled insulin group and from 8.53% to 7.70% in the subcutaneous group.
William T. Cefalu, MD, of the University of Vermont College of Medicine, Burlington, reported similar findings in a second study of 51 patients with type 2 diabetes. Levels of HbA1c decreased by 0.71% in patients taking inhaled insulin and by 0.72% in injected insulin patients. In Dr. Cefalu's opinion, inhaled insulin taken before meals throughout the day better mimics the natural insulin-producing action of the pancreas than does one long-acting injection every morning.
In each study, the incidence of hypoglycemia was similar between treatment groups, and testing showed no significant adverse effects or changes in pulmonary function. Eighty percent of type 1 patients and 92% of type 2 patients chose to continue the inhaled insulin treatment for 1 year.
Clinicians should direct patients who are interested in participating in similar studies to call (800) 438-1935.
New Agent Enhances Insulin Sensitivity.....
A new oral medication, rosiglitazone maleate, has been associated with "impressive" decreases in blood glucose levels, reported study group investigator Barry Goldstein, MD, of Jefferson Medical College, Philadelphia, Pa. In a multicenter, placebo-controlled, phase III clinical trial involving 493 patients with type 2 diabetes, rosiglitazone administered at 8 mg/d lowered blood glucose levels over 26 weeks by as much as 76 mg/dL. "In trials of this type, it is rare to see a reduction in blood glucose levels greater than 60 mg/dL with any single drug," noted Dr. Goldstein.
Rosiglitazone is one of a new class of antidiabetic agents called thiazolidinediones, or insulin sensitivity enhancers. Rather than increase pancreatic insulin production or decrease glucose output through the liver, these agents help the body use its natural insulin more effectively. Earlier trials have shown that rosiglitazone does not cause liver toxicity, nor does it interact adversely with digoxin, metformin, ranitidine, warfarin, nifedipine, or other commonly used medications.
Patients who took 4 mg/d of rosiglitazone experienced reductions of 58 mg/dL in blood glucose levels. Levels of HbA1c fell 1.54% in the 8-mg group and 1.21% in the 4-mg group.
Answer
Good job on the research, Mary.
The inhaler does look very promising for the diabetic patient in general.
But it will probably take some real pushing to get the DOT to waive or accept it because it is still 'INSULIN'. But according to the studies cited in the article, the blood sugar control may be more stabilized with this method as opposed to the injection method. Not as many highs and lows that can cause problems with mental alertness. I beleive this is the factor that made the DOT disqualify insulin dependent drivers.
When they have reached that stage of their diabetes, they become more 'brittle'(meaning sugar levels change rapidly and unpredictably). If this inhaler can be proven to maintain levels more evenly, it may eliminate that problem.
It will certainly be worth watching the trials as they progress. Then will come the tricky part. If the inhaler can do that, somehow, it will have to be brought in front of the DOT for reconsideration.
Let me know if you hear more on the subject.
Keep up the good work, and thanks for your help.
Keeping you safe, healthy, and on the road.
Nurse Red
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Keeping you safe, healthy and on the road.
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Answer
Nurse Red,
Thanks, I will try to find some more current information on the studies and post them.
I wanted to commend you on your article in the "Read Only" Forum. It was an excellent read and very informative. Even with as much reading and research as I try to do, there were some facts in your article that I was unaware of.
My only minor....itty bitty
As I'm sure you're aware, more and more people are turning to doctors who practice natural and/or holistic methods of treatment. I, myself, see a D.O. for treatment of my diabetes and hypothyroidism. I also coordinate that treatment with visits to an endocrinologist, because there is a third condition, and all three are inter-related. However, the point that I am trying to make is that my diabetes is controlled through diet, exercise, and an herbal supplement called Glucosim. I have regular fasting blood tests done and this product...for me...is doing the job. It was my choice to go this route....the natural route.... because of my experience with the thyroid problems and prescription medication.
I just feel that people should be aware of all their options in regard to courses of treatment.....both natural and prescription, understanding though that what might work for one might not work for another.
Thanks for your articles! To borrow a phrase..."Knowledge is Power", and when it comes to making medical decisions and choices...I believe it to be vitally important to be "informed".
Mary
Answer
Mary,
Thanks for the thanks on the Diabetes article. However, Doc was the author on that one. I will take your suggestion to him regarding holistic treatment and medications. What do you think about expanding that topic to discuss holistic treatment in general and then break it out into specific diseases and the treatments for each?
Keeping you safe, healthy, and on the road. Nurse Red
_________________
Keeping you safe, healthy and on the road.
Visit us at
Answer
Nurse Red,
Darn, you sure are ambitious! And that is meant in the kindest way.
I think that it's a great idea to expand your Forum to include information concerning holistic/ homeopathic practices and treatments. The more information....the better... to my way of thinking.
Thanks!
Mary