The Laws on Driving With Diabetes
The ADA's view: One size doesn't fit all
In most parts of the United States, a driver's license is a passport to freedom. Laws that make it harder for all people with diabetes, particularly those who rely on insulin to stay healthy, to get and keep a license are discriminatory and ill-conceived, according to a position statement released by the American Diabetes Association (ADA) in January. While people with diabetes may be at a slightly higher risk of driving mishaps than those without the disease, there is evidence that these risks can be identified and reduced.
Each state has its own take on licensing drivers with diabetes. While some pose no particular restrictions, others can be quite harsh. Most states will take away the license of anyone who experiences a severe hypoglycemic event, low blood glucose that requires assistance to treat, at any time until he or she has been free from such an episode for a certain period of time or can prove it won't happen again.
"The ADA legal advocacy people have been fighting against one-size-fits-all diabetes policies for a long time," says Daniel Lorber, MD, FACP, CDE, who chaired the committee that wrote the position statement. For cases in which the medical fitness of a driver with diabetes is in question, the ADA recommends an individual assessment and notes that, by and large, most people with diabetes operate vehicles safely.
Research suggests that people with diabetes have between a 12 and 19 percent increased risk of having an accident relative to those without the disease, though results have been mixed. To put that into perspective, among all motorists, driving at 1 a.m. on a Sunday increases the risk of an accident by 14,200 percent compared with driving at 11 a.m. "If society thinks [allowing people to drive in the wee hours] is an acceptable risk," Lorber contends, then targeting people with diabetes seems unfair.
The likely cause of the increased risk of driving with diabetes is low blood glucose. There is just one study that found that severe hyperglycemia (high blood glucose) can hamper driving skills. Daniel Cox, PhD, of the University of Virginia studies the effects of hypoglycemia on driving ability in his laboratory using a simulator. He has found that moderate hypoglycemia impairs driving safety and judgment, which may make it more difficult for drivers to know when they need to self-treat.
While hypoglycemia can increase the risk of an accident, there are effective ways to lessen this risk so that people with diabetes can stay on the road and stay safe ("Safety Tips," right). Cox is currently enrolling people with type 1 for an Internet program to identify people at high risk for accidents and reduce that risk through education. For more information and to enroll, go to www.diabetesdriving.com.
For more on driving with diabetes, including state laws, go to diabetes.org/driverslicenses.
A car that can alert drivers of low blood glucose levels sounds like science fiction, but a prototype already exists. The technology is based on Ford's Sync system, which enables users to access their phones, control music, or interact with other Bluetooth-enabled devices wirelessly through voice commands. The prototype designers enabled Sync to tap into Medtronic's continuous glucose monitor, so the car could literally tell a driver what was going on with his or her blood glucose as it rolled on down the road. It's not clear when or if the product may come to market.
If you are on insulin or are prone to lows, check blood glucose before getting behind the wheel, even if you wear a continuous glucose monitor. "Even though I'm wearing the [CGM] sensor, there's a 20-minute delay," says Emily Stunek, 22, of Moorhead, Minn. "Because blood glucose fluctuates so fast, you can't rely on the sensor."
- Keep fast-acting glucose products, such as tablets and gel, at hand.
- If it becomes difficult to see or you experience any symptoms of low blood glucose, pull over as soon as safely possible and treat immediately.
- If blood glucose seems to be dropping, have something to eat even if you're still in the normal range.
- For a long road trip, plan out your stops along the way in advance.
- When driving long distances, pull over and check blood glucose every one to two hours, even if you wear a CGM. "The vibrations and fatigue from driving a car can disguise my symptoms of a low, such as that hollow stomach feeling or tiredness," says Forecast Editorial Director Kelly Rawlings, who has driven with type 1 for 27 years.
- Pack your own road food if you're not sure when you'll find a location to eat a meal. "I'm a huge snacker when I drive," says Stunek. "Instead of eating gas station junk food, I can bring carrots and then not have to worry about insulin adjustments."