Relying on CGM for hypo awareness while driving

Satan’s little helper said:
I think it would be unwise not to respond to the box regarding hypo awareness. As it could imply you didn’t get symptoms? Even though I rarely drop that low to get that messed up. I’m still aware of the subtle early warning.
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This is the current DIAB1 form https://assets.publishing.service.g...13/diab1-confidential-medical-information.pdf

Question 6 asks if you are aware of the warning signs, ie do you know what they are, not do you get them. Then goes on to ask if you get warning signs - here the first possible response is “never had episodes of low blood glucose” and you move to Qu 7, which asks you to confirm that you will test your BG at times relevant to driving. Otherwise you answer yes or no to the question about warning signs.

I believe that covers all bases
 
I can't remember how the form/question is worded but I know I took a good few moments to read and double read it before I completed it because the wording is not entirely straight forward. Obviously I have had hypos so I know my hypo signs but I still feel that I have to be very careful about how I reply to that. It is probably the key question on the form.

Maybe it should be mandatory for people who want to drive to prove hypo awareness, but to do that you would have to deliberately overdose and that is clearly ethically wrong.

I remember one guy who came to the forum who was newly diagnosed. He had had a hypo during surgery when he was anaesthetised. He was told about it after the surgery. He had not had a hypo other than that, so he ticked to say he had had a hypo but then he had to tick the next question to say that he was unaware of it and of course he lost his licence and he was having a right battle with DVLA to even speak to someone about it let alone get it sorted because there was no way to clarify the situation on the form itself, so he had answered each question literally and truthfully.
 
Thanks for clarifying that @JJay
 
Thank you all for your responses.
I readily admit to being mea culpa for reading driving info and watching videos but totally missing the link to the DVLA leaflet where the info on hypo awareness and CGM's is tucked away inside. However, specialist health professionals in possession of all the facts do indeed have a duty of care in this area.
The debate around the definition of hypo awareness is interesting. For car driving it just has to be "adequate" which means you experience symptoms in time to stop driving safely. If definite symptoms are experienced at low 3/high 2 level, but there is no impairment of function and ability to pull over safely is retained, would that do? I intend to log any symptoms I do experience and link them to sensor readings and finger prick tests and eventually take them to a specialist for an opinion.
I still think a set of safe rules for CGM use could be drawn up, for example:
  • You must have your phone or reader safely mounted and on continuous display.
  • You must set the low glucose alarm to 4.9 before setting off. Pull over and test if it goes off.
  • If there is sensor error or signal loss, you must pull over and test and wait for signal return.
  • If your sensor fails you must either replace and wait for activation, or perhaps set an alarm and test every 30 mins until reaching destination or eat carbs to be sure of running high until reaching destination.
 
Swimmer said:
If definite symptoms are experienced at low 3/high 2 level, but there is no impairment of function and ability to pull over safely is retained, would that do?
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There is usually cognitive impairment below mid 3s and I would say definitely high 2s, but as I said in one of my posts, it may depend on which meter you are using as to whether that meter is reading lower than your actual BG for you.
 
Swimmer said:
If your sensor fails you must either replace and wait for activation, or perhaps set an alarm and test every 30 mins until reaching destination or eat carbs to be sure of running high until reaching destination
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My understanding is that you must carry a finger prick meter with you when driving.
I assume it is for these kind of scenarios.
And, when using finger prick testing, 2 hour tests are sufficient.
If they are insufficient, you could argue that you are back to the discussion about hypo awareness.

It has always surprises me that there are no rules about when you last ate/bolused.
If I am steady at 4.6, no active bolus and eaten in the last 30 minutes, I know I am safer to drive than if I have active bolus, 2 hours since eating and falling arrow with BG of 5.9.
 
If definite symptoms are experienced at low 3/high 2 level, but there is no impairment of function and ability to pull over safely is retained, would that do? I intend to log any symptoms I do experience and link them to sensor readings and finger prick tests and eventually take them to a specialist for an opinion.

My consultant seems unusual in that she always asks me about hypo symptoms and what number I feel them at. Low 3 is far too low to be driving, presuming that’s accurate. 4’s the floor, 5 to drive. Most people would be having unpleasant symptoms in the low 3s. I know I do.
 
JJay said:
This is the current DIAB1 form https://assets.publishing.service.g...13/diab1-confidential-medical-information.pdf

Question 6 asks if you are aware of the warning signs, ie do you know what they are, not do you get them. Then goes on to ask if you get warning signs - here the first possible response is “never had episodes of low blood glucose” and you move to Qu 7, which asks you to confirm that you will test your BG at times relevant to driving. Otherwise you answer yes or no to the question about warning signs.

I believe that covers all bases
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Thanks, what I was suggesting was not responding positively to awareness with an acknowledgment on what the signs are, could forfeit the licence. The BG testing is a responsibility we have to agree to. Another possible forfeit if we don’t? I’ve never done otherwise to find out. 😉
 
Satan’s little helper said:
what I was suggesting was not responding positively to awareness with an acknowledgment on what the signs are, could forfeit the licence
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And rightly so. I do wonder how likely is it that anyone prescribed BG-lowering medication would not be told that (a) they may have hypos and (b) what the warning signs of hypos might be?

As others have said, if I have the “warning” signs listed by DVLA, I’m already hypo! My physical warning signs are lightheadedness and slight hunger, but thankfully Libre, via Sweet Dreams and Apple CarPlay, alerts me way before then.
 
JJay said:
And rightly so. I do wonder how likely is it that anyone prescribed BG-lowering medication would not be told that (a) they may have hypos and (b) what the warning signs of hypos might be?

As others have said, if I have the “warning” signs listed by DVLA, I’m already hypo! My physical warning signs are lightheadedness and slight hunger, but thankfully Libre, via Sweet Dreams and Apple CarPlay, alerts me way before then.
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I’ve had it reiterated over the decades from professionals, especially when I’ve achieved HbA1s lower than the target at the time? “Oh, you must be having lots of hypos.” “Are you feeling hypo symptoms?” I’ve had no more than usual & always managed to corner them so they are less severe. But given the general advice on what to look out for with a “hypo.” I do wonder if some in the past (prior to CGMs) have let things go too far down the line before treating? I’ll hold my hands up & say I couldn’t perform complex tasks if I allowed myself to experience what the “textbook” symptoms of a hypo is. (Other than snaffling fast acting carbs.)
 
This is the current (Aug 2024) up to date DVLA fitness to drive document.

This explains 'every' condition etc, not just diabetes. I came across this due to an article in the 'Telegraph', about general fitness to drive, for elderly people, or those with a medical condition.

www.gov.uk

Assessing fitness to drive: a guide for medical professionals

Advice for medical professionals to follow when assessing a patient's fitness to drive.
www.gov.uk www.gov.uk

I thought it might be interesting for others, and also those that take other medication, and the possible driving requirements/restrictions.

So, looking at this document, as I'm new to diabetes (8 weeks) and have not suffered a 'hypo', I can't drive?

I Will not be allowed a licence, until I do suffer or know the symptoms of a 'hypo'?

What if I never have a hypo, because I always run 'high', does that mean I'll never be allowed to drive again?

I've already notified DVLA, I'm an insulin diabetic, and have had my licence restricted to 3 years.

Whilst I'd agree that if an alarm went off to alert you that your close to being 'hypo' shouldn't happen, being able to see your bg readings constantly maybe shouldn't require a finger prick (fp) check every two hours?

Having read some of the above document, 'technically' I'm not permitted to drive as I'm also dependent on codeine, as a medication.
 
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Minotaur said:
So, looking at this document, as I'm new to diabetes (8 weeks) and have not suffered a 'hypo', I can't drive?

I Will not be allowed a licence, until I do suffer or know the symptoms of a 'hypo'?

What if I never have a hypo, because I always run 'high', does that mean I'll never be allowed to drive again?

I've already notified DVLA, I'm an insulin diabetic, and have had my licence restricted to 3 years.
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That isn’t the way I understand the form and guidance.

You should be able to tick ‘No’ to show you haven’t had hypos, but also that you are aware of the warning signs that you need to look out for?

I don’t think the DVLA want you to deliberately give yourself a hypo just to satisfy their form!
 
Minotaur said:
So, looking at this document, as I'm new to diabetes (8 weeks) and have not suffered a 'hypo', I can't drive?
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If you’re new to diabetes you really should have experienced the feelings of a hypo. You don’t need a bg below 4 to know you get hypo symptoms. You should get the symptoms far earlier when first starting insulin and bring down high bg levels.
 
helli said:
My understanding is that you must carry a finger prick meter with you when driving.
I assume it is for these kind of scenarios.
And, when using finger prick testing, 2 hour tests are sufficient.
If they are insufficient, you could argue that you are back to the discussion about hypo awareness.

It has always surprises me that there are no rules about when you last ate/bolused.
If I am steady at 4.6, no active bolus and eaten in the last 30 minutes, I know I am safer to drive than if I have active bolus, 2 hours since eating and falling arrow with BG of 5.9.
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According to the DVLA leaflet I got from the hospital after my surgery the finger prick kit is only needed for Group 2 licences/driving. For cars a glucose meter is acceptable.

I agree about the active bolus though as I know my levels can drop very quickly depending on when I ate and when the bolus kicks in. There's certain situations where I wouldn't drive even though I might be in the 7-9 range as I know there's a big chance of a sudden drop.
 
Standup said:
According to the DVLA leaflet I got from the hospital after my surgery the finger prick kit is only needed for Group 2 licences/driving. For cars a glucose meter is acceptable.
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You probably need to reread it. If you are on certain diabetes medications then you must always carry a fingerprick blood glucose machine with you when driving a car and you must understand when you need to use it.
 
"Finger prick blood or flash glucose monitoring (Libre) is required to fulfil DVLA requirements to assess fitness to drive. Group 2 licence holders must test finger prick blood glucose"

You could argue that flash monitoring isn't CGM although I would have thought that was better as you have alarms.

There's lots of mention about finger prick tests for group 2 but not for group 1.
 
Standup said:
"Finger prick blood or flash glucose monitoring (Libre) is required to fulfil DVLA requirements to assess fitness to drive. Group 2 licence holders must test finger prick blood glucose"

You could argue that flash monitoring isn't CGM although I would have thought that was better as you have alarms.

There's lots of mention about finger prick tests for group 2 but not for group 1.
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If you look at DVLA guidance https://www.google.com/url?sa=t&sou...sQFnoECBwQAQ&usg=AOvVaw23rZfwJm_ybLHesPvkDBbX
you will see

"Important notes for car or motorcycle
(Group 1) drivers about using RT-CGM and
FGM whilst driving
You must get a confirmatory finger prick glucose level in the following circumstances
• If your glucose level is 4.0mmol/L or below.
• If you have symptoms of hypoglycaemia.
• If your glucose monitoring system gives a reading that is not consistent with your symptoms (that is you have symptoms of hypoglycaemia and your system reading does not indicate this).
• If you are aware that you have become hypoglycaemic or have indication of impending hypoglycaemia.
• At any other times recommended by the manufacturer of your glucose monitoring system.
• Alarms on RT-CGM devices must not be used as a substitute for symptomatic awareness of hypoglycaemia. You must recognise hypoglycaemia through the symptoms you experience for the purposes of Group 1 driving. Should you become reliant on these alarms to advise you that you are hypoglycaemic you must stop driving and notify
the DVLA."

You undertake to abide by this guidance when you sign your licence application.
 
Standup said:
There's lots of mention about finger prick tests for group 2 but not for group 1
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Read the conditions you signed up to when you applied for your medically restricted licence. You agreed to carry a fingerprick meter and use it at particular occasions
 
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