Happy Saturday, and welcome back to our weekly advice column, Ask D’Mine, hosted by veteran type 1 and diabetes author Wil Dubois.

This week, Wil's tackling a question about how diabetes can play into work-life experiences for those who are often on the road -- literally, those who sit behind the wheel for a living. Read on, to learn more.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

  

Enrico, type 2 from California, asks: How does having diabetes affect those who travel for a living? You, know, like bus and truck drivers.

Wil@Ask D’Mine answers: Great question! Thanks for writing in, Enrico. That’s quite a bit more complex than it sounds, but the bottom line is that it makes diabetes… well… a bit more exciting.

 

But a little background is in order first. A common question we’ve gotten over the years here at Ask D’Mine is: Can you still be a truck driver if you get diabetes? And the answer is, you bet! Well… probably. Maybe…

OK, it depends.

Because here’s the deal: Diabetes isn’t so much a problem for professional drivers as is the kind of diabetes medication used to treat it. For many decades, if you made your living behind the wheel, being put on insulin meant being put out of work. Luckily that changed in 2005, but this still isn’t a simple matter. Why?

Well, there isn’t just one kind of commercial driver. Some drivers only work in a single city. Others drive back and forth across a single state. Others still span the nation. Some carry passengers, some freight. Some both. The size of vehicle a professional driver sits behind the wheel of makes a difference too: Taxis, FedEx vans, armored cars, limos, large delivery trucks, and the hulking 18-wheelers of the Interstate Highways all have different requirements for the drivers, and those requirements can be different in different cites and in different states. On top of all that, if you work for a city government, the city itself may have different requirements for their truck drivers that can be either more strict or more lenient than the surrounding state norms.

Luckily for me, all of this is nicely summarized by the Diabetes Council in their article, You Can Become A Truck Driver with Diabetes, which saves me the trouble of digging through all of this, and frees me to focus on your question of the effect of a nomadic profession on blood sugar levels.

Let’s consider what it means to travel extensively, professionally. You’ll cross time zones. You’ll eat and sleep in strange places. In the case of truck drivers, not only can your days be long, but you’ll be literally sitting behind the wheel all day. Hell, office workers get more exercise, what will the commutes to deliver memos and hit the water cooler and all.

All of this introduces variability, and diabetes detests variability. The easiest way to control your diabetes is to make every day as much the same as possible, with predictable sleep, consistent exercise, and uniform food intake.

Holy crap. How do you do that on the road? You don’t.

So to answer your basic question, the main effect of travel for a living on PWDs is poor blood sugar control. With traveling folks it’s most commonly a toxic mix of elevated overall sugars (basically a high A1C) and bouts of hypoglycemia. That’s about as bad as it gets. High overall sugars are deadly in the long run, and greatly increase the risk of painful and debilitating complications, while bouts of low blood sugar increase the risk of accidents and injury, are frightening, and can leave the victim confused and ill, sometimes for hours.

So what can be done about it? Is this lifestyle hopeless for people with diabetes? No, not at all. But because the environment is inherently chaotic, you must be nimble in your response to it. And to do that, you need to leverage technology and stay focused.

Let’s talk about tech first, because that’s easy. As a person with diabetes, if you are going to choose a lifestyle that is erratic in its nature, you need the best tools you can get. And the most important tool—bar none—is one that will monitor your blood sugar. And as you are facing an erratic, quickly changing environment with many variables, you really need to know what your blood sugar is doing almost all of the time. For this I highly recommend some sort of Continuous Glucose Monitoring (CGM) system.

The Dexcom is an awesome option, but it’s pricey and hard to get for type 2s. Medtronic, once the pioneer in stand-alone CGM systems, is back in the game again with the upcoming Guardian that will use your smart phone as a monitor. And even though I personally had some issues with it, the budget-minded FreeStyle Libre works great for many folks, and could be a game changer for life-on-the-road type 2 PWDs.

But what to do with that information once you have it is where the rubber meets the road. The antidote to chaos is frequent adjustment. You need to be constantly aware of where your blood sugar level is, and where it is going—just as a professional driver keeps track of the vehicles surrounding him or her. Who’s going faster, who’s going slower, who’s passing, who needs to be passed. Then you need to take action based on that information.

In short, healthy living on the road requires constant evaluation and flexible decision-making. Traffic stress you out? Sugar above target? Skip that chicken fried steak at Lisa’s Truck Stop and hit the salad bar. Running low? Always have some glucose handy. Know how a short night of sleep affects your sugar (as well as that extra cup of coffee) and plan ahead; just as you’d look at a road map and decide on the best route for your truck.

Diabetes is a tough gig, and even more so for the road warrior. But that said, using the right tech, and keeping the right focus, it is completely doable.

As an interesting side note, according to the American Association of Diabetes Educators (AADE), truck drivers are at especially high risk of developing type 2 diabetes. So much so, in fact, that current AADE President Donna Ryan told DiabetesMine in a recent interview that the organization, “chose to focus on truck drivers, who have a very high rate of inactivity, sedentary behavior that leads to obesity and type 2” as one of their key targets in a new CDC-funded diabetes prevention program.

This program will be similar to the new Medicare Diabetes Prevention Program we covered recently, but will be offered to at-risk groups who aren’t covered by Medicare. According to AADE Vice President of Science and Practice Leslie Kolb, “Now that CMS has announced that the new Medicare Diabetes Prevention Program will be a covered benefit, we can focus on priority populations where there is little to no access. Specifically, making sure the program is available and serving at-risk populations such as over-the-road truck drivers.”

How are they going to do that?

Apparently, the AADE, in partnership with the Healthy Trucking Association is creating content for use on the trucker-popular Renegade Radio, which streams music out of Nashville.

And there are a lot of truck drivers out there; the American Trucking Associations estimate that there are 3.5 million professional truck drivers in the United States. For the time being, with all those Internet purchases being delivered, it’s a good and growing field, but one with a dark cloud on the horizon. I was interested to learn recently that just like Ubers, self-driving trucks are under development, so the future road warriors are likely to be diabetes-free robots.

Still for this, perhaps the last generation of human truck drivers, diabetes is certainly a challenge -- but it’s not a deal-breaker.

 

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.