Diabetes Mellitus

sec_arr Impairing Events
SECTIONS

Impairing Events

Severe Hypoglycemia
Severe hypoglycemia is defined as an event requiring assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions.6,7(p 1584)

The LEO should be restricted for severe hypoglycemia when there has been:

  • One or more episode(s) of severe hypoglycemia within the past 1 year, or
  • More than 2 episodes of severe hypoglycemia in the past 3 years or since diagnosis of diabetes – whichever is shorter.

The LEO may be returned to full duty after the following evaluation has been completed:

  • A documented analysis of the hypoglycemic episodes and its causes has been performed by treating physician;
  • Treatment has been reviewed and, if indicated, adjusted;
  • Information, as described in Appendix B (Physician Evaluation Form), has been reviewed by the treating physician and the police physician;
  • Review of the glucose log demonstrating no blood glucose <70 mg/dl for at least 1 month, after the last adjustment in medication.

Hypoglycemia
Repeated episodes (two or more episodes in the glucose log) of blood glucose <70 mg/dl or a single episode of <60 mg/dl should be reviewed by the police physician to assess the frequency of events, presence of hypoglycemia unawareness, and potential for increased risk of incapacitating events (see Appendix A for evaluation of glucose logs).

The LEO should be restricted if the glucose log reveals one or more episodes of blood glucose of <50 mg/dl (unless the low measurement is documented to be caused by a technical error).8(p 520),9(p 696-728.)

The LEO may be returned to full duty after the following evaluation has been completed:

  • A documented analysis of the causes of any hypoglycemic episodes has been performed by treating physician;
  • Treatment has been reviewed and, if indicated, adjusted;
  • Information, as described in Appendix B (Physician Evaluation Form), has been reviewed by the treating physician and the police physician;
  • Glucose log demonstrating no blood glucose <70 mg/dl for at least 14 days, after the last adjustment in treatment.

Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is the result of acute insulin deficiency, often associated with type 1 diabetes, causing hyperglycemia, ketosis, and acidemia.8(p 504-518) It may be the presenting event for type 1 diabetes or may be caused by inappropriately withholding insulin, by a major physiologic stress (e.g., myocardial infarction, sepsis), or by dysfunction of an insulin pump.

The LEO should be restricted after an episode of DKA until the following evaluation has been completed:

  • A documented analysis of the causes of DKA has been performed by treating physician;
  • Treatment has been reviewed and, if indicated, adjusted;
  • Criteria from the above medical evaluation and quantitative glucose monitoring sections are met;
  • Information as described in Appendix B (Physician Evaluation Form) has been reviewed by the treating physician and the police physician.
  • Review of glucose log after the last adjustment of treatment.

Hyperosmolar Hyperglycemic State
Hyperosmolar hyperglycemic state (HHS) occurs in people with type 2 diabetes who still have insulin secretion. The blood glucose is generally over 600 mg/dl. HHS is seen more frequently in elderly patients and those with newly diagnosed type 2 diabetes. The mortality rate is high, between 10-50%.8 (p 518-519) The LEO should be restricted after an episode of HHS until the following evaluation has been completed:

  • The treatment has been reviewed and, if indicated, adjusted.
  • Criteria from the above sections on Overview of Medical Evaluation and Quantitative Glucose Monitoring sections are met.
  • Information, as described in Appendix B (assessment form), has been reviewed by the police physician (especially glucose logs).