Some of the medicines used to treat diabetes (insulin, sulfonylureas, repaglinide, and nateglinide) can cause hypoglycemia, which can affect reflexes and judgment. In addition, long-term diabetes complications, especially vision problems and neuropathy, may interfere with driving ability.
There have been a number of research studies that have looked at the impact of diabetes on car accidents. Generally speaking, the impact appears to be modest if it exists at all. It does seem that the risk for future car accidents is increased if there has been a recent episode of severe hypoglycemia, hypoglycemic unawareness, or a history of past crashes.
All the states have special licensing rules. The ADA website has information about your state (see Resources). Many states do not allow drivers who are on insulin to drive a commercial vehicle. Unfortunately, sometimes this means that some drivers are reluctant to go on insulin and have long-term poor glucose control. Recommendations for safe driving if you have diabetes include the following:
• Check your blood glucose immediately before driving.
• Keep a glucose meter and fast-acting carbohydrates in the car.
• If you feel that your glucose levels are low, pull over and check.
• Be extra vigilant if you have complications, especially vision problems and diabetic neuropathy.
• Hypoglycemia, or low glucose reactions, can occur in people with both type 1 diabetes and type 2 diabetes.
• The autonomic symptoms of shaking, sweating, anxiety, and racing heart occur at a glucose level of around 54 mg/dl. If the glucose falls to around 49 mg/dl, the brain is starved of energy and you may feel tired or confused or have blurred vision (neurogenic symptoms). If the glucose falls even further into the 30s you can become comatose or have seizures.
• Hypoglycemia occurs principally because of
• Overestimation of carbohydrate intake, failure to adjust insulin for exercise, or being overaggressive with insulin dosing
• Impairment of the counterregulatory mechanisms, especially glucagon with long-standing diabetes
• To prevent hypoglycemia:
• Be vigilant for symptoms of hypoglycemia
• Monitor blood glucose levels frequently, especially before driving
• Set realistic targets for your glucose: premeal targets between 90 and 130 mg/dl
• Treat hypoglycemic reactions with fast-acting carbohydrates such as juice or glucose tablets. Family members and colleagues should know how to use glucagon injections in an emergency.
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