Driving and Alcohol
I drive a lot in my work and my lunch time varies from day to day. Does this matter? I am on two injections of insulin a day.
Yes, this can be a bit of a problem. The twice-daily insulin regimen is designed to provide a boost of insulin at midday to cope with the lunch time intake of food. Once the early morning injection of insulin has been given, there is no way of delaying the midday surge. It is very common for people who are well controlled on two injections a day to feel a little hypo before lunch.
There are two possible solutions to your problem.
• Eat some biscuits or fruit while you are driving – only do this in emergencies as you will not know how much to havefor lunch when you do get the chance to eat properly.
• Change your insulin regimen so that you have a small dose of short-acting insulin before each main meal and only have long-acting insulin in the evening to keep your diabetes under control during the night. You may have to eat snacks between meals but the three- or four-injection method should make the timing of meals more flexible. With an insulin pen an extra injection is really no hardship.
If I have diabetes, do I have to declare this when applying for a driving licence? If so, am I likely to be required to provide evidence as to fitness to drive?
Anyone whose diabetes is treated by diet alone does not need to inform the DVLA (Driving and Vehicle Licensing Agency). If your diabetes is treated by tablets or insulin, you must declare this when applying for a driving licence. If you already hold a driving licence, you must tell the DVLA as soon as you have been diagnosed. When you have notified the DVLA, you will receive a form asking for details about your diabetes and the names of any doctors whom you see regularly. They will also ask you to sign a declaration allowing your doctors to disclose medical details about your condition. There is usually no difficulty over someone with diabetes obtaining a licence to drive.
If you are treated by tablets, you will be able to obtain an unrestricted licence, provided that you undertake to inform the DVLA of any change in your treatment or if you develop any complications of diabetes.
If you are treated by insulin, the licence will be valid for only 3 years instead of up to the age of 70, which is normal in the UK. It is the risk of sudden and severe hypoglycaemia, which makes people liable to this form of discrimination. In general the only people who have difficulty in obtaining a licence are those on insulin with very erratic control and a history of hypos causing unconsciousness. Once their condition has been controlled and severe hypos abolished, they can reapply for a licence withconfidence. Diabetes UK has successfully campaigned for regulations on C1 licences to be changed. Previously, blanket restrictions were imposed on insulin users wishing to drive small vans and lorries between 3.5 and 7.5 tonnes. This now enables anyone on insulin, including those who have previously had their entitlement withdrawn, to be individually assessed on their fitness to drive. Restrictions on other Group 2 vehicles (heavier vehicles and passenger-carrying vehicles, such as mini-buses) remain.
When I was filling out a form for the DVLA, one of the questions asked whether I had had laser treatment in both eyes. Why do the DVLA need this information?
The DVLA may ask you to have a ‘visual fields test’ if you have had laser treatment in both eyes, and your licence will be revoked if you cannot pass this test. If you are having a visual fields test, we would recommend that you have the type in which both eyes are tested at the same time. This test, which examines both eyes together is the DVLA driving standard.
Do I have to inform my insurance company that I have diabetes?
When applying for motor insurance, you must declare that you have diabetes. Failure to disclose this can invalidate your cover if you need to put in a claim. The Disability Discrimination act 1996 has reduced the problems of insurers loading premiums surrounding motor insurance. The Act outlaws the charging of higher premiums for groups of people where no higher risk rate has been proven, as is the case with diabetes. Unfortunately, there are some companies that still discriminate, but Diabetes UK Services have arranged a car insurance scheme to help make life easier.
I have heard that a driver who had a motor accident while hypo was successfully prosecuted for driving under the influence of drugs and heavily fined. As someone who takes insulin I was horrified to hear this verdict.
Several people on insulin have been charged with this offence after a hypo at the wheel when the only ‘drug’ that they have used is insulin. It may seem very unfair but, for any victim of an accident, it is no consolation that the person responsible was hypo rather than being blind drunk. These cases emphasize the importance of taking driving seriously. Remember the rules:
• Always carry food/glucose in your car.
• If you feel at all hypo, stop your car (as soon as possible), take some glucose, and move into the passenger seat.
• Check that your blood glucose is above 5 mmol/litre before driving again.
• On a long journey, check blood glucose levels every few hours.
I have been a bus driver for 15 years and was found to have diabetes 5 years ago. Up until now I have been on tablets but may need to go on to insulin. Does this mean I will lose my job?
As a bus driver you will hold a PCV (Passenger Carrying Vehicle) licence. People on insulin are not allowed to drive a PCV. You are faced with a very difficult choice – either to continue on tablets feeling unwell but holding down your job, or else to start insulin and feel much better, but lose your source of employment. We would have to advise you to go onto insulin as you will come to this eventually anyway. Holders of a LGV (Large Goods Vehicle) licence will also lose their licence and thus their livelihood if insulin treatment is to be started. LGV drivers who have been on insulin since before 1991 and held their HGV licence since then may keep their licences provided that they can prove that their control of their diabetes is good and they are not subject to hypos.
I recently read a newspaper article that implied that people with diabetes who are breathalysed can produce a positive reading even though they have not been drinking alcohol. What does this mean?
Diabetes has no effect on breathalyser tests for alcohol even if acetone is present on the breath. However, the Lion Alcolmeter widely used by the police does also measure ketones, though this does not interfere with the alcohol measurement. Anyone breathalysed by the police may also be told that they have ketones and that they should consult their own doctor. These ketones may be caused either by diabetes that is out of control or by a long period of fasting.
Alcohol
My husband likes a pint of beer in the evening. He has now been found to have diabetes and has to stick to a diet. Does this mean he will have to give up drinking beer?
No. He can still drink beer but, if he is trying to lose weight, he will need to reduce his overall calorie intake and, unfortunately, all alcohol contains calories. There are about 180 calories in a pint of beer and this is equivalent to a large bread roll. Special ‘diabetic’ lager contains less carbohydrate but more alcohol so in the end it contains the same number of calories, with the draw-back of being more expensive and more potent. He should probably also avoid the ‘strong’ brews, which are often labeled as being low in carbohydrate, as these are higher in alcohol and calories than the ordinary types of beer and lager. Low-alcohol and alcohol-free beers and lagers often contain a lot of sugar, so,
if he decides to change to these, he should look for the ones also labelled as being low in sugar.So overall your husband is probably better off drinking ordinary beer, but if he is overweight he should restrict the amount he drinks.
My teenage son has had diabetes since the age of 7. He is now beginning to show interest in going out with his friends in the evening. What advice can you give him about alcohol?
Most people with diabetes drink alcohol and it is perfectly safe for them to do so. However, if your son is on insulin he must be aware of certain problems that alcohol can cause – in particular alcohol can make hypos more serious. When someone goes hypo a number of hormones are produced that make the liver release glucose into the bloodstream. If that person has drunk some alcohol, even as little as 2 pints of beer or a double measure of spirits, the liver will not be able to release glucose and hypos will be more sudden and more severe.
In practice alcoholic drinks that also contain carbohydrate tend to increase the glucose in the blood. So the overall effect of a particular alcoholic drink depends on the proportions of alcohol to carbohydrate. For instance, lemonade shandy (high carbohydrate/low alcohol) will have a different effect on blood glucose from vodka and slimline tonic (low carbohydrate/high alcohol). Your son may notice that ‘diabetic’ lager is more likely than ordinary beer to cause a hypo because it contains less carbohydrate but more alcohol.
If your son has been drinking in the evening, then his blood glucose may drop in the early hours of the morning. To counter act this it would be sensible for him to eat a sandwich or cereal and milk to provide extra carbohydrate before going to bed.
I am 18 and go out a lot with my friends. I am careful never to drink and drive but, when it is not my turn to drive, I do drink quite a lot. I am careful not to miss any meals and I am not increasing my insulin as I used to when I first started drinking, but I have had quite a few bad hypos recently. Why should this happen?
This is because alcohol blocks the release of glucose from the liver (see the previous question for more information about this). If your blood glucose is dropping because it is a while since youhave eaten or because you have been out and active longer than usual, then your body cannot come to the rescue as normal. Ideally it would be better if you could try not to have more than three or four units of alcohol in any one session. One unit of alcohol is half a pint of beer or lager or cider OR one glass of wine OR one single pub measure of spirits OR one measure of sherry or aperitif.
If you are going to have more than three or four units in one go, then make sure that you have your usual meal before you go out, have a snack while out and, very importantly, have a sandwich before you go to bed. Following this plan will help prevent you having hypos.
I believe that it is dangerous to drink alcohol if certain tablets are being taken. Does this apply to tablets used in diabetes?
In general the answer is no. Some people on chlorpropamide (Diabenese) experience an odd flushing sensation when they drink alcohol but those people can easily be changed on to an alternative tablet (e.g. gliclazide), which does not cause this problem.
The other consideration is that alcohol may alter the response to a hypo and most tablets used for diabetes can cause hypos. If you are on tablets and are going to drink any alcohol, then you must be extra careful not to go hypo.
I’ve heard that there is evidence that a moderate amount of alcohol is part of a healthy diet, and that it reduces the risk of heart disease and strokes.
My dietitian made me cut down my alcohol intake to one glass of wine a day, which is much less than I used to drink. What should I do?
Recent research shows that alcohol in moderation reduces the risk of heart attacks, trokes and premature death in people with diabetes (or without); indeed the effects may be even more impressive in people with diabetes. Our view is that moderatealcohol intake (up to a maximum of half a bottle of wine a day, or equivalent) should be encouraged, but within a calorie-regulated diet, if the person is overweight.
