HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Soule, J. B. Articles by Egede, L. E. Search for Related Content PubMed Articles by Soule, J. B. Articles by Egede, L. E. Social Bookmarking                What's this?

Challenges of Managing Diabetes in Commercial Truck Drivers

The first 20% of the full text of this article appears below.

	PRESENTATION

 
P.A., a 54 year-old Hispanic man with a 5-year history of uncomplicated type 2 diabetes, reports to the Veterans Administration (VA) clinic for follow-up. After an initial period of partial glycemic improvement soon after diagnosis, his glycemic control has deteriorated, as reflected by hemoglobin A_1c (A1C) levels that gradually increased from a nadir of 8.3 to 11.1% during several years. P.A. reports fingerstick blood glucose measurements between 250 and 400 mg/dl. He complains of fatigue and endorses polyuria and polydipsia, which he attributes to hyperglycemia.

Insulin therapy has been recommended repeatedly at the clinic for the past several years but has always been refused. P.A. works as an interstate truck driver and fears initiation of insulin therapy would disqualify him from holding a commercial license. He denies needle phobia, fear of complications, or other barriers to insulin therapy. P.A. voices awareness of the risks of developing diabetes complications and the relationship between uncontrolled glucose levels and his hyperglycemic symptomatology. Because he holds a loan on his truck and driving is his sole source of income, loss of his license is perceived as tantamount to financial devastation. Despite counseling, P.A. is unwilling to consider alternative occupations. His diabetes regimen consists of high-dose oral therapy with metformin, 1,000 mg twice daily; rosiglitazone, 4 mg twice daily; glimepiride, 4 mg twice daily; and acarabose, 100 mg three times daily with meals. Counseling on lifestyle measures for diabetes with a dietitian and diabetes educators had been pursued soon after . . . [Full Text of this Article]

Follow-up 3 months after initiating exenatide

	QUESTIONS

 

	COMMENTARY

 

	CLINICAL PEARLS

 

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?