title: The perception of safe driving ability during hypoglycemia in patients with type 1 diabetes mellitus.
abstract: OBJECTIVE
  Insulin-induced hypoglycemia and its sequelae of cognitive impairment may place patients with type 1 diabetes at risk when driving and when making decisions about driving. Little is known about the factors that influence judgments of safe driving ability during hypoglycemia in these patients.
  
  
  METHODS
  Thirty men and 30 women with uncomplicated type 1 diabetes (age [mean +/- SD] 33 +/- 9 years, duration 9 +/- 3 years, hemoglobin A1c level 8.7% +/- 1.0%) underwent a stepped hypoglycemic insulin clamp. Serum glucose levels were reduced from 120 mg/dL to 80, 70, 60, 50, and then 40 mg/dL during 190 minutes. At each glucose plateau, patients completed a symptom questionnaire and neuropsychological test, estimated their glucose level, and reported whether they could drive safely.
  
  
  RESULTS
  The proportion of patients judging that they could drive safely decreased as serum glucose levels decreased from 70% at 120 mg/dL to 22% at 40 mg/dL. Men and middle-aged patients were more likely to consider it safe to drive during hypoglycemia than women and those under 25 years of age. Those who were symptomatic and those who recognized hypoglycemia were less likely to report safe driving ability during hypoglycemia. Most patients who were cognitively impaired appeared to recognize this and reported that they could not drive safely at a serum glucose level of 40 mg/dL.
  
  
  CONCLUSIONS
  Adults with type 1 diabetes need educational reinforcement of safe driving habits, particularly to check glucose levels before driving. Glucose levels less than 70 mg/dL should be treated before driving. This information is as important for middle-aged, experienced drivers as it is for younger, inexperienced drivers.
authors.affiliation: Section on Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
authors.forename: K
authors.initials: K
authors.lastname: Weinger
authors.forename: B T
authors.initials: BT
authors.lastname: Kinsley
authors.forename: C J
authors.initials: CJ
authors.lastname: Levy
authors.forename: M
authors.initials: M
authors.lastname: Bajaj
authors.forename: D C
authors.initials: DC
authors.lastname: Simonson
authors.forename: D J
authors.initials: DJ
authors.lastname: Cox
authors.forename: C M
authors.initials: CM
authors.lastname: Ryan
authors.forename: A M
authors.initials: AM
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D000339:Affect; D000367:Age Factors; D001334:Automobile Driving; D001786:Blood Glucose / Q000378:metabolism*; D003071:Cognition; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000523:psychology*; D007328:Insulin / Q000009:adverse effects* / Q000097:blood; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010465:Perception; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D007328:Insulin