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Monday, January 17, 2000
By Steve Twedt, Post-Gazette Staff Writer
LOUISVILLE, Ky. -- Sitting in a truck stop near the Louisville airport, Paul Sasso took a quick draw on his cigarette before grabbing his jangling cell phone. "Good, good," he said in his smoke-husky voice after a few seconds. "That'll get me home."
Sasso's workday had begun before 5 a.m., when he pulled his black Freightliner onto Interstate 65, heading north from Nashville. On the back of his 70-foot drop-deck flatbed trailer, he had the metal covering for a Boeing 757 engine that he'd picked up in California the week before.
He delivered his cargo to a United Parcel Service plant in Louisville at 9 a.m., grabbed some breakfast at a nearby Waffle House, then waited for this call.
Setting his phone down, Sasso said he would be driving back to Nashville that afternoon to pick up a load of scaffolding, for delivery in Sarasota, Fla., two days later. By Thursday -- the day before New Year's Eve -- Sasso figured he'd be home in Edgewater, Fla.
For the first time in a month, he would sleep in his own bed.
The road signs along Sasso's work life -- 130,000 driving miles a year, a dozen different states each month, waking up Christmas morning 2,500 miles from home in Blythe, Calif. -- make a cast-iron case for the harshness of a trucker's life.
For Sasso and perhaps 5 to 10 percent of the other 9 million commercial drivers, the job is further complicated because they have diabetes.
By federal regulation, those who take insulin to control their diabetes cannot drive interstate roads. (Some individual states allow waivers for experienced, safe drivers who stay within state boundaries.) The regulation has a simple purpose: No one wants a diabetic driver to lose consciousness at the wheel of an 80,000-pound truck.
In 1993, the Federal Highway Administration asked researchers at Carnegie Mellon University and the University of Pittsburgh to study the risk of allowing insulin-treated diabetics to drive commercial trucks. They estimated an additional 42 crashes would occur each year if the insulin ban were lifted, an added risk they said that falls well within other accepted risks, such as allowing 16-year-olds to drive.
The insulin ban nearly cost Sasso his job five years ago, when his blood sugar shot up to six times more than a safe reading and he temporarily went on insulin. And it poses a thorny dilemma for many veteran drivers:
What happens when, after driving a truck or bus for 25 years, you need insulin to control your diabetes? Do you walk away from your only source of income, from the only job you've known? Do you drive illegally, taking insulin on the sly? Or do you try to get by with pills, knowing the high blood sugar will leave deposits in vital organs and slowly jeopardize your own health?
During its investigation of truck drivers' medical conditions, the Pittsburgh Post-Gazette interviewed drivers who have faced those questions:
Paul Sasso
For two months early in the summer of 1994, Paul Sasso felt lousy. Looking back, he says now, he had all the classic symptoms of diabetes: insatiable thirst, frequent urination, profuse sweating, extreme fatigue. He chose to ignore them.
"I still thought I was Superman. I didn't want to know I was sick," he said. "I've driven with walking pneumonia, and you don't moan about it. You can't get a note from your mother saying you're too sick to drive. There are no sick days out here."
Sasso's been hauling freight since he graduated from high school 25 years ago, working the piers in his native New York City, driving meat trucks in Colorado and, more recently, hauling jet engines and other goods for Air Industries Inc., of Sparr, Fla.
But on July 3, 1994, he'd just gotten home from making a haul to New York when he suddenly felt so lethargic he could hardly stand. By the time his girlfriend got him to a hospital, Sasso, then 39, was nearly comatose.
Tests showed Sasso's blood sugar was 640, more than six times the normal level.
He spent three days in intensive care, where doctors gave him 50 units of insulin to moderate his blood sugar. Sasso recovered, but his doctor urged him to report his condition to motor vehicle officials.
"In a matter of weeks, they jerked my license."
He got three weeks of unemployment benefits, but his application for disability pay was denied. Facing a financial calamity, Sasso went on a strict diet, lost 45 pounds, got his blood sugar down, and within four months he was back driving a truck. By taking two 10-milligram tablets of Glucotrol XL each day and watching his diet, his blood sugar hovers around 140-150 now.
"If I had a normal life I could get it back down to 100, or 95," said Sasso, as he drove south to Nashville the week after Christmas. "I'm not denying my lifestyle as a truck driver makes it a little harder to control."
By watching what he eats, Sasso has bought himself some time, but not much. His doctor has told him he will need insulin in two to five years, as his pancreas continues to falter. He's not sure what happens then, except that he'll have to stop driving.
"I don't have anywhere to go," he said. "A lot of companies don't want to hire someone my age and train them on a computer for two years."
Sasso believes diabetes is more prevalent among truckers than people realize. "Our lifestyle is sedentary. A lot of guys are overweight. And our diets and sleeping habits are all contributing factors," he said. But he thinks the blanket ban on insulin users is unfair.
"I have a good driving record. I have a good safety record. Why would you want to take me out of the equation and replace me with an unknown quantity fresh out of driving school?"
Fred Faerber
A third-generation mover, Fred Faerber, 60, has operated his own truck out of Kingston, N.Y., for 43 years. He's moved families from New York to Florida and has a wall full of awards for good service. "I was bred to load and drive furniture. That's my life and I don't want to change."
That's why, before he agreed to go into the hospital for foot surgery, he made one stipulation: Doctors could not treat him with insulin. Faerber knew that once he started insulin, he'd have to stop driving his moving truck.
"One doctor started saying I may have to go on insulin, but I cut him short. I said, 'If that's what you've got to do, don't even think I'm going in that hospital.'
"I had a meeting with my kids and I told them, 'Look, this is the way it's got to be.' If they put me on insulin, you can go get the tombstone because there's no sense in me living. I'm real serious about that."
Faerber developed diabetes 14 years ago. He controls his high blood sugar with oral hypoglycemic medication instead of insulin, which must be injected.
In August, he accidentally dropped a barbell on his left foot during a move in Fort Lauderdale. Because of his tight delivery schedule, "I didn't even take my shoe off at the time," said Faerber.
Mindful of the high infection risk with diabetes, Faerber tried to treat his injury with antiseptic. But, a few days later when the foot started to ache, he pulled his sock off again to find his toes had turned a garish black and green. He could see the exposed bone of his toes. "I knew then they were gone."
Faerber still completed two more deliveries before agreeing to let the doctors operate.
The doctors relented on Faerber's no-insulin demand, and Faerber has now undergone four surgeries on his foot, removing the lower third of it. Using pills, he's keeping his blood sugar around 130.
Last month, Faerber was fitted for a special boot that he hopes will get him back in his moving van by next month. Faerber's in good shape from his years of moving furniture, and he doesn't drink or eat sweets.
He hopes to work another six or seven years.
"I'm probably going to have to learn to walk again," Faerber said. "But if I have to starve myself to death, I wouldn't take insulin."
David Ojala
A life-long Michigan resident, David Ojala, 44, had a comfortable lifestyle, driving an 18-wheeler from his Upper Peninsula home to Lansing to pick up steel coils, then winding back home making deliveries along the way. He had regular hours and regular meals. He knew his customers on a first-name basis. And, after his deliveries, he was back at the family's new house in Sault Ste. Marie every night.
He's driven more than 22 years without incident.
Ojala learned he had diabetes in 1990 during a routine physical. Admittedly overweight at 270 pounds, Ojala said he could control his blood sugar with pills and still drive legally. For a while, anyway, until he had to turn to something stronger.
"I've been on insulin the past two, two-and-a-half years," Ojala said recently. But he continued to drive. With a new house, a wife and two children to support, Ojala believed he had little choice.
His employer, who runs a special delivery trucking firm, "knew I was diabetic, but they didn't really know I was on insulin," Ojala said.
"I didn't really tell them. I knew the consequences."
The ruse ended in April, when Ojala ended up in the hospital. His blood sugar, typically around 250, shot to more than 400 in two days. "I just felt sick, and I had cramps in my legs. A couple of days I could hardly get out of bed to go to the bathroom."
He had to go to the hospital to get his runaway blood sugar under control. And that's when his boss learned he was on insulin.
Michigan has an insulin waiver program for drivers like Ojala who stay within state borders. But because most of his freight came from out of state, Ojala was subject to interstate regulations. As long as he's on insulin, he can't drive for his old company. He's been out of work since April, a $30,000-a-year loss in income.
The family is living on his wife's income as a hospital dietary aide. Ojala says he's looking for any kind of work to get them through the winter.
"I'm having trouble even paying my heat and electric bills," he said.
He's closing out his 401K fund to pay bills, but he still expects the bank will foreclose on their house in March. Once winter breaks, he and his son plan to travel to Montana, to find "someone who can pay me a decent wage."
With his spotless driving record, Ojala is bitter about being labeled a risk. That feeling deepened after he drove to Lansing, to ask state officials about getting an intrastate waiver.
"They told me, 'You know, you can go ahead and drive a school bus.' But I'm a safety hazard if I drive interstate freight. It makes no sense."
Steve Twedt can be reached by phone at 412-263-1963, or by e-mail at stwedt@post-gazette.com
Paul Sasso holds one of the pills he takes twice a day to control his high blood sugar. (David R. Lutman, special to the Post-Gazette) 
Fred Faerber said he wouldn't go into the hospital until doctors agreed not to give him insulin. (Will Waldron, special to the Post-Gazette) 
David Ojala, worried about family bills, kept his insulin use hidden. (Sherry A. Smith, special to the Post-Gazette)