Behind the Wheel with Diabetes

 Fingers gripping the steering wheel, a dizziness setting in — with a knowledge that the cold sweats and soon-blurring vision are on the way.

Whatever the reason for the plunging blood sugar, the reality in that moment is that you are going low and need to do something about it. To pull over. To check. To eat something.

But as sometimes happens when floating in a hypoglycemic daze, you can't bring yourself to take action even though you know it's needed. The brain just isn't connecting and forcing you to pull that treatment trigger.

I've been there. More than once. And they've been life-changing lessons that have influenced my driving habits.

With National Drive Safely Week running the first week of October, this seemed like ideal timing to share some personal stories about the dangers of driving with diabetes.

My two significant driving-while-low experiences both happened during the workday, when I managed to find myself behind the wheel while on the job.

Years back, I wasn't the most responsible in this sense. I didn't always test before getting behind the wheel. And when I first started on my insulin pump, my lows would hit more quickly, taking me to the brink in a flash. That led to one situation in my early 20s where I went out on my late lunch hour, and ended up getting pulled over for driving erratically. Thankfully, no one was injured, and that motivated me to start testing before driving -- most of the time.

All was fine, until a few years ago. It was August 2009, and I was in my third decade of life and had more than a quarter century of D-life under my belt. But I still had much to learn, apparently.

In those days before starting on a continuous glucose monitor (CGM), I tested before driving most of the time but there were occasions when I didn't check — I felt fine and assumed all was well.

That summer, I did what seemed to fall in the category of "doing everything right." Mid-afternoon at work in downtown Indianapolis, I did a regular meter check and clocked in at just about 100 mg/dL. Feeling a tad Low, I re-checked and came out a few notches lower just below that Century #bgnow.

All seemed OK, and I prepared for an upcoming phone meeting.

But, diabetes had another road in mind — literally and figuratively.

Within 20 minutes, my blood sugar plummeted and tossed me into a state of confusion that I just didn't see coming. I found myself wanting to just see my beloved dog at home, irrationally, and also thinking my phone interview was actually one I needed to leave the office to get to in-person. I wasn't thinking clearly, but managed to get to the parking garage. To my Ford Escape. And to drive away, recalling that I'd "just tested" and all was OK.

My brain just wasn't connecting to the body's response mechanism.

The 20-minute drive home took a detour as I dropped lower on the expressway, missing my exit and driving another 10 miles before exiting and then getting lost — in a hypo fog — on the back farm roads of central Indiana. And yes, all the while dipping even lower.

Somehow, I made it back to my subdivision. I'll never know how. Thanks to my erratic driving, someone called 911 and reported me. Apparently, I drove up onto the side of the road at one point and took out a speed limit sign (as I learned later by the indent on the front of my SUV).

I ended up driving into a ditch directly in front of the entrance to our subdivision, where the police responded. I don't know what I was thinking, but remember a feeling of trying to back up and get away from them. Luckily, an officer recognized something was wrong and took my keys from the vehicle, and then called paramedics. The adrenaline rush of that experience started boosting my BGs slightly, and by the time I was strapped into the ambulance for a glucose IV drip, I started becoming aware of my surroundings.

They wouldn't let me refuse transport at that point, so what followed was a two-hour ER experience. Thankfully I wasn't injured, but when the ordeal ended, what I ended up with was an ER bill costing an arm and a leg, not to mention the front-end damage to the SUV!

From that point, I didn't drive for several months, and hesitated for a while after that every time I even had to think about driving.

And from then on, a BG check immediately before driving was my routine!  That experience also was the final motivator in my starting on a CGM.

Why retell this unpleasant story now?

Well, it was scary as hell and is a daily reminder of how important it is for all PWDs who drive to take diabetes seriously. It's especially important to think about this now, as we see efforts nationally to restrict PWD drivers and examples of police unable to recognize diabetes medical emergencies when they occur behind the wheel.

This January, the American Diabetes Association published its first-ever position statement focused on driving with diabetes. The six-page document advises against "blanket bans or restrictions." Rather, the organization recommends that individual PWDs who might pose a driving risk (hypoglycemic unaware?) be assessed by an endocrinologist.

A survey in 2011 by the American College of Endocrinology (ACE) and Merck shows that nearly 40% of people with type 2 experienced a low blood sugar at some point while driving or traveling (!). There's no widespread data on type 1 driving impacts, but several formal documents mention — since it's pretty common sense — that those PWDs on insulin are more likely to experience driving issues than others.

It's not rocket science, but the obvious To Dos that can prevent a Low-while driving include:

• Check your blood sugar before starting any commute. If it's 70 mg/dL or lower, eat or drink something that will raise it quickly. Then wait until your blood sugar is back to normal before getting behind the wheel or starting the drive.
• Always have fast-acting glucose and snacks or drinks in the vehicle. Not to mention blood sugar testing supplies close by.
• And follow all the advice that goes along with D-Management 101, such as being aware of meal and exercise or insulin changes that could impact BG levels and throw off your safe driving.

These are safety tips for any PWD who may be behind the wheel, but clearly it's even more critical for those who might be driving as part of their job.

Maybe my situation was dramatic. But I still have no clue what caused that 2009 low, as everything that day seemed normal and nothing stands out in my memory as a trigger for the low. Maybe the wind was blowing a different direction that day... Who knows?

In my world, diabetes accidents sometimes happen, so I want every possible tool to help keep me safe and to protect others who are on the road. That's my absolute responsibility of having the privilege to possess a driver's license.

And a simple BG check and waiting a few minutes, if needed, are worth the price!

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Originally published at DiabetesMine