Pulse
Driving While Low
Should people with diabetes be required to test before they drive?
By Lisa Harden
Minneapolis attorney Claire Topp doesn’t remember much about the 11 car accidents she had while driving down Interstate 35E one day three-and-a-half years ago. Topp was driving from a friend’s house in Eagan, where she had been playing her cello that afternoon, to her home in Eden Prairie when she crossed lanes of traffic and careened between construction barrels and the concrete median, overshot an exit ramp, and backed into a car before coming to a stop in Forest Lake, which is about 45 miles from Eden Prairie.
Blood Check Reminders from Your Car
A few years from now, cars may remind drivers to check their blood sugar.
Fridley-based Medtronic and the Ford Motor Company announced last spring that they are working together to develop an application that would connect a car’s Sync computer system to Medtronic’s continuous glucose monitor and alert drivers with a dashboard message when their blood glucose level gets low.
The application is still years from becoming a reality and may only benefit those individuals who use continuous glucose monitors. Only about one-third of patients with type 1 diabetes currently use such monitors, according to Chris Kodl, M.D., head of endocrinology for HealthPartners Medical Group.—L.H.
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Topp, who has type 1 diabetes, was just a mile into the drive when she went into a state of reduced consciousness because of low blood sugar. (She experienced none of the usual warning symptoms.) Miraculously, neither Topp nor anyone else was hurt; but the state revoked her driver’s license for four months.
Although Topp agreed to test her blood sugar every time she gets behind the wheel in order to get her license back, she doesn’t want testing before driving to be mandated through legislation. Yet she shares her story every chance she gets to raise awareness about the importance of testing.
“More people need to be aware of how serious it could be that one time,” Topp says. “I didn’t have a history of problems with driving until that day, so I didn’t test before I got in the car. Either I gave myself too much insulin at lunch or I didn’t eat enough and that, combined with the cello practice, caused my blood sugar to drop.”
Like Driving Drunk
Elizabeth Seaquist, M.D., Topp’s physician and director of the Center for Diabetes Research at the University of Minnesota, says she sees about two or three cases of diabetes-related driving mishaps a year in her practice. Although the state does not keep data on such incidents, state troopers say they encounter drivers who are having problems managing their diabetes “quite regularly,” according to Lt. Eric Roeske, public information officer for the Minnesota State Patrol.
Teaching Teens to √B4U DRIVE
As a parent, Troy VanDyke knows it can be hard to get teenagers to do things for their own good. So the mom of a 17-year-old with type 1 diabetes asks her daughter to text her her blood sugar levels prior to driving. “Texting works because I don’t feel like my mom is nagging me, and I know I have to test every time to keep myself and others safe,” says Cameron VanDyke.
To address the unique issues teen drivers with diabetes face, the American Diabetes Association (ADA)-Minnesota is working with the Minnesota-based Juvenile Diabetes No Limits Foundation to offer a free day-long program called √B4U DRIVE this fall.
The national program, now in its second year, includes training on managing diabetes by a certified diabetes educator, a behind-the-wheel session on driving safety, and a pep talk by race car driver Scott Kuhne.
“Teenagers aren’t always good at testing because they don’t want to be different than others,” says Chris Schaefer, director of ADA-Minnesota. “We want them to know they need to check every time they get in the car.” The √B4U DRIVE program will be offered in Minneapolis September 24 and 25. For more information, go to www.jdnolimits.org.—L.H.
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A December 2009 University of Virginia Health Sciences Center study of adult drivers with diabetes in Minneapolis, central Virginia, and Boston found more than half of 452 participants reported at least one driving mishap such as zoning out, becoming disoriented, being stopped by police, or having someone else take over driving when their blood sugar was low in the past year. Of those, 35 percent had checked their blood sugar 30 minutes prior to driving and 78 percent had a reading of less than 90 mg/dL and 48 percent had a reading of less than 70 mg/dL.
According to Chris Kodl, M.D., head of endocrinology for HealthPartners Medical Group, driving simulation experiments show that blood sugar levels less than 70 mg/dL can affect the driver’s ability to steer and control speed and braking. Blood sugars higher than 270 mg/dL slow cognitive function, cause inability to focus, and impair memory.
“Driving with hypoglycemia is as dangerous as driving drunk,” says J. Michael Gonzalez-Campoy, M.D., Ph.D., F.A.C.E., medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology in Eagan. “The same holds true for very high glucose levels, especially if they are associated with diabetic ketoacidosis in type 1 diabetes, or hyperosmolar nonketotic state in type 2 diabetes.”
The Test Question
Milk Move
Chocolate milk won’t be available in the lunch line in Minneapolis public schools this fall. In a move reflecting the growing concern about obesity among children, the school system banned chocolate milk from its offerings.
The lunchroom favorite joined French fries on a growing list of foods the district has deemed unhealthy—a cup of chocolate milk contains more sugar (about three teaspoons more) than plain milk.
Not all health experts would recommend such a ban, however. In an article on childhood nutrition on its website, the American Academy of Pediatrics articulates its concern about kids’ inadequate calcium intake: “Encouraging kids to have milk, milk products, or calcium-rich alternatives, even if it means they have to add chocolate syrup to their milk to make it more palatable, should help them get more calcium.”
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Testing glucose levels every time they drive is recommended for people with insulin-dependent diabetes but is not legally required. The American Diabetes Association (ADA) advises people with diabetes to check their blood glucose before getting behind the wheel and at regular intervals, carry a snack, and wait 15 minutes if their glucose level is low and check it again before driving. People with diabetes who experience hypoglycemia unawareness should stop driving, talk with their health care provider, and not resume driving until it’s no longer an issue, the ADA advises.
But Chris Schaefer, director of ADA-Minnesota and who has type 1 diabetes and tests every time she gets behind the wheel, notes that the ADA has been reluctant to issue a blanket statement about driving. “Every person has a different response when driving, and different factors can affect blood sugar, so it’s important for patients and doctors to talk about driving when they are first diagnosed as well as when they are filling out the state driver’s license evaluation form,” she says.
The ADA will issue a position statement on driving with diabetes later this year.
Minnesota law requires people who are diagnosed with insulin-treated diabetes or who have an episode where they lose consciousness or voluntary control to be evaluated by a physician to determine if they are medically qualified to drive. Patients should be re-evaluated for a period determined by their physician as long as they are episode-free.
According to Joan Kopcinski, a driver’s services director for the Minnesota Department of Public Safety, the state relies on the physicians’ evaluations when it comes to issuing driver’s licenses. “When you take away someone’s driving privilege, it has a significant impact on an individual’s life, so we evaluate very carefully,” she says, adding that they receive about 35 medical forms a day related to diabetes. “But in the interest of public safety, we want to make sure they are getting medical treatment.”