Diabetes Policy Statement
For School Bus, Class 7d, and Class 7d½ School Pupil Transport Vehicles

Approved by the Registry of Motor Vehicles Medical Advisory Board on March 24, 2008 and recommended to the Registrar for adoption on the same date.

The following standard is applicable to all persons applying for a SCHOOL BUS OPERATOR CERTIFICATE OR CLASS 7D OR 7D½ SCHOOL PUPIL TRANSPORT VEHICLE LEARNER'S PERMIT OR LICENSE.

For the purpose of this standard, the approving physician must be a Massachusetts board certified or board eligible endocrinologist.  A “serious hypoglycemic event” is defined as a hypoglycemic episode or event so severe that it interfered with on-going activities or it required the assistance or aid of another person. “Hypoglycemic unawareness” is defined as the inability to recognize the early symptoms of hypoglycemia such as sweating, anxiety, forceful heartbeat, light-headedness, and/or confusion.

The Registrar, or her designee, may require such additional evidence of the applicant’s or licensee’s medical qualification criteria as she deems appropriate, or may modify this standard as an individual case may require.

  1. DIABETES STANDARD:
    1. Diabetic licensees or applicants are eligible to receive a school bus operator certificate or class 7D or 7D½ school pupil transport vehicle learner’s permit, or license if:
      1. The individuals have never had a hypoglycemic episode or spell (as certified by the physician); and
      2. The individuals do not use insulin to control their diabetes.
    2. (2) Diabetic licensees or applicants who use insulin to control their diabetes or have had a serious hypoglycemic event are eligible to receive a School Bus Operator Certificate or Class 7D or 7D½ School Pupil Transport Vehicle learner's permit or license upon meeting the following conditions:
      1. The individual possesses a currently valid operator's driver license;
      2. The individual is not diagnosed with "hypoglycemic unawareness";
      3. The individual has not had a "serious hypoglycemic event" as certified by a Massachusetts board certified or board eligible endocrinologist within the last three years.
      4. The individual provides a Massachusetts board certified or board eligible endocrinologist with a complete written medical history including, but not limited to, the date insulin use began, all hospitalization reports, consultation notes for diagnostic examinations, all results of studies conducted for diabetes, and follow-up reports and reports of any hypoglycemic insulin reactions within the last three years.
      5. The individual is examined by a Massachusetts board certified or board eligible endocrinologist every six months and a complete School Pupil Transport Diabetes Medical Evaluation Form, issued by the Registry of Motor Vehicles, is 1) certified by the examining endocrinologist, 2) signed by the license applicant and 3) submitted to the RMV every six months.
      6. The examining endocrinologist signed statement on the School Pupil Transport Diabetes Medical Evaluation Form certifies the following medical determinations:
        1. The endocrinologist is familiar with the applicant's medical history for the past three years either through actual treatment over that time or through consultation with a physician who has treated the applicant during that time. Review of a complete written medical history for the past three years may be substituted for actual consultation with the other physician;
        2. If applicable, the applicant has been on a stable insulin regimen to control his/her diabetes on the date of application;
        3. The applicant does not have serious hypoglycemic events or altered consciousness that interfere with on-going activities or require the assistance of another person to regain control;
        4. The applicant does not have hypoglycemic unawareness or the inability to recognize the early symptoms of hypoglycemia (such as sweating, anxiety, forceful heartbeat, light-headedness and/or confusion);
        5. Within the past three years, the applicant has not had an hypoglycemic reaction, at any time, that resulted in any change in mental status that would have been, in the examining endocrinologist's opinion, detrimental to the safe operation of a school bus or a school pupil transport vehicle;
        6. Complications of the applicant's diabetic condition, such as neuropathy, visual impairment or cognitive impairment will not adversely affect his/her ability to operate a school bus or a school pupil transport vehicle.
        7. The applicant has been educated in diabetes and its management, thoroughly informed of and understands the procedures which must be followed to monitor and manage his/her diabetes and what procedures should be followed if complications arise by a National Standard for Diabetes Self-Management Education Program; and
        8. The applicant has the ability and has demonstrated willingness to properly monitor and manage his/her diabetes including signing the School Pupil Transport Diabetes Medical Evaluation Form, as witnessed by the treating endocrinologist, that the applicant understands his/her medical regime and agrees to comply with all criteria concerning eligibility for the 7D, 7D½ license or School Bus Certificate.
      7. The following special conditions are required for the issuance of a 7D, 7D½ license or School Bus Operator Certificate to any driver who uses insulin to control his/her diabetes. Each driver must:
        1. Carry, use, and record, in a log, the readings from a portable self-monitoring blood-glucose device (SMBG) that is equipped with a computerized memory including date and time of test. Blood glucose monitoring must be performed immediately prior to driving and every four hours thereafter while on duty. Paper tapes generated by SMBGs having a printing capability may be used in lieu of a log prepared by the driver. Log records of blood glucose values (with time and date) must be available to law enforcement or authorized registry personnel upon request. Log records must also be submitted to the certifying endocrinologist for each renewal application;
        2. Carry upon your person at all times and use, as necessary, a source of rapidly absorbable glucose;
        3. Not operate a school bus or a school pupil transport vehicle unless blood glucose measures within the target parameters of 80 and 350;
          1. If blood glucose measures between 60 and 79 then operator cannot drive school children until blood glucose measure is within the target parameters defined above;
          2. If blood glucose measures below 60 then the operator cannot drive school children until certified as "safe to operate" by a Massachusetts board certified or board eligible endocrinologist;
          3. If blood glucose measures 350 or more, then the operator cannot operate a school bus or school pupil transport vehicle until certified as "safe to operate" by a Massachusetts board certified or board eligible endocrinologist;
        4. Report and surrender his/her 7D, 7D½ license, permit or School Bus Operator Certificate immediately to the Registry of Motor Vehicles if a serious hypoglycemic event should occur;
        5. Submit a glucose log within 15 days of a serious hypoglycemic event to the treating endocrinologist;
        6. Acknowledge every six months, through signature and in the presence of their treating endocrinologist, that he/she understands and will adhere to the special conditions of his/her 7D, 7D½ license, permit or School Bus Operator Certificate.

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