Science post from Dr. Kim Kelly

October 12, 2011

There are lots of new developments in the technology and treatment of type 1 diabetes as well as a number of myths related to diabetes care.  As you may have read in Christina’s introduction in CDN’s August newsletter, my name is Kim Kelly, and I have an extensive background in the field of diabetes, most recently as the former Director of the J&J Diabetes Institute in Silicon Valley, CA.  I will be blogging on the CDN site about some of the developments in the field as well as some tips from time to time.  I will include a reference or two at the end of the blog in case you want to get the original article(s) on which it is based.  I want to make sure these blogs are relevant to the concerns of college students with type 1 diabetes, and I am happy to address any questions as part of the blog schedule so don’t be shy about asking questions.  Questions can be emailed to croth@collegediabetesnetwork.org. So let’s get started with our first blog.

Use of insulin comes with many caveats.  We learn so many factors that impact our blood glucose levels from carbohydrates to exercise, stress, insulin dosage and timing, and many more.  In the midst of all of these factors, as you all know…life happens.  One facet of adulthood we all take for granted is driving.  We often hop in the car without giving it a second thought.  The topic of today’s blog is protecting yourself and others when you drive.  I’ll start with the most recent poll done by Children with Diabetes of the young adults who participate in CWD activities.  The question: “For teens and adults with diabetes, How often do you check your blood sugar before you drive” resulted in 38% ‘always’, 23% ‘usually’, 23% ‘sometimes’, 12% ‘rarely’ and 4% ‘never’.  For the 62% who were not ‘always’ some thoughts from the diabetes literature.  Dr. Daniel Cox, and others who have worked a lot in this area have found that driving mishaps occur twice as often in individuals with type 1 diabetes as they do in their non-diabetic spouses, or in people with type 2 diabetes.  Motor skills begin to deteriorate when blood glucose is around 65 mg/dL, but drivers frequently did not recognize the deterioration and treat for hypoglycemia.  In a separate study of over 450 adults with type 1 diabetes, they found that over a 12 month period, 52% reported at least one hypoglycemia-related driving mishap, and 6% reported at least 6 or more!  Mishaps were related to mileage driven, past history of severe hypoglycemia, and insulin pump therapy.  The latter perhaps due to lower blood glucose levels associated with better control in pumpers.  His article recommended steps to avoid hypoglycemia while driving, such as measuring blood glucose before driving, encouraging a higher blood glucose threshold for when not to begin driving (e.g. >90 mg/dL), and, when hypoglycemia is detected while driving, safely ceasing driving, eating fast-acting carbohydrates, and not resuming driving until blood glucose and cognitive motor functioning have recovered.  When was the last time you checked your glucose before driving?  Hopefully it was the last time you drove the car!

If you would like to get more information on this study:  Cox D, et al. Diabetes Care 2009;32:2177-2180


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