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Tuesday, October 02, 2018

You don’t have to give up driving just because you have diabetes, but a few precautions are essential, says Dr Manjunath Malige

Having diabetes does not imply that you must surrender driving, yet it means that you must arrange things ahead of time before you get in the driver's seat.

According to WHO, 69.2 million Indians are diabetic and a sizable percentage of them seek or currently hold a driver’s license. Driving is indispensable for people who are working and for performing many other functions of daily life but the combination of driving and diabetes is hazardous.

THE ISSUE

Some of the medications (like insulin and certain tablets) can put you at risk of low blood sugar levels (hypoglycaemia) causing patients to lose concentration or even consciousness. Hypoglycaemia reduces the ability to drive, retinopathy or cataract development impairs vision needed for driving, and neuropathy affecting the capability to feel foot pedals can impact driving gravely.

Diabetes can cause cloudy vision which is linked with disturbed blood glucose level which can also cause your feet or hands to become numb, which may impact on your driving ability.

Various studies have clearly indicated that mishaps such as collisions, road traffic accidents leading to serious injuries and death can occur if the driver has poor control of diabetes and does not get the warning symptoms of hypoglycemia.

Outcomes recommend the need for laws that limit driving in patients with diabetes who are at risk of low blood sugar levels and those with diabetic retinopathy affecting their vision. Diabetic retinopathy refers to an eye disease which results from damage to small blood vessels in the retina. It is a leading cause of visual impairments and blindness in adults.

Diabetes is frequently connected with hypertension and high blood cholesterol and metabolic syndrome, which increases the risk of heart disease and stroke. Studies show that people with diabetes are two to five times more likely to have heart disease than those without diabetes.

Peripheral neuropathy which is caused by diabetes can lead to weakness, ulceration and amputation of feet and legs, which may have negative impacts on a few drivers.

CURRENT SCENARIO IN INDIA

There has been significant discussion worldwide whether, and to what extent, diabetes could be a related factor in influencing driver’s ability and eligibility for a license. This position statement addresses such issues considering current scientific and medical evidence.

Though India is in dire need of stronger reforms to prevent road accidents, other countries like the U.S.A., Australia, Ireland, Switzerland and the U.K. have made suitable changes in law including regular review and certification by an endocrinologist, while issuing driving licences. We never know what could affect a driver’s ability to drive but we definitely cannot live in ambiguity.

SOME TIPS TO KEEP IN MIND WHILE DRIVING

Check your blood sugars before driving. Only drive with stabilised sugar levels. Keep blood sugar between 100 to 180 mg/dl.

If in doubt, never test your sugars while driving. Pull the vehicle off to a side and only then perform the check.

Be ready for a hypoglycaemic (blood sugar less than 70) occurrence. Carry plenty of immediate sugar-providing food like glucose, biscuits or a bar of chocolate.

Always carry your medical ID stating your condition and contact person details.

If you have a hypoglycaemic episode whilst driving, pull over and turn off the ignition. Have some sugar biscuits or chocolate. Restart driving only after 45 minutes, so the blood glucose level gets to normal. It takes about 45 minutes for the brain to recover completely.

Always avoid alcohol.

On long trips, plan systematic stops for blood glucose testing and food breaks. Check blood sugars every two hours.

If you have hypoglycemia and you do not get any symptoms then it is dangerous to drive as you don’t get any warning symptoms. Stop driving and consult an endocrinologist.

Remember, by driving without good diabetes control, you are not just risking your own life, but also of others on the road.

Your health is your biggest asset; invest time and money on it.

Dr Manjunath Malige is Consultant, Diabetes and Endocrinology, Fortis Hospital Bannerghatta Road, Bengaluru

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