Taking stock prior to driving reduces risk for drivers with Type 1

By Lisa Foster-McNulty, MSN, RN, CDE

Before driving, Type 1 diabetes patients should ask themselves a series of questions to ensure safe driving. 

1. Have you had extra exercise, more insulin or less carbohydrate than typical, are you experiencing unusual symptoms? 
2. Is your BG low or apt to go low while driving? 

If your response to any of these questions is yes, you need to take action to avoid hypoglycemia. 

According to some recent research published in Diabetes Care, there is a brief questionnaire which can pinpoint Type 1 drivers who are at high risk for a mishap.  An online intervention can help them to avert disaster.  The purpose of the study was to develop and validate both of these tools.

The increased risk is related to factors such as insulin pump use, collision history, profound hypoglycemia, and prior hypoglycemia-related driving incidents. 

Daniel Cox and colleagues from the University of Virginia Health System and Virginia Driving Safety Laboratory in Charlottesville developed a questionnaire containing 11 items.  It screens drivers with Type 1 for high risk in driving mishaps.  Driving mishaps were defined as moving vehicle violations, collisions, severe hypoglycemia while driving, finding themselves somewhere without recollection of how they got there, loss of vehicle control, and episodes of impaired driving where someone else took over driving.  They developed an online intervention to assist those at high-risk so that they may avoid future problems.  Their Risk Assessment of Diabetic Drivers (RADD) scale inquires about prior driving experiences, such as, ” have you had an automobile accident or received a moving vehicle violation in the past 2 years?” and questions about diabetes like, “have you had low blood glucose in the past 6 months?” and “was it a hassle trying to hide dizziness or other symptoms of low blood glucose?”  The RADD could alert high-risk patients and their clinicians of the need to take preventative action.

Having Type 1 diabetes doesn’t automatically place you a high risk for driving mishaps. 

In answering these questions, approximately 35% of people with Type 1 may be classified as high-risk drivers.  Their mishap rate is roughly three times more than that of individuals in the low-risk category.  The high-risk drivers who participated in the online program DiabetesDriving.com experienced a driving mishap rate over the next year of approximately 2.5 per year.  For the high-risk drivers who didn’t take the intervention, the mishap rate was 4.25 per year.  It’s worth noting that the high-risk drivers who participated in the intervention still had a higher mishap rate than that of the drivers who were classified as low-risk.

So…what makes someone high-risk? 

Compared to people without driving mishaps, the research showed that drivers who had at least two mishaps in the prior 12 months were more insulin sensitive, produced less epinephrine while hypoglycemic, had less symptoms specific to their hypoglycemia, exhibited poor driving in a simulator during hypoglycemia (but not during normal glycemia), and displayed poor performance on neuropsychological testing during hypoglycemia.   

It sounds obvious, but people with diabetes need to realize that it’s never okay to drive with a glucose level less than 70.  It’s just simply too easy to go from a mild hypoglycemia without perceived symptoms,  to moderate hypoglycemia, where the driver has impairments to judgment, reaction time, and information processing speed.  If you are driving and realize that you have or may have hypoglycemia, you should immediately pull off the road.  Treat the low, and don’t drive until the hypoglycemia is resolved.

Go to http://care.diabetesjournals.org/content/early/2017/04/11/dc16-0995 to access the article from Diabetes Care.  According to the American Diabetes Association’s professional web site at https://professional.diabetes.org/risk-assessment-diabetic-drivers-radd, the RADD online screening test will soon launch.  It was expected to be available on June 1, 2017, so stay tuned.

Driving isn’t a right, it’s a privilege.  This study was about Type 1 diabetes, and there are other medical conditions that can make a driver at high-risk.  We all need to be responsible to ourselves, our families, and to society–so make sure you are a safe driver!