Diabetes and Driving
This week I have seen so many teens aged 15 years and 9 months. Why is this age so important? In states such as Maryland, 15 and 9/12 is the age that teens can apply for a learner’s permit. About eight years ago, the medical director of the Motor Vehicle Association (MVA) in Maryland called several directors of diabetes programs in the area and asked how the agency could assist in decreasing the number of teenage-driver motor vehicle accidents. There is an increased incidence in serious motor vehicle accidents in teenagers: this is one of the reasons that automobile insurance is so high for families with teenage drivers.
How is diabetes related to driving? Operating a motor vehicle requires a certain skill set. Passing a written exam is necessary prior to obtaining a learner’s permit. After obtaining the permit to drive, most students attend driver’s education classes to learn the basic operation of a car as well as the maneuvers and judgment required to drive safely in all kinds of driving conditions. This education includes driving in inclement weather, on freeways, expressways, and one-lane roadways. After obtaining the necessary practical experience, a teen can then apply to take the actual driving test to obtain a rookie license. Keep in mind that the entire experience is a process by which you develop knowledge in motor, intellectual, and judgment abilities.
It is difficult enough for teens that have no major health issues to learn how to drive safely. When there is an additional level of complexity due to health conditions such as diabetes, think of the additional ramifications. In previous blogs we discussed hyperglycemia, hypoglycemia, alcohol, and drug use in relation to diabetes. How might these factors relate to driving? These factors have a common denominator: all conditions may impair motor, intellectual, and judgmental abilities. Therefore, it is imperative that the teen with diabetes be cognizant of any situation that could lead to danger. The MVA is aware that certain medical conditions (such as a seizure disorder or diabetes) may impact driving. Most MVAs require that the applicant complete several medical forms prior to issuing a learner’s permit. In Maryland, students and families need to fill out a medical form indicating any illnesses that may impact driving as well as providing a list of medications. In essence, all students with diabetes (in Maryland, at least) must have their medical forms filled out and signed by their diabetes team.
I fill out many of these forms and am always honest. My goal is to keep my teens with diabetes safe, as well as other drivers that might share the road. What is important to think about when deciding whether or not to approve obtaining a learner’s permit? Naturally, I would like for my teen to have good diabetes control. However, that is not always possible and I am somewhat understanding if the hb A1C is not under 8 percent. My main concern is blood glucose monitoring. In fact, approximately six months to one year prior to applying for a learner’s permit, I alert my patients to the fact that if they do not test at least four times/day, I will not sign the forms necessary for the learner’s permit. To many of my teens, this sounds rather harsh. However, with further explanation, they understand that my goal is SAFETY for all. I continually remind all students nearing the magical age of 15 and 9/12 that they need to test at least four times/day. In addition, once the permit is approved and driver’s education begins, it also is necessary to test before operating the motor vehicle to ensure that you are not low. During the last few weeks, the Medtronic Minimed corporation announced a new device that can be installed in an automobile to enable you to test blood sugars and be safe. I would suggest that you do not even start a car unless your blood sugar is greater than 100.
It is essential that you always test your blood sugar prior to driving a motor vehicle. In addition, we ask that you have rapid acting carbohydrate stored in the car and on your person at all times. Even conscientious teens may be in the position of being unable to respond to hypoglycemia if they are not prepared. This particular situation occurred in one of my teens when he offered to drive his girlfriend home in her car. Unfortunately, despite having rapid acting carbohydrate available in his car, in his haste to take his girlfriend home, he experienced a severe neuroglycopenic episode (severe low resulting in mental changes and problems in thinking) due to the lack of carbohydrate on his person and in his girlfriend’s car, resulting in an accident. Upon arrival to the police station, he called me to provide medical information and support. I helped him to avoid losing his license due to his normally excellent self-care skills. Don’t let this happen to you. Please test often–even if you feel that you are ok due to the possibility of hypoglycemic unawareness (a low blood sugar without symptoms of hypoglycemia). As a driver you must always be responsible for the very important cargo in your car: YOU
Fran Cogen, M.D., C.D.E., is the director of the Childhood and Adolescent Diabetes Program at Children’s National Health System. She wrote about diabetes for HealthCentral.