In 1971, the U.S. Supreme Court held in Bell v. Burson that driving is an "important interest" that may not be taken away from a licensed driver without a government agency's providing procedural due process.

In 1983, the California Supreme Court found that the revocation or suspension of a license "can and often does constitute a severe personal and economic hardship," in Berlinghieri v. Department of Motor Vehicles .

And, in 1993, a California Court of Appeals noted that a person with insulin-dependent diabetes is not automatically subject to license forfeiture or nonrenewal, and an agency may do so only if the diabetes affects the driver's safe operation of a motor vehicle (People v. Superior Court [Wilson]).

Low Blood Sugars and Driving

No one with any sense would get behind the wheel knowing his or her blood sugar is at 50 mg/dl. Unfortunately, too many persons do so without knowing it because they did not check, or they keep driving after many hours without pulling over to check their blood sugar and eat (see accompanying story "Diabetes and the Open Road," p. 17). The obvious precautions of testing and eating are the easiest ways to avoid problems.

Among the many side effects that can arise from hypoglycemia are problems with driving safety and maintaining a driver's license. But, just as other diabetic complications can be controlled and avoided with proper planning and care, so can driving problems.

As an attorney who has type 1 diabetes, I am familiar with these problems, both from my own experiences and those of persons I have represented before the Department of Motor Vehicles (DMV) in California. As long as you have already demonstrated the ability to drive safely and received a license, you have a right to operate a motor vehicle (some DMV officers mistakenly believe that it is a privilege).

When I appear with clients before DMV hearing officers to seek reinstatement of a license, I emphasize that my client will be prepared to avoid and handle hypoglycemic events when driving in the future.

I work with my clients to make certain they are aware that frequent testing of blood sugars is critical to maintaining safety as a driver (in addition to all the other safety and health reasons). Whenever a person taking insulin is about to drive, it is essential to know that his or her blood sugar is at a proper level. Proper meal planning before and during a long drive is also critical.

Steps To Driving Safety

Unfortunately, anyone taking insulin has a chance of going too low while driving, however cautious he or she might be. Therefore, it is essential to be prepared for a hypoglycemic event that occurs while driving. The following are what I consider the critical steps to driving safety when a low hits. I make certain all my clients are familiar with them before I represent them at a DMV hearing:

1. If you feel low blood sugar symptoms, pull over promptly as soon as it is safe to do so.
2. TREAT THE LOW IMMEDIATELY. Make absolutely certain you have something to treat the low in a place where you will not forget it. This is critical because your mind will not be working properly if you get too low. You may not remember where you put your juice unless it is very obvious and can be easily reached. Don't ever bury your juice in a messy glove box.
   
   Things that spoil quickly will not work, so keep something that will last and not be destroyed by weather conditions. Orange juice will not last long, but apple juice does. Glucose tablets work quickly and weather well, but be sure you have enough of them. You need to know how many tablets it normally takes for you to treat a low, then keep three or four times that amount nearby while driving.

3. Do not start driving again until your blood sugar is back to normal and you feel okay. Have your testing equipment nearby while driving, and not in the trunk or too far away to reach easily.
4. Drive calmly and carefully until you reach the next place you can stop and get a meal.

Once these steps were taken, all of my clients were able to get their driving licenses back and were able to drive with more confidence and safety. These steps should work fine for most persons in most situations. However, if you have difficulty recognizing low blood sugar symptoms, you must learn to overcome that problem.

Recognizing a Low

In cases where my clients have had that difficulty I have worked with health care professionals who can train persons with diabetes on how to recognize low blood sugars. The process involves carefully elevating blood sugars so that the symptoms of lows become recognizable again. If done properly with qualified health care specialists, the low blood sugars can become readily recognizable again without damaging overall diabetes care. Your own certified diabetes educator, therapist or medical specialist may be able to assist you with this problem, as long as they have been trained to assist people in recognizing low blood sugars (see "Manual Teaches People How to Recognize Low BGs").

For your own health and safety, ability to work and enjoy the benefits of driving, and, above all, for the safety of those around you on the road, maintaining hypoglycemic awareness and being prepared for a low blood sugar can never be ignored.