Relying on CGM for hypo awareness while driving

[CliffH]

Just as long as it isn't in hand & toyed with whilst driving. Cited as "driving without due care & attention?" Regarding DVLA hypo awareness. Fitness to drive means you need to know the signs. A warning from a CGM, just don't cut it for them.

Perhaps it depends upon whether one's using a mobile phone's CGM app (in which case presumably it's the same penalty as texting whilst driving using a handheld mobile?) or an actual meter, in which case I guess there isn't specific legislation.
I bet, though, that were it to be tested in court (following a serious accident, say), using a 'handheld' specific CGM would be regarded as the same as using a handheld mobile phone. Does anyone know if anyone's ever been prosecuted on that basis?

 

[CliffH]

Libre 2 works as a full CGM and sends updated readings to your phone automatically every few minutes, so you shouldn't need to scan unless you have a very old operating system?

Thank you: that's interesting! Given the chance, I'm sure that I am using "a very old operating system", as I'm not very technological. I don't have a cradle for my phone in my car anyway, though, so it would still be illegal for me to pick it up periodically to look at the reading. I think I'll stick with actually stopping every two hours.

 

[rebrascora]

I am also a bit of a dinosaur with tech which is why I use a Libre reader rather than my phone, although I have updated the operating system on my phone so I could use it as a full CGM instead of just having Flash glucose readings. I believe it can be a security issue if you don't upgrade and eventually the old operating systems may become defunct.

 

[CliffH]

I am also a bit of a dinosaur with tech which is why I use a Libre reader rather than my phone, although I have updated the operating system on my phone so I could use it as a full CGM instead of just having Flash glucose readings. I believe it can be a security issue if you don't upgrade and eventually the old operating systems may become defunct.

Oh no: I hate having to upgrade things! I had my annual diabetes check recently and they didn't laugh at my app, so I'll persevere with it for the time being. I have a 'regular' meter too - but I can't get pretty graphs on it.

 

[rebrascora]

I have a 'regular' meter too - but I can't get pretty graphs on it.

When you say you have a regular meter too, what do you mean? Are you saying you have a Freestyle Libre 2 reader that will scan your sensor the same as your phone? And if so, which pretty graphs can't you get?

 

[Satan’s little helper]

So can we agree on what constitutes a hypo to start with?

According to the DVLA. Early symptoms include sweating, trembling, shakiness, feeling hungry, fast pulse, anxiety, and tingling lips? But I’d need to let my potential hypo go untreated at 4mmol or even 3.5. Long before that. However, (What DVLA stipulate as “early symptoms.”) There are subtle signs I personally get. Which taking action avoids getting to the point where I experience the above. At the 4.5 mark. Personally, providing I’m in tune with my preliminary symptoms, I don’t get to the point where I’m in a confused state operating a vehicle under the influence of insufficient blood glucose. (Which in essence is what the DVLA are wanting the driver to avoid.)

 

[rebrascora]

According to the DVLA. Early symptoms include sweating, trembling, shakiness, feeling hungry, fast pulse, anxiety, and tingling lips?

To me too, those are not "early signs" but quite late "effects" of a hypo. If I get to those symptoms, I am definitely hypo but like you, there are more subtle signs before that, that levels are dropping too far, but sometimes you do have to be quite consciously checking for them to notice or at least not to focused on something else. For me they are things like feeling a bit withdrawn or isolated, my peripheral vision going very slightly blurry and sometimes a slight feeling of indigestion or a sort of stomach flip, a bit like you get when you go down in a lift, but less obvious. It would be very easy not to notice these things particularly if you don't know to look out for them, but if you don't have any hypos or very few, then I think it would be very hard to identify these early signs and that is why I wonder if people newly diagnosed and using CGM from the start, will ever learn to recognise these mild warnings. But are these hypo awareness or prehypo awareness?
Surely everyone gets the heart pounding and sweating and shakiness and vision disturbances because the only thing after that is unconsciousness I would imagine, but maybe that is naivety on my part. This is why I asked @Swimmer why they thought they had no hypo awareness and I have asked other people the same. I wonder if it is a fear of hypos which leads people to say they are hypo unaware, because they simply haven't actually experience a real hypo, especially if they are newly diagnosed and only ever had CGM to keep them out of danger.

 

[helli]

Surely everyone gets the heart pounding

No.
As i have previously mentioned, when i measured my heart rate at the gym, failure to raise my HR was an indication my BG was falling.

Like everything else diabetes, hypos are very personal
For example, the hypo-munchies are something I fail to recognise. Disinterest in food and not wanting to eat is another of my hypo symptoms.

 

[Satan’s little helper]

To me too, those are not "early signs" but quite late "effects" of a hypo. If I get to those symptoms, I am definitely hypo but like you, there are more subtle signs before that, that levels are dropping too far, but sometimes you do have to be quite consciously checking for them to notice or at least not to focused on something else. For me they are things like feeling a bit withdrawn or isolated, my peripheral vision going very slightly blurry and sometimes a slight feeling of indigestion or a sort of stomach flip, a bit like you get when you go down in a lift, but less obvious. It would be very easy not to notice these things particularly if you don't know to look out for them, but if you don't have any hypos or very few, then I think it would be very hard to identify these early signs and that is why I wonder if people newly diagnosed and using CGM from the start, will ever learn to recognise these mild warnings. But are these hypo awareness or prehypo awareness?
Surely everyone gets the heart pounding and sweating and shakiness and vision disturbances because the only thing after that is unconsciousness I would imagine, but maybe that is naivety on my part. This is why I asked @Swimmer why they thought they had no hypo awareness and I have asked other people the same. I wonder if it is a fear of hypos which leads people to say they are hypo unaware, because they simply haven't actually experience a real hypo, especially if they are newly diagnosed and only ever had CGM to keep them out of danger.

In-between the DVLA stated symptoms & loss of consciousness can be spasms or a sort of “fit?” Which you don’t want at the wheel of a car. Or even on a pushbike should one take it up due to revoked licence regarding the topic.

 

[Lucyr]

Surely everyone gets the heart pounding

No. I take beta blockers.

 

[rebrascora]

In-between the DVLA stated symptoms & loss of consciousness can be spasms or a sort of “fit?” Which you don’t want at the wheel of a car. Or even on a pushbike should one take it up due to revoked licence regarding the topic.

So if people feel they don't have hypo signs then presumably they would have experience of this "fitting" or unconsciousness or they simply have never had a hypo?? Is that a fair suggestion?

My theory is that those newly or recently diagnosed people who believe they don't have hypo signs or hypo awareness, simply have not experienced a hypo and perhaps the meter or sensor they are using is under reporting their BG and making them think they are hypo but not feeling it, when in fact they are not actually hypo.

 

[Satan’s little helper]

So if people feel they don't have hypo signs then presumably they would have experience of this "fitting" or unconsciousness or they simply have never had a hypo?? Is that a fair suggestion?

My theory is that those newly or recently diagnosed people who believe they don't have hypo signs or hypo awareness, simply have not experienced a hypo and perhaps the meter or sensor they are using is under reporting their BG and making them think they are hypo but not feeling it, when in fact they are not actually hypo.

I see your point. I was diagnosed as a kid. I was told the classic symptoms of a hypo & what to watch out for. I didn’t even have a meter when I was diagnosed. I have some of them with the rush of getting dropped from a great hight. However, I can feel very subtle signs. Which a meter can confirm. (Think prior to CGM use.) I very rarely get to the point of the stereotypical symptoms. I personally don’t think the problem is “hypo unawairness?” It’s the mindset or personality of the person going low? Some people can unfortunately, switch off from the fundamental self preservation of protecting the brain when it comes to carbs in that situation. I’ve even read of some hypo sufferers aggressively rejecting outside help to fix the hypo. I spoke to one guy whose wife punched out a paramedic after his attempts failed. There may need to be some sort of controlled environment assessment for those concerned with not feeling hypos first. Maybe an induced monitored hypo where the subject asks for the JBs & a BG meter? (Making it a pass on awareness.)

 

[rebrascora]

I see your point. I was diagnosed as a kid. I was told the classic symptoms of a hypo & what to watch out for. I didn’t even have a meter when I was diagnosed. I have some of them with the rush of getting dropped from a great hight. However, I can feel very subtle signs. Which a meter can confirm. (Think prior to CGM use.) I very rarely get to the point of the stereotypical symptoms. I personally don’t think the problem is “hypo unawairness?” It’s the mindset or personality of the person going low? Some people can unfortunately, switch off from the fundamental self preservation of protecting the brain when it comes to carbs in that situation. I’ve even read of some hypo sufferers aggressively rejecting outside help to fix the hypo. I spoke to one guy whose wife punched out a paramedic after his attempts failed. There may need to be some sort of controlled environment assessment for those concerned with not feeling hypos first. Maybe an induced monitored hypo where the subject asks for the JBs & a BG meter? (Making it a pass on awareness.)

Yes, that was very much what I was getting at.
And, if people are actively resisting hypo treatment and being aggressive, then they are clearly very much hypo unaware because their brain has become too starved of glucose to recognise their situation. I would expect someone in that situation to have been struggling with quite bad hypos for a number of years and been made aware of it by their nearest and dearest. Again it would be really unusual for a relatively newly diagnosed person to get into that situation though, which is why I suspect that people who are relatively newly diagnosed simply haven't experienced a proper hypo even if their BG meter said they had dipped below 4 or even 3.5. Hence my question to the OP about what makes them believe they have no hypo awareness.

 

[Satan’s little helper]

Yes, that was very much what I was getting at.
And, if people are actively resisting hypo treatment and being aggressive, then they are clearly very much hypo unaware because their brain has become too starved of glucose to recognise their situation. I would expect someone in that situation to have been struggling with quite bad hypos for a number of years and been made aware of it by their nearest and dearest. Again it would be really unusual for a relatively newly diagnosed person to get into that situation though, which is why I suspect that people who are relatively newly diagnosed simply haven't experienced a proper hypo even if their BG meter said they had dipped below 4 or even 3.5. Hence my question to the OP about what makes them believe they have no hypo awareness.

I feel it’s a valid question. The OP said, “little in the way of hypo awareness symptoms, I was completely honest with my medical team and asked for a CGM.” They should have prescribed a sensor regardless of this fact. But they may have been experiencing the early symptoms, treating, & not dropping to the point where an “earth shaker” (according to the DVLA.) was ever felt? I hope @Swimmer can help?

 

[Satan’s little helper]

Like everything else diabetes, hypos are very personal
For example, the hypo-munchies are something I fail to recognise. Disinterest in food and not wanting to eat is another of my hypo symptoms.

I couldn’t agree more hypos are not a one size fits all. But I would be a little concerned about this trait, It’s a little like touching a hot surface & not having the instinct to recoil.

 

[rebrascora]

I got the munchies early on with my first few hypos but I very rarely get them now, maybe because I have learned to be disciplined and I absolutely hate the frustration of going high after a hypo, so my brain has learned this pattern or maybe it is because I very rarely go low enough to get the munchies any more. Usually 1 or 2 jelly babies is all I need.
I agree that we are all different and I would have to be ill in some other way, like a really bad migraine for me not wanting to eat.

I feel it’s a valid question. The OP said, “little in the way of hypo awareness symptoms, I was completely honest with my medical team and asked for a CGM.” They should have prescribed a sensor regardless of this fact. But they may have been experiencing the early symptoms, treating, & not dropping to the point where an “earth shaker” (according to the DVLA.) was ever felt? I hope @Swimmer can help?

I think one of our other regular members, @Tdm perhaps, who I think also feels they have limited or no hypo awareness, mentioned it to their consultant about it and their consultant was of the opinion that they simply hadn't had a proper hypo.

I think something as important as losing a civil liberty should be investigated properly, rather than taking the word of someone who may be too inexperienced to make that judgement call and at least they should be offered some form of test like you suggest in the form of an induced hypo in a safe and controlled environment to clarify the situation, before losing their licence.

In fact I think perhaps all insulin dependent diabetics should experience an induced hypo early on in a controlled environment (medical facility) so that they know what it is like and how to deal with it before they experience one "in the wild" or at least have the chance to do so. I was on my own for my first couple and it was pretty scary.

 

[Satan’s little helper]

I got the munchies early on with my first few hypos but I very rarely get them now, maybe because I have learned to be disciplined and I absolutely hate the frustration of going high after a hypo, so my brain has learned this pattern or maybe it is because I very rarely go low enough to get the munchies any more. Usually 1 or 2 jelly babies is all I need.
I agree that we are all different and I would have to be ill in some other way, like a really bad migraine for me not wanting to eat.

I think one of our other regular members, @Tdm perhaps, who I think also feels they have limited or no hypo awareness, mentioned it to their consultant about it and their consultant was of the opinion that they simply hadn't had a proper hypo.

I think something as important as losing a civil liberty should be investigated properly, rather than taking the word of someone who may be too inexperienced to make that judgement call and at least they should be offered some form of test like you suggest in the form of an induced hypo in a safe and controlled environment to clarify the situation, before losing their licence.

In fact I think perhaps all insulin dependent diabetics should experience an induced hypo early on in a controlled environment (medical facility) so that they know what it is like and how to deal with it before they experience one "in the wild" or at least have the chance to do so. I was on my own for my first couple and it was pretty scary.

I don’t think it’s a “civil liberty.” “The freedom of action” to drive has first to be earned with a driving test. A qualification, if you wish. Governed also by factors like fitness to drive. Along with vehicle ownership for road use insurance cover incase of own fault accident & roadworthy conveyance. (MOT.) along with road tax. Which without. Due to not having an MOT can also invalidate insurance. I was on my own with the first couple. I was told the “ride” would stop if I ate or drank sugar. & it did. I didn’t even bother waking my parents like I was told.

 

[Minotaur]

I'm an newbie to diabetes, and have had a cgm, since being diagnosed (6-8 weeks ago). So I'm probably hypo unaware as some have stated, as the symptoms are sometimes the same as 'other' issues. Some will have notice that I've been active in the 'smart watch' thread. So my question is, I've now managed to get my cgm linked to my smart watch, does looking at my watch constitute 'driving without care and attention'? Does me being able to look at my watch, and seeing my bg (it's on the main face of the watch) making it easier for me to control my levels, by eating JB to ensure my lvls are constantly high, a danger?

I'm not suggesting 'flouting' the laws, but it might be something that should be looked at more?

 

[Lucyr]

I'm an newbie to diabetes, and have had a cgm, since being diagnosed (6-8 weeks ago). So I'm probably hypo unaware as some have stated, as the symptoms are sometimes the same as 'other' issues. Some will have notice that I've been active in the 'smart watch' thread. So my question is, I've now managed to get my cgm linked to my smart watch, does looking at my watch constitute 'driving without care and attention'? Does me being able to look at my watch, and seeing my bg (it's on the main face of the watch) making it easier for me to control my levels, by eating JB to ensure my lvls are constantly high, a danger?

Most watch complications don’t update instantly, you often have to tap them to refresh the reading, or on some to wake up the screen. You definitely couldn’t do that whilst driving as you can’t interact with a device. If you happen to see it in your eye line and don’t touch it then I think that’s fine.

 

[CliffH]

When you say you have a regular meter too, what do you mean? Are you saying you have a Freestyle Libre 2 reader that will scan your sensor the same as your phone? And if so, which pretty graphs can't you get?

I've got the standard meter that I was given when I started using the Libres (five years ago). As far as I know it just shows the BS number when I scan it, whereas the app on my phone shows graphs of average BS per hour of the day and so on.