I would like to take a few moments to share a little bit about a diabetes class we recently held for our Over-the-road (OTR) drivers at the Clarion Hospital, in Clarion County, PA.
Clarion County is 2 hours North of Pittsburgh, 1 Hour from the Ohio line and 1.5 hours south of Erie PA. We have a very rural population with very little industry. Many of our local business that historically were large employers have closed over the past 15 years. Our area is not unique as other rural areas across Pennsylvania have experienced similar shifts in economic climates. We are the home for four modular home manufacturing companies. Many of our local men work in this industry or in the trucking industry. Several trucking companies employ Over-the-Road (OTR) drivers, and there are still some coal mining companies, and smaller employers that employ local drivers as well. OTR drivers are often away from their homes several days to weeks at a time.
Drivers put in long days and must follow strict driving regulations. According to Department of Transportation (DOT) hours of service rules, U.S. property-carrying CMV drivers generally have 14-hour windows to finish all driving related work. ... Drivers must also take a 30-min break after 8 hours of driving. The 16-hour short haul exception though extends that 14-hour window by 2 hours. However, this driver must depart and return to their homes within the 16 hours.
We have had multiple referrals over the past few years for Diabetes Education for redemption of the CDL (Commercial Driver License). It seems that OTR drivers are at more risk of developing diabetes. We have had difficulty getting these folks to attend our program because of their schedules so we decided to offer an all-day Saturday class. Our first class was offered in May. Class was held from 8AM-4:30 PM.
We started off by providing the written requirements of the state of PA DOT for monitoring glucose levels, which is three times a day when working with a CDL. We stressed the importance of testing and making sure they reviewed their results with their Endocrinologist each month as monthly reporting is a requirement of many of our endocrinologists when a driver has the exemption form with Type I diabetes. During our review of meters and continuous glucose monitors, one of our participants shared that he was wearing a Dexcom continuous glucose monitor. He discussed the benefit of the device and loved that it sounded an alarm when his blood sugar was decreasing. He highly recommended this to the other participants…..the power of the group at its finest!
An overview of medication was provided, along with written materials for drivers to keep as a resource. The DOT has forms and regulations regarding use of insulin in management of diabetes including instructions on obtaining an exemption while on insulin and the steps needed to maintain this exemption. I provided instruction on the storage of insulin and emergency preparedness to assure that the proper amount needed is always on hand. We also addressed compliance with medication routines, barriers and additional common medications that are often ordered for people living with diabetes.
We provided written information on Hyperglycemia, Hypoglycemia, 15/15 rule. I instructed drivers to never drive if they are having any symptoms of hypoglycemia and that they must log blood sugars until they are 80 and greater. Instruction was given on the best fast acting sources of glucose and the importance of following up with a meal as soon as necessary to maintain the blood glucose level.
Diet and exercise topics were geared specifically for our audience. Mary Obenreder, the clinical dietitian provided information on nutrition and carbohydrate counting with healthy tips for eating out and eating in the truck. Exercises that could be done around the house, in the truck and the benefits of getting out of the truck for walks every time they stop for fuel were discussed, including ways to increase steps by parking farther from the buildings, taking extra laps around the parking lot and walking at rest areas as well.
Driving can be very stressful so we made sure our audience understood the relationship between stress and increased blood sugars. We discussed anger and stress management techniques including the use of sound machines and guided imagery for relaxation. Diabetes distress was addressed and we provided the class with the suicide prevention hotline number.
Lastly, we discussed the importance of ongoing diabetes management support via additional classes, local agencies, print, apps or websites. Information was provided for the upcoming support group June 12th at 5:30 PM and the date of our annual Diabetes Health Fair with over 40 vendors which will be held this year on November 14th.
OTR drivers living with diabetes have many challenges when it comes to managing their blood sugars. We as Diabetes Educators and CDE’s are well equipped to keep this population safe and healthy behind the wheel. I hope my story about our successful OTR diabetes class will motivate other CDE’s to offer one in their community. Please feel free to email me, Gretchen Frye, RN, BSN, Diabetes Education Program Coordinator, Clarion Hospital and AADE LNG Lead for NWPA LNG with your questions/comments/or success story at gfrye@clarionhospital.org