Driving While Diabetic

One of the scariest situations Diabetics can face is being behind the wheel with a low blood sugar, particularly one that's dropping even lower.

Recent new stories have told some horror stories of this happening across the country: here in Ohio, and a tragic story here in Orange County, California. Regardless of the particular facts of each situation and whether that person involved did or didn't do what they should have as far as Testing Before Driving, some reader comments question why these and all diabetics aren't prevented from driving completely. An Outright Ban. Those stories come on the heels of a study showing tight-control leads to even more crashes and driving incidents of diabetics.

Of course, in writing this blog initially, I'd forgotten about an outstanding blog post in November 2009 by Shannon over at LADAdeeda, touching on this very topic that's so very dear to her. She was more harsh and on point, but we relay the same point of personal responsibility - especially when it involves situations like those found in the news articles above. So, here's a revision with a shout out and accompanying revisions that came to mind after re-reading her post.

I've faced this scenario myself. Sadly, more than once. Generally, I test before I am going to drive. MY policy is to not get behind the wheel if my blood sugar is 60 mg/dL or less. If it is Low like that, then Eat and Wait. Test Again Before Driving, just to make sure. Seriously, the test itself takes less than a minute - even on the older monitor models. We're not talking routine-changing time here. But the pre-driving testing doesn't always do the trick to stop the practice. For a Key Reason.

I have, on occasion, faced dropping blood sugar levels that have caused me to lose awareness and get behind the wheel. Without Being Fully Aware of It. Now, it wasn't as if I'd made the decision to started driving, knowing I'm low. It just kina happened. (Not an Excuse. Just saying.)

Once it happened during lunchtime when I was en route for food. At a safe level prior to driving, I managed to quickly drop and create confusion about what I wanted to eat, therefore continuing the Food Search Drive and creating even lower sugars. That time, police pulled me over and called paramedics who IVd me back to normal levels. Luckily, no one was injured.

Early last year, I dropped quickly about the time I was leaving work. Walking outside and during the block-length walk to my parking garage, my levels dropped incredibly low. Luckily, I managed to not get behind the wheel in this state - actually, I got confused and found myself riding up and down the parking garage elevator for 30 minutes. Phoned Suzi, and she was on her way to me when I eventually had enough sense to eat Glucose Tabs and sit in waiting, in my car, but not turning on the ignition to drive. Luckily.

Scariest Driving While Low incident happened in August 2009. Did a test and was in the 90s before getting ready for an interview mid-afternoon. Turns out, though, I was dropping even lower and somehow decided to leave the office for my interview, even though it was a phone-based interview that required me only to be sitting at my desk. But I left the office. Wandered to my car. Drove home (a 20 minute drive mid-day, without traffic). I recall thinking that I was going to interview my dog because I missed her, something that just doesn't make sense in a Normal State of Mind but in a Low Reaction State, is not out of the ordinary. Apparently made it most of the way, but missed my expressway exit and had to drive another 5 miles south, getting off and then getting lost in this Low State as I manuevered the back cornfield roads on my way back to my subdivision - still dropping. I recall seeing the road, and not realizing why the drivers were on the wrong side of the road. Ended up driving into a ditch directly in front of my subdivision entrance. Learned later that someone called 911, reporting that I was driving erratically. Police responded, and I decided to put it in reverse to get away from the officer who was trying to steal my keys. Before I could, he reached in and grabbed the keys from the ignition.

Paramedics arrived, and strapped me into the ambulance where they began pumping me full of sugar and bring up my levels. They took me to the hospital, and after this incident I'm still paying off about $1,200 post-insurance coverage resulting from this incident. Learned later that I'd also taken out a speed-limit sign on the grassy side of the road, which I'd apparently driven up onto at some point in aimlessly driving the area. It caused damage to my red Ford Escape, as can be seen here.

This could have been so incredibly worse. Luckily, someone above was protecting me and other drivers nearby that day. I'm blessed, and eternally grateful for that.

Am I an unsafe driver because of the above incidents, and because I still drive? Should I voluntarily surrender my license? Should there be a law aimed at preventing my ability to legally drive, absent of or based upon my history Driving While Diabetic History?

I don't think so, but it does concern me.

I'm in relatively good control, and have what I consider to be a responsible practice of testing before driving. My practice is also to have quick-acting sugar on hand, just in case. Like Shannon and others in the D-O-C, I keep a full-sleeve of Glucose Tabs in my driver's side door and also (in the winter) have one in my coat pocket, as well as other candy placed in the center console. But when I push for Tight Control, my sugar levels sometimes drop to scary-levels and that can happen despite the best Before and During Preparation. Sometimes, you don't always have the ability to recognize these dangerous situations. At night when sleeping, and unfortunately when driving is going to happen. This has motivated me in the past to avoid tight control, and instead keep my sugars higher to avoid this from happening.

I've pondered: Is it better to stay higher, risking possible future complications that may never materialize, to be safe now and not endanger myself, those I love, and strangers? OR do I push for tight control, and do all I can to prevent these situations but face the reality that they could happen no matter what I do? It's an ongoing mental and emotional struggle.

Practically, I can't afford to not drive. We just don't have adequate public transportation here in Indy that I can take advantage of. So, with this, I'm eager and motivated to fight for a CGM - a device that can catch and alert me to those dangers of both Night-time Lows At Home but also Driving While Low incidents. Recently, I've trial-tested two CGMs (Navigator and Dexcom) and these have both caught some Driving While Low episodes. I've tested beforehand, but then managed to dip lower while driving. The alarms notified me, and allowed me to inhale some glucose tabs to curb the drop. Otherwise, I may not have felt them coming on before it was too late. (Note: We won't debate that it wasn't the smartest decision to make in Driving While Low, Snapping a Photo for D365 While In Motion.... Agreed it's bad, but I feel I had it under control. Just sayin.)

We can easily sit back and read of these above stories, shaking our heads and wondering why the Diabetic didn't test or take better care of themselves, or as an extreme just stop driving if they realize this could happen. What should be a big fear for any PWD is how these above situations, and those highliy-publicized tragedies, will stand out to lawmakers and create a justification for law changes. Despite all of those who test before driving, who've stopped voluntarily, or who use a CGM for the prime reason of keeping this in check. They stand out and could provide a foundation for those arguing that Diabetics shouldn't be able to drive, no matter what. I fear we could someday have a misdemeanor or felony, Driving While Diabetic (DWD).

In the UK, a Diabetic must inform the licensing agency of their diagnosis or health condition, as it may impact driving. Apparently California has this rule, according to an article found here. Courts have addressed this in some fashion already: The Supreme Court of the United States ruled in the 1971 case of Bell v. Burson that driving is an "important interest" that can't just be taken away from a licensed driver without a government agency's providing procedural due process. In 1983, the California Supreme Court found in Berlinghieri v. DMV that the revocation or suspension of a license "can and often does constitute a severe personal and economic hardship, and a lower California appellate court found in the 1993 case of People v. Superior Court that a person with insulin-dependent diabetes is not automatically subject to license forfeiture or nonrenewal, and an agency may do so only if the diabetes affects the driver's safe operation of a motor vehicle.

Maybe all of us diabetics should have a CGM, if we're going to drive. But requiring this could create any number of legal and practical issues, among them the one that spawns a whole other debate about health insurance coverage of these CGM systems, and that inevitable fight many of us face about getting coverage for these in order to prevent the above driving disasters or night-time lows. This isn't the time to blog about that, for fears of digressing...

Reflecting on this, I think the overall point is that Diabetics must be even more aware that meticulous care is necessary before and during our drives. We must always be keen to where our sugars are, even if the numbers just before appaer to be fine. That's not enough. A CGM can offer peace of mind, but until we get to the point where it's 100% accurate AND more people have them, we must take on the task ourselves. Or give up driving voluntarily. We must prove that just because we're diabetics, we aren't destined to create crashes or erratic driving. Though it's possible, we can be just as prepared as anyone who gets behind the wheel.

Still, it comes down to personal responsibility. Realizing that even with the best preparation, sometimes you can't stop the Lows While Driving and that may mean sacrificing what you love to do. It comes down to you. I personally believe that, and would hate it even more if laws changed because of those unprepared diabetics who allow this bad driving to happen because of poor control. It's our job as Diabetics not only to prevent this kind of stuff from happening in our own driving worlds, but also to make sure those bad examples don't dictate driving laws for all of us.