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[IP] Low blood sugar impairs diabetic drivers


SOURCE: Diabetes Care 2000

NEW YORK, Feb 10 (Reuters Health) -- Falling blood sugar can impair the
ability of diabetics to drive, but many delay taking action, increasing the
risk of accidents, US researchers report.

The study authors advise type 1 (insulin-dependent) diabetics to measure their
blood sugar before driving, and not to drive if the test result shows a blood
sugar less than 4 mmol/L.

Low blood sugar, or hypoglycemia, can occur when the dose of insulin is too
high relative to food intake, or if the diabetic injects insulin and skips a
meal. The condition can lead to fatigue, weakness, headaches, confusion, and
impaired coordination. Therefore, patients who become hypoglycemic while
driving are at greater risk of accidents.

"Prevention of hypoglycemia-related driving crashes relies on both a driver's
ability to recognize his/her driving impairments and then immediately take the
corrective actions of consuming carbohydrates and/or pulling off the road,"
write Dr. Daniel J. Cox, and colleagues with the University of Virginia Health
System in Charlottesville.

To investigate patients' ability to decide when they are at risk, the team of
researchers tested the driving performance of 37 adults with type 1 diabetes,
as their blood sugar declined.

Using a driving simulator, Cox's group monitored driving performance, brain
wave activity, and the effect of corrective behaviors such as drinking a soda
to correct blood sugar or pulling off the road.

Every 5 minutes, the investigators assessed blood glucose, how subjects
perceived symptoms of hypoglycemia, and how they judged their ability to

According to the results, even mild hypoglycemia could lead to dangerous
driving, as demonstrated by swerving over the middle line, using brakes on an
open road, and speeding.

Yet only 30% of patients took corrective action such as pulling off the road
or eating a high-carbohydrate snack. Corrective actions were more likely to
occur among those most impaired patients.

"There appears to be a disconnect between awareness of driving impairment and
corrective action," Cox and colleagues note. They recommend that diabetics
measure their blood glucose before driving and keep a snack in the car.

"Patients should treat themselves while driving as soon as low blood glucose
and/or impaired driving is suspected," the authors conclude.

Although the researchers stress that their findings are not relevant to the
driving privileges of people with type 1 diabetes due to the small size of the
study and the use of a driving simulator instead of an actual vehicle, some
experts fear that the study findings will be used against diabetics.

"Given the ubiquitous need for driving in this country, it is imperative that
we exercise great caution in the interpretation of the data, particularly when
considering the potential burden if driving privileges for all people with
diabetes are adversely affected," write Drs. David Marrero and Steve Edelman
with Indiana University School of Medicine in Indianapolis, in an editorial.

Their concern is underscored by another editorial in which Dr. Brian M. Frier
with the Royal Infirmary in Edinburgh, Scotland, writes that "diabetic drivers
who are at high risk of developing unpredictable disabling hypoglycemia will
have difficulty retaining their driving licenses as a consequence of the
results of this important study."

"It is na´ve to believe that the results of this study will be ignored by
driving licensing authorities and their medical advisors, for whom public
safety is paramount," Frier adds.

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