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June 4, 2001

Other Social Issues

Question from Maryland, USA:

My teenager has consistently high blood sugars and a history of extremely high A1c results (up to 14.9%). My question pertains to her chances for obtaining a learner's permit and eventually a driver's license with numbers that high. The medical review board at the motor vehicle agency says there shouldn't be a problem if a teen is well-controlled, but she isn't. We were given a form for her doctor to fill out which asks for the A1c results. Does this mean the motor vehicle agency has a cut-off level and if her A1c exceeds that, she'll be refused? What is the reasoning about high blood sugars and safe driving? I certainly see the connection between low blood sugars and compromised safety, but does the motor vehicle agency see an increased risk by having high blood sugars? Do you know of any instances where a teen was denied for being too high?


I suggest that you check directly with your local MVA as to whether they can withhold a provisional driver’s license on the grounds of an A1c test above a certain level. I suspect that there may have been a number of problems where hypoglycemia has been the cause of an accident to the point that there has been community pressure to try to prevent them. As you point out a high A1c test is primarily an indication of high blood glucose levels; but it is also a measure of poor control and of a significantly increase risk of sudden loss of consciousness due to hypoglycemia. And an A1c of 14.9% is really a considerable measure above what normal reasonable control can achieve so that there might be an additional issue of visual acuity from early retinal damage. The message is surely that your daughter with the help of the rest of the family needs to make a major effort to achieve better control before she is allowed to drive the car.

Additional comments from Dr. Stuart Brink:

Why would anyone allow an adolescent who is having problems taking responsibility for her health to drive a car? Hemoglobin A1c levels this far out of range usually indicate major insulin omission, eating disorders or some other major psychosocial problem and adding driving a car is a recipe for a disaster.

There are good data now to suggest that high blood glucose levels, as well as low blood glucose levels, both interfere with brain function as well as reflexes. I would discuss this directly with your teen’s diabetes team. Perhaps driving a car will be some motivation to improve diabetes care.

Additional comments from Dr. Larry Deeb:
States have the right to insure the public’s safety. High blood sugars mean lack of control. The public has a right to worry that if you are not committed to control, you aren’t testing and might drive when low.