In recent years, a number of state motor vehicle agencies have either instituted or contemplated the institution of driving restrictions on people with diabetes. In Pennsylvania, for example, if a patient has a severe hypoglycemic episode (defined as requiring the assistance of another individual) or symptomatic hyperglycemia (defined to include loss of attention or confusion), then the physician must report this to the state motor vehicle division, and the patient may lose his or her driver’s license for six months.
“We were worried,” says Daniel Lorber, MD, FACP, CDE, of the American Diabetes Association. “The Association is very alert to issues like this because there’s a recurrent attempt to restrict people with diabetes from doing many activities. This is because of what I call hypoglycemaphobia. For example, there are restrictions on pilots, police officers, firefighters, commercial drivers, etc.”
Several years ago, Lorber and his Association colleagues attended a meeting of the American Association of Motor Vehicle Administrators, where the issue of licensing for people with diabetes was part of the agenda. “It was apparent from that meeting that there was no consensus about exactly what should be done, but there was clearly a strong sense that there should be restrictions. And the restrictions were likely to be blanket restrictions rather than individualized ones,” says Lorber. “We felt it was our responsibility to put together a group of people representing both the scientific side and the legal advocacy side of the Association to come up with our own statement on the licensing of people with diabetes.”
The Position Statement that the Association produced was published in a special supplement to the January 2012 issue of Diabetes Care. It argues that determining whether someone’s diabetes poses a driving risk should be done on an individual basis and tied to concrete evidence of risk, rather than on a diagnosis of diabetes alone. The statement warns against blanket restrictions on driving for people with diabetes, and urges that when considering restrictions for licensure, the assessment be done by a health care professional knowledgeable in diabetes.
The challenge, according to the Association, is not to classify all persons with diabetes as unsafe drivers, but rather to identify specific individuals and develop measures to assist them in lowering the possibility of driving mishaps.
The Position Statement also calls for the introduction of a standardized questionnaire that would help identify those individuals with diabetes who may require further evaluation for driving risks, rather than the current inconsistent system of state laws, which can range from states that have no restrictions at all for people with diabetes to states that impose stringent restrictions on all people with diabetes.
According to the Association, people with diabetes who may require further evaluation for driving risks are those with decreased awareness of hypoglycemia, those who experience hypoglycemia episodes while driving, or anyone who experiences severe hypoglycemia. Remember, though, that most drivers with diabetes are not high-risk drivers.
The Association recommends simple measures that can be taken to help people with diabetes stay safe on the road:
- If the person with diabetes is on a medication that may cause hypoglycemia, the Association recommends blood glucose testing before starting to drive and at regular intervals while driving.
- Remember that you must pull over to the side of the road when testing blood glucose levels. If you’re on a limited access highway, you should exit the highway. Do not try to test your blood glucose while driving. “Testing while driving is as bad as texting while driving,” says Lorber.
- If you sense your blood glucose dropping, safely pull over, test, and treat if necessary. If low, wait until blood glucose levels rise and cognition has recovered before driving again.
- Keep glucose tablets and juice boxes right next to the driver, ideally in the front seat or in the center console. Do not keep them in the glove compartment and do not keep them in the trunk.
- For added safety, wear a medical alert bracelet or neck charm.
Jessica Apple is the co-founder and editor-in-chief of the online diabetes lifestyle magazine A Sweet Life. Her writing has appeared in many publications, includingThe Sunday New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, and Tablet Magazine. Apple is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewees, and not of Sanofi US, its employees, agencies, or affiliates.
© 2012 The DX: The Diabetes Experience