Letter: Driving advice should come from the whole diabetes team

David Kerr and Joan Everett make many important points in their timely article on managing the hypoglycaemic driver (Vol 1, No 4, p108). However, although they suggest that a formal dietetic review can prevent further episodes, the importance of regular eating when driving is advice that should come from all members of the diabetes team. The limitations of current regimens produce insulin levels that are inappropriately high between meals. This results in rapid falls in glucose concentration as the effects of the previous meal wear off. By the time symptoms of hypoglycaemia appear, cognitive ability is often already impaired, so the emphasis should be on prevention with carbohydrate snacks taken every 2 hours if driving long journeys.

The restrictions that surround the driving licence are particularly irksome to patients who are urged to live as normal a life as possible. The limited research concerning the safety of drivers with diabetes is reassuring, although, as the authors point out, somewhat unreliable. Indeed, considering the potentially lethal threat that a person with diabetes poses when incapacitated by hypoglycaemia, the attitude of the DVLA is generally sympathetic. Even an episode of hypoglycaemia unawareness causing an accident does not mandate withdrawal of a driving licence. My own experience is that the licensing authorities are prepared to judge each case sympathetically according to its merits. Until advances in treatment remove the risk of hypoglycaemia, those with diabetes will always face some limits to their activities, particularly those that may affect others. Professional carers have a duty to explain the reasons for these limitations but be prepared to argue their patient’s case when dealing with regulatory authorities.