insulin reaction while driving

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Question:

In so far as you have a medical condition that you know about and don’t/can’t control well enough to avoid dangers to others while driving, you are at fault. You need to understand when you have to eat to avoid hypo problems. For most known diabetes (at least most type IIs) who are not in full denial, hypos are the acute problem when driving. Whether it is by "live" testing or conservatively interpreted historial knowledge, when driving or doing similar things you need to "push" in the direction of avoiding hypos. Art Schor …. – Hide quoted text — Show quoted text – my question about diabetics’ bodies actually being like "likker" stills: }and that sometimes in auto accidents where the person is killed, }they are misdiagnosed as DWIs because of all the alcohol in their }blood, which actually came on after death, from the diabetes. I know that people can have a natural occurrence of alcohol in the .001% range, very low as .010% is the legal limit in most states. As to alcohol production after death, that is a new one on me (I am a DWI Investigation/Breathalyzer instructor). I will check with our death investigators. Later, Dave Thanks for the offer to check this out, Dave. (Obviously *I’m* not a good investigator – can’t recall the source of that info.) It’s bad enough to be diabetic; worse still if one of us hypo’s, wrecks on hwy. and gets killed – and then is reported to be a drunk driver and therefore at fault!

Response:

In so far as you have a medical condition that you know about and don’t/can’t control well enough to avoid dangers to others while driving, you are at fault.

<snip, snip These discussions can roll along pretty fast. My original question had been concerning the DCCT and the resultant focus on diabetics maintaining ‘tight’ control – which unfortunately for many has evolved not into tight control, but into inducing repeated hypos in failed efforts to avoid spikes and get ‘good HbA1c scores.’ I had worried in a posting whether this was resulting in a rash of hwy. accidents by diabetics hypoing, and whether this would focus more govt. attention on the question of whether *all* insulin-dependent diabetics should have their drivers’ licenses yanked. (I’m just a professional worrier, I guess.) Most respondents felt this idea would never fly politically. But there were several reports from folks in-the-know – police dispatchers, ambulance attendants, et al., that we are indeed seeing an explosion of hwy. hypos since DCCT. Thanks for your response, Art, and I’d be happy to hear your feelings about DCCT and all these related issues. I’m trying to digest so much material so rapidly – seems many diabetics are gravitating toward Humalog for meals, in combination with a very long-acting insulin – given once or twice a day – to try to avoid the spikes while also avoiding the crashes. Susie.

Response:

The A1C shows the glucose spikes, but there’s no opposite test, to reveal how many dangerously low readings they may have experienced to achieve the low A1C.

Er, the A1C shows neither the spikes nor the lows except in the sense that they both affect the rate of glycation of the hemoglobin and, therefore are cumulatively involved in the test’s result. IDDM, dx’d 6/72, MI (R & UL)

Response:

my question about diabetics’ bodies actually being like "likker" stills: }and that sometimes in auto accidents where the person is killed, }they are misdiagnosed as DWIs because of all the alcohol in their }blood, which actually came on after death, from the diabetes. I know that people can have a natural occurrence of alcohol in the .001% range, very low as .010% is the legal limit in most states. As to alcohol production after death, that is a new one on me (I am a DWI Investigation/Breathalyzer instructor). I will check with our death investigators. Later, Dave

Thanks for the offer to check this out, Dave. (Obviously *I’m* not a good investigator – can’t recall the source of that info.) It’s bad enough to be diabetic; worse still if one of us hypo’s, wrecks on hwy. and gets killed – and then is reported to be a drunk driver and therefore at fault!

Response:

}and that sometimes in auto accidents where the person is killed, }they are misdiagnosed as DWIs because of all the alcohol in their }blood, which actually came on after death, from the diabetes.

I know that people can have a natural occurrence of alcohol in the .001% range, very low as .010% is the legal limit in most states. As to alcohol production after death, that is a new one on me (I am a DWI Investigation/Breathalyzer instructor). I will check with our death investigators. Later, Dave

Response:

DOT regs currently allow hypo’s to work . Insulin deps are not currently allowed to drive cdl, however, a great many drivers out there are insulin dep but appear to have been granted waivers.I know several. jim.

Response:

[snip] I remember the DCCT report consisted of pages and pages about the benefits of intensive insulin therapy (reduction in complications) and a few sentences about the drawbacks (3 times the hypos). These sentences mentioned minor motor vehicle accidents in which nobody got hurt. Although I do not want to argue about the benefits, which are major, I thought the authors treated these "highway hypos" awfully lightly. Obviously, this type of hypo can kill people, including bystanders who have not chosen to take the risk of driving with an elevated risk of hypo. From what I’ve heard in many forums from people who are in Calfornia the rules there require that the D.M.V. ask you the question and you may be required to have your doctor fill out a form attesting to the fact that you have not had any dangerous Hypo inicidents in a specified amount of time. [snip] However just having diabetes, In itself, is not enough to cost you your license in California. But when you go for renewal, GO EARLY (Give yourself time to see your doctor before your license runs out)

I do not remember being asked for a doctor’s statement when I was first licensed in California, but I may have forgotten, since it was 12 years ago. This form was required in Connecticut, so California may have accepted the Connecticut license as evidence that my doctor thought I was OK to drive. California hasn’t asked me for any such form at renewal time. As for insurance companies, some have different rates for insulin-dependent diabetics, some don’t. Shop around (good advice for anyone buying insurance). Tom a few days shy of 22 years Type I

Response:

John Carroll wrote a very informative response to my questions regarding glucose levels and driving. Thanks so much. Since the release of the DCCT(?), with new emphasis on achieving lower A1C readings and more monitoring and combination therapy of pills and insulin, even on what used to be called Type IIs or adult onset diabetics, my guess is that, instead of keeping glucose in, say 70 – 200, people now are getting a range of maybe 40 – 150. The A1C shows the glucose spikes, but there’s no opposite test, to reveal how many dangerously low readings they may have experienced to achieve the low A1C. I guess what I’m stumbling around, trying to say, is that I think that instead of achieving an ideal, nearly flat glucose level, we are still rollercoastering, but now at a lower level than before DCCT, which its emphasis on avoiding spikes. Sorry if I’m slow to catch on to all this. It’s new to me. My mom’s an alleged "Type II", on 70-80 units Humalin 70/30 a day, plus 2-4 pills, and she still spikes and crashes. People seem to be maybe overmedicating, confused, trying to get themselves sorted out, but perhaps are presenting a driving risk, jeopardizing the future driving privileges of their fellow insulin-dependent diabetics, and causing as much damage to their bodies from low readings as they were before, with spikes. Does this make any sense? My concern about the license issue is that is we experience a wave of diabetes-related M.V. accidents, there will be a _blanket_ denial of driving privileges to all diabetics. Already, insulin-dependents cannot drive tractor-trailer. I apologize in advance for verbosity. Susie.

Response:

I’m a brand new AOL member, and diabetes questions were the primary reason. There is so much focus on hemoglobin A1C results, but where’s the test to show how many times your glucose was too low?

There ain’t one. You may be one of the lucky ones who can sense lows, or you may catch a low by taking a lucky BG measurement. But lots of mild lows are undoubtedly missed. I am concerned that as more and more do frequent finger-sticks and insulin shots, we are going to see a rash of related hwy. accidents that will force more attention on the question of whether we should have our licenses yanked.

Well, if we drive without measuring BG and taking precautions to be sure we don’t go hypo while driving, we _should_ get our licenses yanked. I knew a woman who smashed up five cars in separate collisions before her own car stopped. She was hypo, hadn’t measured BG in a long time, and didn’t even know about the crashes till she was recovering in the hospital. Strangely, her license wasn’t yanked, but she decided it was time to quit driving. I have been thinking of going back over the road. I’m not on insulin yet, and in fact am more worried about the high b.p. making me flunk the DOT physical. I think we have a major concern about this issue. Maybe high sugars caused health problems, but the low sugars people are experiencing now are affecting those around them.

The low sugars are nothing new. Shortly after insulin was first used people had a terrible time with hypos because they were trying to control their BG with just regular insulin and no BG testing at all except when they saw the doctor. The man who made a big difference in treating diabetes at the time (a Ph.D., not an M.D.) was Michael Somogyi, who believed that low BG led to overreaction and consequent high BG. (The famous "rebound") To avoid this problem, he recommended that low BG be avoided like the plague and that it was okay to be a little high and have a bit of urine sugar on a regular basis (which is _very_ high by today’s standards). In fact, the people who followed Somogyi’s advice did better for a while — far fewer hypos. They seemed to be leading healthy lives. Only then came the complications and the deaths, at least partly from perpetual high BG. However, there were lots of lows in the earliest days of insulin treatment and a fair number of serious lows all along because if all you know is that your urine sugar is low or zero, you don’t know whether the BG is normal, a bit above normal, or dangerously low. The point I’m talking all around is that lows have been with us since the dawning of effective treatment. I heard that diabetes turns the body into a still, and that sometimes in auto accidents where the person is killed, they are misdiagnosed as DWIs because of all the alcohol in their blood, which actually came on after death, from the diabetes. Anything to that?

Don’t know about after death, but while we’re alive, we produce acetone if we don’t have enough insulin. It can impart a somewhat alcohol-like odor to the breath. Apparently some diabetics have died in the drunk tank, having been misdiagnosed by the police and judges. John Carroll

Response:

Has anyone had a accident due to an insulin reaction while driving? And if so was your drivers license suspended/revoked? Also how does this affect your auto insurance? I appreciate any info or advice. sign me very worried in California! As a police dispatcher I’ve never had what I call a "Highway Hypo" (Term I invented for hypo while driving) however since DCCT came out I’ve had to dispatch troopers to well over a dozen of them. 2 people went to hospital with broken arms when a hypo in a pick up truck ran over their motorcycles (I provided emeregency glucose for that driver by the way, Still Med Tecs, when they got there, said he was "Very Low") In Michigan a police officer or a doctor can submit your license for medical review and if the Sectary of State (Our D.M.V) feels that you are not safe to drive. Kiss that license good by. In the 17 years I’ve been on the job BEFORE DCCT we had one driver, Just one, who went hypo twice. Both times he realised it and pulled off the freeway in time to prevent incident. However he still lost his license. Even though he did not so much as scratch the paint on his motor home. Most states have some form of "Unable to operate a vehicle safely" rule wording varies from state to state. From what I’ve heard in many forums from people who are in Calfornia the rules there require that the D.M.V. ask you the question and you may be required to have your doctor fill out a form attesting to the fact that you have not had any dangerous Hypo inicidents in a specified amount of time. You may also be prevented from driving selected vehilcles (IE: I can not drive a SEMI as I can’t get a DOT medical card, I’m on Insulin) (Yes I do know how to drive a Semi and have in the past, LONG, LONG time ago that is, I’ve checked out on everything from riding lawn mowers to Semi’s) However just having diabetes, In itself, is not enough to cost you your license in California. But when you go for renewal, GO EARLY (Give yourself time to see your doctor before your license runs out) "Nothing adds excitement like something that is none of your business" Reality is a figment of your imagination. Net-Tamer V 1.07X; Beta – Registered

Response:

I’m a brand new AOL member, and diabetes questions were the primary reason. There is so much focus on hemoglobin A1C results, but where’s the test to show how many times your glucose was too low? I am concerned that as more and more do frequent finger-sticks and insulin shots, we are going to see a rash of related hwy. accidents that will force more attention on the question of whether we should have our licenses yanked. I have been thinking of going back over the road. I’m not on insulin yet, and in fact am more worried about the high b.p. making me flunk the DOT physical. I think we have a major concern about this issue. Maybe high sugars caused health problems, but the low sugars people are experiencing now are affecting those around them. I heard that diabetes turns the body into a still, and that sometimes in auto accidents where the person is killed, they are misdiagnosed as DWIs because of all the alcohol in their blood, which actually came on after death, from the diabetes. Anything to that? My other concern about getting behind the wheel again is night vision.

Response:

In some states, I understand that it’s illegal for diabetics to drive with low bg levels or not having had a snack in the last hour or so. Better check your state laws.

Response:

Has anyone had a accident due to an insulin reaction while driving? And if so was your drivers license suspended/revoked? Also how does this affect your auto insurance? I appreciate any info or advice. sign me very worried in California! In some states, I understand that it’s illegal for diabetics to drive with low bg levels or not having had a snack in the last hour or so. Better check your state laws.

Yes, many states have criminalized it as within ‘driving under the influence of drugs’, which in these States includes otherwise-legal drugs. In my experience (yes I have some, the rest of this post describes) it is not nastiness but rather a way to fit the event into their driving records, which really depend on a violation in order to make the bookeeping work right. Following is most of an EMail I sent to Adele, expectng that someone else would take care of the public question. No one did, so here I go again: – - – - Yes. I was suspended in MN, not an accident but I was weaving all over and "didn’t quite figure out" that those blinking red lights had me in mind, until I had led about 10 miles of eratic low-speed chase. On a different freeway than I should have taken, going totally the wrong direction. After I rolled down the window and smiled, the next thing I noticed was waking up in a horizontal position in the paramedic van. So although I didn’t hit anything, THIS WAS SERIOUS and IT GOT THEIR ATTENTION. It also got mine!!! If you want to drive and have any history of unmanaged Insulin shock, I think it is approriate for them to require from you a plan, how you will avoid having an episode in the future. Submit a plan 100% impossible to fail. My management plan was accepted here and they reinstated me after just a few days. Here are my rules: Rule 1: Never begin driving without a test in the last 30 minutes. (Promising to use a meter with memories will improve your chances, I think. The new FAA waiver rules *require* that the meter have a history display.) Rule 2: Never begin driving without the previous a test result 90 or higher. Rule 3: Retest within 120 minutes for the duration of driving. Rule 4: Any test result below 90 I will *STOP* and snack and NOT PROCEED until a later re-test presents a result above 90. No effect on insurance. Because there has never been a claim on this vehichle, they’ve even given me a ‘we-will-never-cancel-you’ rider! (and of course, I’m at their highest accident-free discount.) —

Response:

}Has anyone had a accident due to an insulin reaction while driving?

A few years ago I was sent to our local community college for a "student destroying a copy machine." Upon getting him safely under control (not an easy task), we found that he was in insulin shock (bg was in the 20’s). He was not criminally charged, even though he did extensive damage to a $5,000 Xerox. Most laws require a mental state such as "purposely or knowingly …." Since a person has little or no control over an insulin reaction, there should be no legal ramifications. Now, if a person drank too much alcohol causing a reaction, different story . Later, Dave

Response:

Suggest contacting Dave Groves on the Diiabetes Forum on Compuserve. Hes’s an expert on the subject. — David G. Parker Seattle, WA

Response:

A very dear friend of mine had such an accident. He drove off of the road into a ditch. The state patrol took him 30 miles away to their barracks, and then someone had a silly idea to call paramedics. As far as I know, he was not cited, and there was not enough damage to his car to bother with the insurance. In another case, a sheriff stopped a DUI and from the odor in the car, called an ambulance. The man was in a coma. He was treated and released with no subsequent action from the law.. This is in Ohio. California might be different.

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