Diabetes Mellitus

Overview of Medical Evaluation

The treating endocrinologist or other treating physician knowledgeable regarding the LEO’s diabetes management should provide a narrative report certifying whether the LEO has or has not met the criteria set out in the following discussion below. In addition, the treating physician should include supporting data (see Appendix A, and Appendix B).

The LEO is under the care of an endocrinologist or other treating physician knowledgeable regarding the LEO’s diabetes management. Outpatient and in-patient medical record(s) for the last 3 years or since date of diagnosis or since last review by the police physician (whichever is shorter) should be provided by the treating physician to the police physician for review.

If the LEO has type 1 diabetes, the individual has been on a stable basal/bolus regimena or an insulin pump using analogue insulins for the 6 months prior to evaluation.2

If the LEO has type 2 diabetes on insulin, the individual has been on a stable medication regimenb for the 3 months prior to evaluation.3 If not on insulin, the LEO has been on a stable medication regimen for the month prior to evaluation.c

If the LEO uses an insulin pump, documentation is needed as follows:

• proper understanding and education in the use of the insulin pump;
• start date for the use of the pump;
• history of insulin site infections;d
• history of pump cessation and pump malfunction;
• backup plan for pump malfunction including use of injectable insulin; and
• frequency of infusion set changes.

The LEO has received diabetes self-management education (DSME) and is thoroughly informed of – and understands – the procedures that must be followed to monitor and manage his or her diabetes, and what procedures should be followed if complications arise.3

Criteria for Stable Regimen:

• A stable insulin regimen is defined as maintaining the same types of insulin (long acting, intermediate acting, short or rapid acting). Changes in insulin dose are part of the appropriate self-management of diabetes and do not disqualify an applicant or incumbent under this section.
• Changes in dose within the evaluation period will be allowed, but addition of a new class of medications or insulin should result in a new period of observation:
  • 1 month for addition of a sulfonylurea-containing medication (SU alone or in combination);
  • 1 month for the addition of an additional agent to insulin or a sulfonylurea; or
  • 3 months for the addition of insulin.

aA basal/bolus insulin regimen consists of the use of a basal insulin (glargine [Lantus], detemir [Levemir], Basalglar, Toujeo, Tresiba, or NPH) in a once or twice daily regimen to provide between‐meal insulin, combined with the use of a short‐acting insulin (Regular, Lispro, Aspart, or Glulisine) at mealtimes. Insulin pumps are small (beeper sized) battery‐powered devices that deliver small amounts of short‐acting insulin in a constant infusion to meet basal insulin requirements. The wearer selects an additional mealtime bolus to be infused at the time of meals.

For more information on pumps, see manufacturers’ web sites:

• www.minimed.com,
• www.go‐vgo.com,
• www.myomnipod.com,
• www.snappump.com,
• www.tandemdiabetes.com/Products/t‐slim‐Insulin‐Pump/,
• www.animas.com/animas‐insulin‐pumps/onetouch‐ping.

b A stable insulin regimen is defined as maintaining the same types of insulin (long acting, intermediate acting, short or rapid acting). Changes in insulin dose are part of the appropriate self‐management of diabetes and do not disqualify an applicant or incumbent under this section.

c Changes in dose within the evaluation period will be allowed, but addition of a new class of medications or insulin should result in a new period of observation:

• 1 month for the addition of a sulfonylurea;
• 1 month for the addition of an additional agent to insulin or a sulfonylurea; or
• 3 months for the addition of insulin.

dLEO has not had more than one pump‐site infection that caused him/her to miss work or usual daily activities in preceding 6 months.