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The Disease of Diabetes

The Association’s position on the proposed rule is based on current medical knowledge and treatment of the disease of diabetes. Diabetes is an incurable disease that affects the way the body uses food. It causes glucose (sugar) levels in the blood to be too high. In type 1 diabetes, the pancreas stops making insulin. In type 2 diabetes, the body makes some insulin, but either makes too little or has trouble using the insulin, or both. Insulin allows glucose to move from the bloodstream into the cells where it becomes the source of the energy needed for all of life’s activities.

People with diabetes regulate their blood glucose levels through awareness of body signals, self-administration of blood tests, and self-administration of medication and food. All people with type 1 diabetes and about half of those with type 2 diabetes must administer insulin either through injections or through wearing an insulin pump. Taking insulin in this manner can result in blood glucose levels that are too low, a condition known as hypoglycemia.

The major concern for a driver who takes insulin is that his or her blood glucose level will become so low that it impairs the ability to drive. While this complication of diabetes occurs in a small minority of people, it does not occur in the vast majority of people who take

insulin.

Accordingly,

federal

law

should

not

automatically

prohibit

anyone

with

insulin-

treated diabetes from operating a commercial motor vehicle Rather, each person with insulin-treated diabetes should be workable individual assessment that emphasizes safety.

in interstate commerce. evaluated based upon a

Advances in Medical Care and Treatment of Diabetes Render the Blanket Ban a Relic

For the commercial operator with insulin-treated diabetes, the medical options available today versus twenty-five years ago are staggering. The 1980s and 1990s witnessed an explosion of

advances threat of

in an

diabetes self-management individual's incapacitation

techniques and tools that dramatically reduced the

due

to

hypoglycemia.

Advances

in

blood

glucose

monitors, insulin, injection devices, insulin pumps, contribute to improved diabetes self-management.

and

self-management

education

all

greatly

In the 1970s, visual strips estimated the glucose level in the urine of the patient by comparing the color of the test strip to a color chart. These strips were not only inconvenient but also inaccurate. Urine glucose levels are not comparable to blood glucose levels and usually will grossly underestimate the latter.

In the early 1980s, the invention of new visual strips allowed individuals to determine their glucose level by using a blood sample. With the introduction of blood glucose meters in the mid-1980s, people with diabetes could, for the first time, accurately and immediately test their blood glucose levels in real time. In less than a minute, a blood glucose meter can give an exact measurement in milliliters of glucose in the blood by automatically reading the test strip. A blood glucose reading allows a person with diabetes to evaluate his or her situation and take the necessary steps to maintain the desired glucose level. Because the modern blood glucose

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