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  • Above 5 to Drive

    By Sara-Maria Sanvicens (Broekhoff)

    Type 1 and I had been successfully driving for 10 years blissfully uninformed and over confident, (as my first restricted license examiner told me), oblivious to the potential danger that may have been. It wasn’t until I attended the DAFNE (Dose adjustment for normal eating) course that I heard of this 5 to drive rule.

    I am happy to say that I am unable to tell a scary story of blackouts and crashes, but I have had a few hair-raising experiences of lows whilst driving.

    Luckily I can feel myself dropping and due to growing up in the wop wops I learnt to analyse where I am going how long I will be away from a dairy and do one of those “how am I feeling” type 1 ‘body scans’ before venturing away from home, with my snacks packed.

    In saying that, having been in Auckland for some time now with sweet treats available to me on every corner I have become complacent with my snack pack. My busy lifestyle has also meant that I’m not stopping for a minute to check I’ve got everything I need to test or just give a moments mindfulness to how I’m feeling.

    In amongst this (after not having exercised for years) I started going to the gym. After a workout I could go low quite quickly, hypo symptoms mixed in with my unfit sweaty shaky body – well I couldn’t quite accurately judge my levels in the early gym days. Running late for work one morning after a workout, I jumped in the shower, into my car and got stuck in traffic on the harbour bridge, all of a sudden realising I was feeling low with nowhere to go, no juice and no lollies. All I could do was focus all my waning concentration and energy on driving in a straight line and not into the car in front which was not my idea of fun. it shook me into being more diligent in keeping lollies in my car and testing after exercise.

    Growing up being told you have to test before meals, after meals, before exercise, after exercise, before bed – and now you’re being told test before you drive, Iknow it sucks!! When you’re jumping in your car you’re on your way somewhere; to the movies, to see a friend, to work, to the gym. I get that every time you have to stop to test before doing something that should be as normal as brushing your teeth, it’s another reminder of this stupid impediment on your freedom (diabetes). But you know what, if you were to crash and insurance won’t pay out or worse, someone gets hurt or dies (I’m speaking to myself now) you’d wish to go back in time and take that minute to test. In fact I’m going to take a minute now to read the official guidelines and remind myself of what an A+ star diabetes student would do (It’s impossible to be perfect all the time but let’s all try and be as good as we can for the safety of our lives and our fellow road users)

    Many of you will remember Sara-Maria from DYA events when she worked as the DYA Co-ordinator.

    Can I drive if I have Diabetes?

    If your diabetes is well controlled, you can drive a private car safely.Driving is a complex skill both physically and mentally and for people with diabetes who drive, extra precautions need to be taken to help maximise road safety. The main hazard for those who take insulin is the unexpected occurrence of hypoglycaemia but most episodes can be prevented.

    How to avoid low blood glucose whilst driving

    • Before driving test your blood glucose and make sure it is above 5mmol/L.
    • Re-test your blood glucose every 2 hours during driving to make sure it is above 5
    • Always carry in your car a fast acting carbohydrate food or sweet drink
    • Keep a record of blood glucose levels
    • DO NOT drive for more than 2 hours without considering a snack and do not miss or delay a meal. Stay above 5 during your vehicle journey
    • Carry identification both on yourself and in your car indicating that you have diabetes.

    If you feel a hypo developing while driving

    •  STOP driving as soon as it is safe to do so
    • Remove the ignition key
    • Check your blood glucose level
    • IMMEDIATELY eat at least 15grams of fast acting carbohydrate or have a sugary drink
    • Wait 15minutes and check your blood glucose level again. Repeat treatment if required
    • Follow this up by taking a longer acting carbohydrate (fruit, bread, muesli bar)
    • DO NOT resume driving until at least 30 minutes after your hypo symptoms are completely gone and your blood glucose is above 5. Studies have shown that brain function may take this long to recover.

    Lack of hypoglycaemia awareness

    Lack of hypoglycaemia awareness is when a person does not recognise the symptoms of hypoglycaemia to enable treatment before brain function is affected. This is a serious condition that increases the risk of severe hypoglycaemia.

    Hypoglycaemia, or low blood glucose (below 4mmol/L) may develop quickly and normal hypoglycaemia awareness includes “early warning symptoms” of trembling, sweating dizziness, hunger or headache. When blood glucose falls further, symptoms due to lack of glucose supply to the brain may occur and include lack of concentration/behaviour change, irritability, double vision and a reduced level of consciousness.

    Even when blood glucose is low, some people have few or no symptoms of hypoglycaemia at all, including loss of the early warning symptoms of low blood glucose. They may then become confused and even lose consciousness without ever knowing their blood glucose levels were low. This condition is called lack of hypoglycaemia awareness.

    Under these circumstances, it is especially important to monitor blood glucose prior to and regularly during driving to help avoid severe hypoglycaemia and reduce the risk of a crash. It is critical to be above 5 when you drive. People with hypoglycaemia unawareness in general are not eligible to drive.

    Severe hypoglycaemia

    If you have experienced a severe hypoglycaemic episode involving loss of consciousness in any situation, do not resume driving until you have medical clearance to do so. Your diabetes specialist will need to determine your fitness to safely resume driving.

    High Blood Glucose (hyperglycaemia)

    You should not drive if you feel unwell. High blood glucose levels can result in tiredness, blurred vision and altered decision making, all of which impact on driving.

    You also need to know

    • It is your legal responsibility to advise the Land Transport Authority that you have diabetes and whether or not you take glucose lowering medications including insulin.
    • There may be conditions placed on your drivers licence because of your diabetes
    • You will need to plan ahead for your specialist clinic in relation to your fitness to drive. You will be expected to provide an accurate blood glucose level logbook demonstrating a trend of regular daily blood glucose monitoring (at least 4/day), your corresponding blood glucose meter and a satisfactory HbA1c (HbA1c target 58mmol) before the Starship Diabetes Service will provide a letter of support endorsing your application to drive.
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