This is not strictly a medical question, more one of medical ethics, but your opinions would be appreciated.

My wife is a long term type 1 diabetic and she gave birth to a healthy son, nine months ago after taking inordinate care with her control, including A1cs levels always under 5.8. Our health visitor is a little paranoid about diabetics having children so referred him to the community pediatrician for a check-up. At our appointment, the pediatrician pronounced our son to be absolutely fine, but my wife proceeded to have a bad hypoglycemic reaction, probably due to the stress, whilst we were in the meeting. She had glucose with her and ate it as quickly as possible, so she wasn’t actually incapacitated and didn’t need any help, but she was obviously very out of it and shaking for a couple of minutes. In your opinion, is this going to have any reflection on her as a mother, to be looking after a child and having low blood sugars? The pediatrician seemed quite shocked and insisted that we stay there until she had recovered. Do you think anything will be added to either my wife’s or my son�s medical notes that may affect insurance/driving license applications, etc.?

In the United States, insurers, physicians, law enforcement professionals, and social workers recognize hypoglycemia can be a problem. If you have a car accident with a low blood sugar, you can have your license taken away and an insurance company can refuse to provide insurance to your for your vehicle. I have heard of situations where patients with frequent lows have triggered childcare custody issues by the state. What has been involved with this is that a parent has had a severe low and passed out and the social worker found the child unattended while the mom was incapacitated. This actually happened several times. It caused the child to be put into the grandmother’s custody and an extensive plan for glucose monitoring and medical follow-up was put in place. The mom got better, stopped having lows, and she regained custody of the child. This story is the extreme.

One single low could happen to anyone. If the child was not unattended, I am not sure anyone can fault the parenting. What you and your wife might speak to is how to avoid all the lows to put herself at risk. Make sure she checks her blood sugar when she gets in the car with the child or alone. Make sure she follows up with her physician. Doing all the little things would be important in a situation like yours. In my experience, when you work to avoid lows, you can do this. It takes some preparation, however. As far as the insurance, if no car was involved, and you can show in your records you monitor before driving (and keep glucose with you all the time), things should be okay.

JTL

[Editor’s comment: Also, see the DVLA page about diabetes.

BH]