Road Test: Driving and Diabetes

Could highway patrol officers one day carry glucometers along with breathalyzers? A battle between private rights and public safety is being played out on the nation's roadways.

By Deborah Gardiner

Joanna Scully* has an axe to grind with diabetic drivers. A motorist with insulin dependent diabetes hit her and her father as they were riding on a motorbike in April, killing her father instantly. Scully, 28, was knocked from the back of the bike. She survived with a fractured pelvis.

"The man who hit us had not been feeling well. He was dizzy I was told, yet still got behind the wheel," Scully wrote in an email. "The guy had a diabetic blackout and crossed into our lane. It was a head-on collision on a two-lane road in a very small town. My Dad was 60. He still had a lot of life left in him."

Scully says she feels very strongly that people with diabetes should be restricted in their driving. She has joined a growing debate over whether people with diabetes should have driving restrictions.

Scoping out the problem

The debate affects millions of people. According to the Center for Disease Control, roughly 15.7 million Americans have diabetes – 5.9 percent of the population. Only 10 million have been diagnosed.

Diabetes is a group of conditions in which sugar in the blood can sometimes rise or fall to unsafe levels. These fluctuations can result from a variety of controllable and uncontrollable factors including diet, exercise, stress, illness or medications.

A person with abnormally low or high blood sugar levels can experience symptoms ranging from blurry vision and confusion to loss of consciousness and even coma. But severe symptoms are less likely to occur with well-managed diabetes.

State by state, laws differ

While there are no exact statistics on the number of traffic accidents caused by diabetics, several rules set up by state Departments of Motor Vehicles (DMV) and Departments of Public Safety apply to diabetics and driving. At issue is whether the various state laws should be made mandatory rather than voluntary.

The American Diabetes Association (ADA) says that most states have a law requesting that people with diabetes present the DMV with a physician's report stating that they have diabetes. It is mandatory for that information to be on the diabetic's driving record and license.

Some of the most severe driving laws for people with diabetes are in California. Once a Californian with diabetes has had any lapse of consciousness and is then treated by an emergency room nurse, that ER worker must lawfully report the incident to the DMV. In many cases, even for first-time incidents, the DMV then revokes that person's license.

According to Shereen Arent, National Director of Legal Advocacy for the ADA, when it comes to driving laws for diabetics, the California law is unique and generates a lot of complaints. "Outside of California, state [laws] are specific to the person's health situation," Arent said.

While the DMV won't provide any statistics, Regional Director of Program Services for the ADA, Lisa Murdoch estimates that in California, the number of people with diabetes losing their license annually is in the thousands.

Body of evidence

In the United States, there is no clear data demonstrating that patients using insulin are more likely to get into auto accidents than people without diabetes.

Dr. Charles Clark, M.D., professor of medicine and pharmacology at the Indiana University School of Medicine and former president of the ADA, pointed out that epidemiological studies from 1970-1980 revealed diabetic drivers have the same number of auto accidents as non-diabetic drivers. One is no riskier a driver than the other, Clark said.

But that's not to say that a person with diabetes cannot become impaired when driving with low blood sugar, a condition called hypoglycemia, or high blood sugar, called hyperglycemia.

In the April issue of Diabetes Care, Dr. William L. Clark, M.D., from the University of Virginia studied 37 adults with Type 1 diabetes and concluded that driving performance is disrupted even with mild fluctuations of blood sugar levels.

Legal sparring

The current driving restrictions may overlook the fact that while some people with diabetes are prone to swings in blood sugar levels, many know their condition well enough to know when not to drive.

When it comes to the California laws, attorneys like Kriss Haplen say that the rules themselves are fine, it is the way that they are implemented that is unjust towards diabetic drivers.

Haplen explained that many of his clients had acute diabetes symptoms in their homes or at work, but nowhere near their car. And yet, because an emergency worker complied with the DMV rules by reporting the incident, his clients had their licenses taken away and then had to pay an attorney to retrieve it on their behalf.

"The problem is that the DMV officers involved in making these decisions are unfairly implementing the rules and not adequately investigating the medical condition of the drivers involved."

Health care pros call it

ADA's Murdoch, who has diabetes herself, says, "while we empathize with the misfortune of people who have had auto accidents involving people with diabetes, the current policy for suspension is not appropriate.

"It's a hard call," says Murdoch. "I am very concerned of the safety of the driver and of other people on the road. But we don't think that an incident of hypoglycemia is a reflection of a person's overall control."

*Joanna Scully asked that her real name be withheld to protect her identity.

Deborah Gardiner is a freelance journalist from New Zealand based in San Francisco. If you have questions or comments, she can be reached at kiwichick@earthlink.net.



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