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DOT Exam Oakstone Course > Diabetes > Flashcards

Diabetes Flashcards

1
Q

The diabetes mellitus standard is (discretionary/nondiscretionary).

A

nondiscretionary

examiners have no discretion in applying the diabetes mellitus standard for driver certification.

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2
Q

What are some factors that make it challenging for long-haul commercial motor vehicle drivers to control their glucose levels?

A

Concomitant illness
emotional conditions
fatigue
lack of sleep
skipped meals
poor diet
stress

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3
Q

Under what circumstances can an insulin-dependent commercial motor vehicle driver be certified, and for how long?

A

Three conditions have to be met in order for the medical examiner to certify the insulin-dependent commercial motor vehicle driver:
1. The insulin-dependent driver must be determined as stable by the treating clinician
2. Treating clinician must supply form MCSA-5870 to the medical examiner prior to the time the medical examiner examines the driver
3. The medical examiner must confirm the driver to be otherwise qualified and to not be at risk for an incapacitating event.
If all three conditions are met, then the medical examiner can certify the driver for up to one year.

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4
Q

When is an insulin-dependent driver unable to be certified to drive a commercial motor vehicle in interstate commerce?

A

The insulin-dependent driver cannot be certified if they’re taking insulin but their sugar level is not stable.

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5
Q

Under what circumstances can a diabetic commercial motor vehicle driver who uses oral hypoglycemics or diet or exercise to control their diabetes be certified to drive a commercial motor vehicle in interstate commerce?

A

This requires the medical examiner’s discretion on a case-by-case basis.

A driver on oral hypoglycemics can be certified for 1 year, as long as he is stable and is tolerating medications with no side effects.

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6
Q

A driver on oral hypoglycemics can be certified for _____, as long as he is stable and is tolerating medications with no side effects.

A

one year

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7
Q

If an insulin-dependent driver experiences a severe hypoglycemic reaction, how does this affect their eligibility for certification to drive a commercial motor vehicle in interstate commerce?

A

Their treating clinician must certify them as stable prior to the medical examiner being able to certify them to drive a commercial motor vehicle in interstate commerce.

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8
Q

Does the treating clinician have to be involved in certification of all diabetic commercial motor vehicle drivers?

A

No. They only have to be involved in patients who are insulin treated. They are not involved in patients who have non-insulin-dependent diabetes (type II diabetes).

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9
Q

What are signs and symptoms of hyperglycemia?

A

Fatigue
Lethargy
sluggishness

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10
Q

_______ and ______ are complications of hyperglycemia that can cause impaired cognitive function. However, these conditions develop slowly and are rare.

A

ketoacidosis

hyperosmolarity

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11
Q

Name conditions that are complications of hyperglycemia and which would disqualify a driver from being certified to drive a commercial motor vehicle.

A

Neuropathy
Retinopathy
Nephropathy
Atherosclerosis

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12
Q

Signs and symptoms of mild hypoglycemia?

A

sweating
weakness
hunger
rapid heartbeat

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13
Q

What is the FMCSA definition of severe hypoglycemia?

A

A condition that results in:
seizure
loss of consciousness
need of assistance from another person
period of impaired cognitive function occurs without warning

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14
Q

What is the most critical and challenging safety issue for any driver who has diabetes?

A

preventing hypoglycemia

be aware that both type I and type II diabetics who use insulin are at risk for hypoglycemic reactions

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15
Q

What are type II diabetic drivers required to carry at all times while driving?

A

They must have a source of rapidly absorbing glucose to take if they start getting symptoms of hypoglycemia.

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16
Q

When are hypoglycemic reactions disqualifying for diabetic drivers?

A

Any diabetic driver whose hypoglycemia is severe enough to cause impaired cognitive function, or who experiences seizure, loss of consciousness, or needs assistance from another person, is disqualified until they are cleared by their treating clinician via form MCSA-5870.

No maximum permitted episodes of severe
hypoglycemia. Each episode triggers
evaluation by treating clinician and return to
driving only if found to have stable insulin
regimen and properly controlled ITDM (insulin treated diabetes mellitus).

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17
Q

What form is the diabetic driver’s treating clinician supposed to provide to the medical examiner prior to the drivers certification exam?

A

Form MCSA-5870
This form is called the insulin treated diabetes mellitus assessment form.

18
Q

What is the time limit by which the treating clinician must provide form MCSA-5870 to the medical examiner?

A

Must be provided by the treating clinician no later than 45 days after determining that the driver is stable on insulin treatment.

Once the medical examiner receives this form, if the driver meets all other criteria for certification, then the medical examiner can certify them certification to drive a commercial motor vehicle in interstate commerce for up to one year.

19
Q

Which MCSA form is the medical examiner’s certificate?

A

MCSA-5876

20
Q

What are some comorbidities of diabetes?

A

Peripheral neuropathy
autonomic neuropathy
microvascular disease of the eye
macro vascular disease

21
Q

What are important things to document regarding the health history of a patient who has diabetes who is seeking certification to drive a commercial motor vehicle in interstate commerce?

A

-Document significant findings associated with positive history of diabetes elevated glucose

-document that you discussed the use of diet, exercise, oral medication, and insulin to control diabetes

-document that you discussed side effects, potential for interactions with other medications including over-the-counter stuff

-document all medicines the driver uses to treat diabetes

-ask about in the document symptoms of diabetes as well as associated and organ damage

-document that you discussed hypoglycemic and hyperglycemic reactions, including severity, frequency, and prevention

-document the driver says they have provided their treating clinician with the past three months of glucose monitoring, and that you have received and reviewed the MCSA-5870 form

22
Q

What information must a diabetic driver provide to the treating clinician as part of the health history regarding glucose monitoring?

A

-Driver must provide to the treating clinician the past three months of glucose monitoring, while being treated with insulin
-treating clinician then uses since information to prepare the MCSA-5870 form and then sends this to the medical examiner

23
Q

What kind of records must the insulin treated driver provides to the treating clinician regarding glucose monitoring?

A

Individuals with ITDM must maintain blood glucose records measured with an electronic glucometer that stores all readings, records the date and time of readings, and from which data can be electronically downloaded.

Handwritten blood glucose records are not acceptable.

Self-monitoring may be performed by finger stick or continuous glucose sensor.

24
Q

What happens if the insulin treated diabetic driver comes to the medical examiner’s appointment but they have not given their treating clinician the prior three months of glucose monitoring? What can the medical examiner do at that point?

A

If an individual does not provide 3 months of records, the medical examiner may grant up to a 3-month medical card to allow time for the individual to collect the necessary records

25
Q

As part of the physical exam, you must order a ______ to test for __________.

A

Urinalysis
Glycosuria
Proteinuria
Hematuria
specific gravity

26
Q

If the urinalysis is found to be abnormal due to glycosuria or some other condition, what will determine the certification decision?

A

The decision is based on whether the examiner believes driving ability is compromised.

Inform the driver of any abnormal findings in the urinalysis, even if they are not disqualifying. Encourage the driver to seek appropriate follow-up care, especially as this condition could develop into a disqualifying illness.

27
Q

You must evaluate for indications of dysfunction of senses caused by target organ damage such as what?

A

Retinopathy
macular degeneration
peripheral neuropathy (mostly lower extremity)

28
Q

What things should be evaluated during the neurological exam?

A

-Motor strength
-pain
-position
-sense of light touch
-vibratory sensation in the toes, feet, fingers, and hands
loss of proprioception, or the inability to perform driving tasks, is disqualifying.

29
Q

Do not certify a diabetic driver if there is a diagnosis of ______ _______ that affects driving ability via _______ loss.

A

Peripheral neuropathy
Sensation

30
Q

Diabetes can cause autonomic neuropathies, which affect the nerves that regulate vital functions such as the heart muscle and smooth muscles. What should you look for on physical exam regarding autonomic neuropathies?

A

-Low blood pressure
-resting tachycardia
-orthostatic hypotension

31
Q

What kind of autonomic neuropathy findings would disqualify a driver?

A

Disqualify the driver if cardiovascular autonomic neuropathy causes:
-resting tachycardia
-orthostatic hypotension

You also have to disqualify the driver if autonomic neuropathy in other systems would interfere with driving ability, such as impaired bladder or bowel control.

32
Q

A diabetic patient might report some degree of visual dysfunction, such as floaters. This can be because of macular edema and/or hard exudates near the macula. Can such a person be certified?

A

Yes, if they meet all other criteria. However, you should suggest an annual medical exam and annual exam by an ophthalmologist or optometrist.

33
Q

Suppose the diabetic patient is diagnosed with severe non-proliferative retinopathy or proliferative diabetic retinopathy. Can they be certified?

A

No. These patients are disqualified.

34
Q

Macular degeneration is a leading cause of blindness in the US. 30% of Americans have it by age 70. It spares peripheral vision, but treatment options are limited. Is macular degeneration a disqualifying condition?

A

Is disqualifying if the patient requires use of telescopic lenses.

35
Q

What are incretin mimetics?

A

These are drugs that mimic insulin to lower blood sugar. Examples include Exenatide (Byetta).
When used in conjunction with sulfonylureas, they increase risk for hypoglycemia.

36
Q

Can patients who are taking incretin mimetics be certified?

A

Once they demonstrate that their treatment is safe and effective, they can be certified for one year.
Must be recertified annually. Driver should provide written statement from treating provider stating how driver tolerates medication, how often drivers glucose levels are monitored, and efficacy of treatment.

However, disqualify them if you feel the driver poses a risk to safety.

37
Q

What are oral hypoglycemics? Can patients on oral hypoglycemics recertified?

A

-Drugs taken orally to stimulate natural production of insulin
-certify for up to one year after treatment has been proven to be safe and effective
-the treatment plan must effectively manage their disease and must not include the use of insulin or have side effects that interfere with safe driving
must be recertified every year; medical examiner has the option to require more frequent exams when indicated

Disqualify the patient only if you feel they pose a risk to safety.

38
Q

How does hemoglobin A1c affect certification decisions?

A

Indirectly. If the hemoglobin A1c is greater than 10%, this means the patient is experiencing fluctuation in blood sugar levels and doesn’t have great glucose control. However, A1c is not used by itself to make a determination about certification.

39
Q

Remind a diabetic driver to carry a form of rapidly absorbable ________ for hypoglycemic episodes.

A

glucose

40
Q

How often should the driver monitor their blood sugar?

A

Self monitor for one hour prior to driving and every four hours while driving

41
Q

Why is it recommended to examine a diabetic driver annually?

A

Because of the progressive nature of the disease and the potential complications

DOT Exam Oakstone Course (28 decks)

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