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Hypoglycemia and Driving   (October 2, 2011)

It seems that almost every week has a theme, and this week, October 3-7, is Drive Safely Work Week. Sounds like a good time to remind those of us with diabetes who drive cars and other vehicles about some hints for preventing and treating hypoglycemia when our attention is focused on getting somewhere safe and sound. Sadly, there are too many reports of drivers with diabetes becoming hypoglycemic and crashing, both figuratively and literally, sometimes with fatal outcomes.

Some hints that I have previously mentioned:

* Check your blood glucose (BG)  before driving.

* Be sure to have ready access to your BG strips and your meter.

* Keep some rapid-acting carbohydrate nearby in case of unexpected lows.

* Check your BG more often than usual. If you are driving a great distance, you can get "highway hypnosis," where you zone out and don't recognize the usual symptoms of hypos. And the BG numbers you will see on travel days are never predictable due to the combination of hours of forced inactivity, eating at roadside diners, drive-in's and dives, all coupled with increasing mental fatigue as the hours go by.

* Be prepared to eat to treat unexpected hypoglycemia.

* Anytime you stop to stretch your legs to prevent blood clots (always a good idea!), you might as well check your BG level.

As you might expect, there are multiple discussions on the Internet about driving with diabetes. Many of these contain the same hints, but sometimes one of these will mention a hint that the others don't point out.

New Zealand has a comprehensive on-line fact sheet about Diabetes and Driving, which includes several hints that aren't in every discussion:

"Don't delay treating low blood sugar levels. The brain becomes confused when the blood sugars reach low levels. Be aware of your own warning signs. Although a mild hypo may not seem to impair your driving it's vital to act before your judgment is affected.

Remember that changing a car tire or pushing a car could result in low blood sugar levels...

If you have diabetes, alcohol can be particularly dangerous because it can cause hypoglycaemia or worsen its effects. We recommend that people with diabetes avoid consuming any alcohol if they're going to drive...

In some situations you may need to refrain from driving. If you have a mild hypoglycaemic episode we recommend that you don't drive for at least an hour, to give your brain time to recover.

If you have a severe hypoglycaemic episode (when you need someone else's help to deal with it), you shouldn't drive for 24 hours. If you have several hypoglycaemic episodes you should talk to your doctor before you return to driving.

If you have a severe hypoglycaemic episode while you're driving, whether you're involved in a crash or not, you shouldn't drive for at least a month. It's likely you'll need to be reviewed by a specialist before you can safely return to driving, and you need to talk to your doctor."

Other discussions which are on-line include:

Checklist for Controlling Low Blood Sugar. This one mentions "Carry identification, such as a bracelet, necklace or wallet card, that has a medical alert message specifying you are taking medication to treat diabetes." (I personally recommend MedicAlert, which is a nonprofit foundation that provides an emergency medical information service in addition to a medical ID.)

Driving Safety (from the American Diabetes Association). This one mentions "Get regular eye exams for early detection of diabetes-related vision problems that can affect your driving ability."

Also, a review of state laws about driving that may apply to people with diabetes is available from the ADA, at Drivers License Laws By State. For each state, answers are given to questions such as "Has the state adopted specific policies about whether people with diabetes are allowed to drive?" and "What is the state's policy about episodes of altered consciousness or loss of consciousness that may be due to diabetes?"

My final hint: Next time you have a free moment, go to your car, and check to see if your supply of carbohydrate is there, and that it's easy to reach from the driver's seat. (I just did, and it is.)

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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