Partial Hypo unawareness.

[PotatoeMash]

Hi everyone,

The law/DVLA, etc. all state that if you are hypo unaware you cannot drive. That's obvious and understandable. But at what point are you considered hypo unaware with driving licence taken away?

For example, if you usually know your hypo by having symptoms but have had a couple where you've only discovered that you're hypo by testing, and you've NEVER had a severe hypo or anything not easily treatable, where do you stand regarding hypo unawareness? If you consider it to be partial hypo awareness, or maybe reduced sensitivity to it - e.g. sensing it at 3.5 instead of 4, where do you stand on being able to continue driving?

Furthermore, if you end-up completely hypo unaware, I know that CGM can be used to help with this due to the alarm functions. Would you be allowed to drive if you had CGM sensing hypo's for you? That way, you can still know you're hypo and stop the car, treat, etc. just with technology sensing it instead of you...

Would appreciate everyone's thoughts on this, but please no preaching aggressive posts. We are all aware of the law and have no intention of doing anything that could ever put anyone in danger. This just seems like an area of diabetes life that lacks sufficient detail in the literature.

Thanks,

 

[Pumper_Sue]

I know that CGM can be used to help with this due to the alarm functions. Would you be allowed to drive if you had CGM sensing hypo's for you? That way, you can still know you're hypo and stop the car, treat, etc. just with technology sensing it instead of you...

As I understand it, no you can not rely on the sensors. I have seen this written somewhere but can't remember where.

 

[trophywench]

If you have 'impaired' hypo awareness - frankly don't risk any other road users lives!

You can get your awareness back by deliberately running your BG a bit higher for a month or two - hence it is obviously better to come clean about it with your doctor otherwise next time he does your A1c test he'll be wanting to know why it's not where it should be, if he's anything like.

 

[Deleted member 27171]

Hi @PotatoeMash

I *think* any loss of hypo awareness would mean that driving should be stopped, even if only a couple of times as the rationale is that it is likely to get worse (if no work done to regain) and does increase the risk of severe hypos. The DVLA likely consider a person to either have awareness or not and a few episodes would put you in the ‘not’ category.

Are you able to call your DSN to ask their opinion rather than wait to your next appointment? Whether they decide you must inform the DVLA or not, you can at least can get some support with regaining awareness sooner rather than later and prevent it getting worse.

The DVLA guidance does now allow for the use of CGM - there are just certain circumstances where readings must be backed up with a finger prick test, including if levels are below 4 or have hypo symptoms.

Driving and Diabetes campaign

We did it! DVLA and DVA give Flash and CGM the green light

www.diabetes.org.uk

 

[everydayupsanddowns]

Welcome to the forum @PotatoeMash

There are clinical scoring systems that will help your Dr assess your hypo awareness.

I think it is complicated by several things... one is that the definition of ‘hypo’ is a little blurry, particularly when you start to speak to professors and research specialists who have spent their careers studying the area.

Frequently said to be ’4 is the floor’, some soecialists are more worried about the BG level where the brain is affected and cognitive impairment is experienced - which i think is more like 3.6-3.5ish.

Another thing is that non-d folks who wear continuous sensors often see multiple readings in the 3.7-3.9s... and they could drive, and no one would a) be any the wiser and b) care very much - because their fully functioning metabolism will correct the dip, and while they might feel hungry etc, they will almost certainly not go low enough for the cognitive impairment to happen that we would get.

But none of this matters all that much between you and the DVLA. Because they treat 4.0 as the cut-off (quite rightly) so that you and other road users have some breathing space.

So stay above 4 and have the impaired awareness conversation with your clinic so that they can support, assess and help you - it’s absolutely vital to keep you and other road users safe 🙂

And yes, the DVLA guidance on sensors is that you cannot simply use them as a ‘proxy’ for your own awareness - you still need to know when you are going hypo with your own symptoms to be able to drive.

 

[Goldiebrowse]

Hi everyone,

The law/DVLA, etc. all state that if you are hypo unaware you cannot drive. That's obvious and understandable. But at what point are you considered hypo unaware with driving licence taken away?

For example, if you usually know your hypo by having symptoms but have had a couple where you've only discovered that you're hypo by testing, and you've NEVER had a severe hypo or anything not easily treatable, where do you stand regarding hypo unawareness? If you consider it to be partial hypo awareness, or maybe reduced sensitivity to it - e.g. sensing it at 3.5 instead of 4, where do you stand on being able to continue driving?

Furthermore, if you end-up completely hypo unaware, I know that CGM can be used to help with this due to the alarm functions. Would you be allowed to drive if you had CGM sensing hypo's for you? That way, you can still know you're hypo and stop the car, treat, etc. just with technology sensing it instead of you...

Would appreciate everyone's thoughts on this, but please no preaching aggressive posts. We are all aware of the law and have no intention of doing anything that could ever put anyone in danger. This just seems like an area of diabetes life that lacks sufficient detail in the literature.

Thanks,

I was lucky enough to get a libre device which I use to help me monitor my levels. I know a lot of non diabetics who have levels of 3.5 and I’ve been 3 and functioned perfectly normally. Levels are a guide and they affect everyone differently - one thing I have found is my mood, some days I can have a level of 5.5 and feel completely washed out. Other days I’ll be 3 and functioning perfectly normally, I put this down to adrenaline and how it causes releases of glucose (or not). Hypo sensitivity can be improved by increasing levels but it isn’t easy (especially if you have busy life like me).

 

[Pumper_Sue]

I was lucky enough to get a libre device which I use to help me monitor my levels. I know a lot of non diabetics who have levels of 3.5 and I’ve been 3 and functioned perfectly normally. Levels are a guide and they affect everyone differently - one thing I have found is my mood, some days I can have a level of 5.5 and feel completely washed out. Other days I’ll be 3 and functioning perfectly normally, I put this down to adrenaline and how it causes releases of glucose (or not). Hypo sensitivity can be improved by increasing levels but it isn’t easy (especially if you have busy life like me).

If you are functioning normally at 3 and no indication you are hypo then you are hypo unaware so I hope you are not driving.

 

[trophywench]

Yep - what Sue said. There was or still is, an International European Medical Advisory Board with an active Diabetes Section, it is where Dr David Cavan, previously a D consultant at BDEC and instrumental in getting BERTIE and its Online version up and running, went and via him ages ago we saw the medical research paper used by the EU countries to base their 'Driving Laws for Diabetics' around.

This stated that BG level for mental impairment varied between different people - however there was absolutely no disagreement that whoever the person is their brain function is ALWAYS affected by the time their BG is down to 3.3 even if the person himself cannot detect this, which is precisely why '4 is the floor' is recommended to be used so as to give everyone enough margin to treat the hypo they don't think they are having before they have an accident.

 

[pm133]

I was lucky enough to get a libre device which I use to help me monitor my levels. I know a lot of non diabetics who have levels of 3.5 and I’ve been 3 and functioned perfectly normally. Levels are a guide and they affect everyone differently - one thing I have found is my mood, some days I can have a level of 5.5 and feel completely washed out. Other days I’ll be 3 and functioning perfectly normally, I put this down to adrenaline and how it causes releases of glucose (or not). Hypo sensitivity can be improved by increasing levels but it isn’t easy (especially if you have busy life like me).

The DVLA are clear on this. You test a maximum of 2 hours before driving and every 2 hours after that if long distance. If you under 4.0 mmol/L whether you feel it or not, you cannot drive until you have take some carbs, tested a little later with a reading of at least 5.0 mmol/L and waited at least 45 minutes after the sub-4.0 mmol/L reading.
If anyone fails to do this and ends up killing someone in a car accident, they'll absolutely throw the book at you if you don't have the meter readings to back you up. I imagine they'd push for death by dangerous driving and that's potentially a life sentence.
They won't make allowances for how you felt when taking to the wheel or how busy your life is. It's a right pain in the backside to remember to pre-test but it just isn't worth the risk if anything goes wrong.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/834451/inf294-a-guide-to-insulin-treated-diabetes-and-driving.pdf

 

[trophywench]

Hypo whilst at wheel = Driving under the influence of drugs.

Doesn't matter that they are prescribed drugs for a properly diagnosed medical condition. A drug is a drug. In this case for the purposes of this Law, insulin is a drug.

NB This has subsequently been shot down in flames as incorrect by a Type 1 retired Doctor

 

[mikeyB]

Hypo whilst at wheel = Driving under the influence of drugs.

Doesn't matter that they are prescribed drugs for a properly diagnosed medical condition. A drug is a drug. In this case for the purposes of this Law, insulin is a drug.

Sorry TW, you are completely wrong for a couple of reasons. Firstly, insulin is not a drug, it is a replacement therapy. Drug driving laws only apply to those medications or recreational drugs which can interfere with your judgement of themselves, whether that be alcohol, cannabis, heroin and its derivatives, MDMA. Indeed, if any medication you take has on the label "May cause drowsiness. If affected do not drive or operate machinery". That applies to any number of antidepressants.

I don't recall ever seeing a pack of insulin with that warning. And if every person on insulin were subject to the current drug laws were prosecutable, we'd have been banned for our first speeding ticket.

Not responding to a hypo while driving might end up with a prosecution for an offence of driving without due care and attention, or careless driving. Those offences escalate if another person is injured or killed, obviously. But at the low end, these don't attract disqualification in the courts.

The DVLA are independent of the courts. The court may not disqualify you, but the DVLA will take your licence away until you can present them with evidence that your diabetes is controlled properly.

There is a fuller explanation of driving under the influence of drugs which I wrote for the pancreatitis forum. Folks with Chronic pancreatitis often need to take heavy pain relief, including opiates and even ketamine. I don't. The powers that be in that group have fixed this for reference on the forum.

Your brief post is not only completely wrong, but, I should imagine, a bit terrifying to some.

 

[Amity Island]

Firstly, insulin is not a drug, it is a replacement therapy.

MikeyB,

Thanks for clearing that up for me, it's a question I've wanted a definitive answer on for some time. Sometimes I get asked this over the counter, "are you using any other drugs?" I always answer no, as the only thing I take is insulin.

 

[Frank87]

I drive lots like i guess most people do. I have been Type 1 for 24 years and still retain my hypo awareness.
I will if I haven't had a hypo for 6 months purposely manufacture 1 (in a controlled environment with family) to see that I still do.

I am not saying this is by any means the right or best thing to do, but I like to know before something bites me on the backside.

 

[trophywench]

Well @mikeyB - I'm only going on what the Policemen told me when I did go hypo at the wheel on the M42 and collided with the central Armco. Was 20+ years ago.

Wasn't prosecuted TG so dunno - but certainly what I've always believed as 'from the horse's mouth'. I now sit corrected, thanks, and apologise for misleading anyone.

 

[Pumper_Sue]

Sorry TW, you are completely wrong for a couple of reasons. Firstly, insulin is not a drug, it is a replacement therapy. Drug driving laws only apply to those medications or recreational drugs which can interfere with your judgement of themselves, whether that be alcohol, cannabis, heroin and its derivatives, MDMA. Indeed, if any medication you take has on the label "May cause drowsiness. If affected do not drive or operate machinery". That applies to any number of antidepressants.

Hi Mike,
there have been many people jailed for driving with no hypo warnings and causing accidents including death.
The charges have always been driving whilst under the influence (mainly as can't be charged and jailed with sheer stupidity)
There are always cases in the paper or on the net every year.

 

[mikeyB]

You can be charged and jailed for sheer stupidity, if you include Causing Death by Careless Driving. (Max 5 years). I'm surprised that no defence barrister has pointed out that insulin isn't a drug if what you say is true. To obtain a finding of guilt in a driving under the influence, the court has to be presented with evidence that the blood levels of the drug amount to a level that could cause impairment. These levels have been established for alcohol, opiates, cocaine and other drugs. But clearly not for insulin, because it's completely inappropriate.

As a by the way, those folk who (like me) use CBD Oil, in my case to ease muscle spasms and fasciculation, it will trigger the oral cannabis test used by the boys in blue when they stop you, even though CBD oil doesn't contain THC, the 'active' ingredient of cannabis. And beware of Co-codamol, particularly the higher strength. Codeine is metabolised into morphine in the body, and if taken regularly can tip you into illegal levels. Bet you didn't know that.