Commerical Drivers

Commercial drivers include people who have licenses to drive commercial trucks, buses, taxi, etc.  As these people are driving for longer hours and sometimes on a shift-work basis they may be at a greater risk of developing hypoglycemia than drivers of private vehicles.  There is also concern about the size of some vehicles (buses and trucks) and the extra danger that size entails.

CDA Guidelines for Commercial Drivers

bulletAll the guidelines listed for private drivers must be upheld in addition to these extra guidelines for commercial drivers
bulletPersons with diabetes controlled by diet therapy alone or in combination with pills (oral hypoglycemic agents) are at low risk of hypoglycemia and can drive commercial vehicles as long as they receive annual medical exams and regular medical supervision (at least 2 clinic visits/year) as outlined in the private drivers guidelines.
bulletPersons who require insulin to control their diabetes are subject to more rigorous evaluation in order to obtain and keep licenses to drive commercial vehicles
bulletSupplies required to be carried at all times while driving include blood glucose monitoring equipment and a source of rapidly absorbable carbohydrate within easy reach in the vehicle.
bulletBlood sugar must be tested within 1h before driving and every 4h while driving.
bulletDriving should be stopped if blood sugar levels fall below 6.0 mmol/L while driving a commercial vehicle.
bulletDriving should not be resumed until blood sugar levels have risen to > or = 6.0 mmol/L after food ingestion.

Initial Application for a Commercial License

bulletQuestionnaire to be completed by person with diabetes with emphasis on the risk (work schedule, insulin regimen, symptoms of hypoglycemia) and occurrence of hypoglycemia (frequency and severity in past 6 months)
bulletAn internist, endocrinologist, or family doctor trained in diabetes care must perform an initial complete assessment
bulletapplicant must supply evidence of attendance to a diabetes education program
bulletapplicant must present medical records from past 2 years and HbA1c measurement within past 3 months
bulletapplicant must have a dilated eye exam by an ophthalmologist or optometrist
bulletapplicant must have a log of blood sugars performed at least twice daily for the past 6 months or since the diagnosis of diabetes if onset occurred more recently than 6 months

When are you not eligible to receive/maintain a commercial license?

bulletSevere hypoglycemia in past 6 months (loss of consciousness, seizure, or required help form someone else)
bulletHypoglycemia unawareness unless there has been documented recovery of warning symptoms at a later date
bulletUncontrolled diabetes: HbA1c > 12 %
bulletUncontrolled diabetes: > 10 % of capillary blood glucose levels in log < 4.0 mmol/L
bulletSignificant change in insulin regimen (recently started on insulin, new insulin type, change in number of injections)
bulletVisual impairment (best eye must be at least 20/40)
bulletHigh risk proliferative retinopathy
bulletPeripheral neuropathy or cardiovascular disease with potential to affect driving
bulletInadequate record of self-monitoring of blood glucose (unreliable or absent measurements)
bulletInadequate knowledge of the causes, symptoms, and treatment of hypoglycemia