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August 11, 2010

Hypoglycemia, Other

Question from Dayton, Ohio, USA:

My boyfriend has type 1. He has a daughter who is 17. The other day, she ended up calling me because he was driving and she was pretty sure his blood sugar was too low; it turned out to be 58 mg/dl [3.2 mmol/L]. He was yelling and swerving the car and she was pretty scared. He refused to pull off of the road until I told him I would hang up and call the police. He goes low very often and thinks driving with a blood sugar of 60 mg/dl [3.3 mmol/L] is fine. He actually tries to keep his blood sugar at 60 or 65 mg/dl [3.3 or 3.6 mmol/L]. I can't get him to agree to keep his blood sugar level up any time, not even when driving. He is really not himself when it is 60 mg/dl [3.3 mmol/L] or lower; he becomes hateful, irritable and obstinate beyond belief and makes very poor choices. He will even refuse to eat or check his sugar. I am pretty sure he should not be driving like that. I don't know what to do. He could easily have killed someone. Even his doctor has been telling him that he is too low too often and is becoming unaware when his sugar is going too low. He is telling me 60mg/dl [3.3 mmol/L] is fine for him to be driving at, but I don't think that is safe. What should his level be to drive safely? If he refuses to check his sugar or keep it at a reasonable level when driving, what should we do?

Answer:

This sounds like a very difficult, frustrating and potentially dangerous situation. NO ONE WITH DIABETES SHOULD DRIVE WITH A BLOOD SUGAR BELOW 80 mg/dl [4.5 mmol/L]! It�s not safe for the person driving and it�s not safe for other drivers on the road.

I would offer your willingness to go to a counselor together to discuss thoroughly what�s going on behind the resistance to driving safely with diabetes. And, if he absolutely refuses to check his blood glucose before getting into the car and treating numbers of 80 mg/dl [4.5 mmol/L] or below before getting behind the wheel, I would treat this the same way you might treat dealing with someone who was drunk and insisted on driving: you would take his keys away because friends and loved ones don’t let friends and loved ones drive drunk or hypoglycemic. And, for your own safety, if he absolutely refuses, I would not get into the car with him. When he drives at those low numbers, he�s putting himself and others in harm�s way in a very deliberate fashion; you don’t have to co-sign that check!

If you need help finding a counselor, your boyfriend’s doctor should be able to help.

JSW
Additional comments from Jeff Hitchcock, CWD Founder and Editor:
This question deals with the unique situation of driving with type 1 diabetes. A couple of recent studies have shows that the lower the HbA1c, the higher the relative risk of a crash. This graph from Motor Vehicle Crashes in Diabetic Patients with Tight Glycemic Control: A Population-based Case Control Analysis clearly illustrates the increased risk:

Click for a larger image

Driving with type 1 presents unique risks, and knowing your blood glucose before you drive — or better yet, using a continuous glucose monitor — is essential to reduce your risk of an automobile accident due to a low blood sugar.

JSH