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DVLA and hypos

Discussion in 'Diabetes Discussions' started by rmz80, Aug 27, 2017.

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  1. rmz80

    rmz80 Type 1 · Well-Known Member

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    Without thinking; on a recent visit to my GP I showed her a list of my BG measurements. Some of the measurements listed were 3.5, 3.8 and 3.9 mmol/L. My GP subsequently advised the DVLA that I was prone to hypos without been aware of having a hypo (below 4.0mmol/L)

    I disregarded these figures at the time as they looked like meter error as most meters are usually rated as only plus / minus 15% accurate. At the time of the readings my driving licence was on hold anyway so the issue of driving wasn’t a consideration. A low meter reading wasn’t an issue pottering around at home so left it.

    I am now in a position where I have to convince the DVLA that this so called hypo unawareness may have been a meter error! I don’t think my doctor had the vaguest idea these meters are not very accurate. (especially on a reading of 3.9!)

    I would guess there should be a crib sheet of what to do if meter gives a reading below 4.0mmol/L and what to do if you drive.

    Does anyone know of this?
     
  2. Daibell

    Daibell LADA · Master

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    I think the surgery was out of order on this. The key thing the DVLA want to know is whether you are hypo aware not so much what your lowest levels are. Your licence should only be challenged if you have had two hypos where you needed the assistance of others (read there advice sheets). I would complain to the surgery Practice Manager. There are rules about not driving below 4mmol and taking glucose then to get you up above 5 mmol but as long as you test before and during driving to meet those figures you are OK. I wouldn't argue the 15% accuracy thing too much as it applies to all meters.
     
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  3. rmz80

    rmz80 Type 1 · Well-Known Member

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    Thats a good one. Thanks
     
  4. catapillar

    catapillar Type 1 · Well-Known Member

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    Do you have hypo awareness? Do you have symptoms when under 4 to let you know you're having a hypo?

    If you are hypo unaware you should not be driving.
     
  5. rmz80

    rmz80 Type 1 · Well-Known Member

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    Thanks for replying. I do not drive as I’m awaiting a clean bill of health on other issues. I tend to be very careful with BG and rarely see even a reading below 4.5. The only time I am sure I got a hypo was when I injected myself twice. Since then I’ve implemented a way to stop this happening again.

    It’s the fact that a reading of below 4mmol/L is assumed to be a hypo when it may be a meter error that’s winding me up.
     
  6. DavidGrahamJones

    DavidGrahamJones Type 2 · Well-Known Member

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    Not sure your doctor did the right thing and I think you should ask where in any guidelines it says to inform the DVLA of someone having low blood glucose when they didn't need assistance or were intending to drive or indeed showed any physical signs of having a hypo.

    GPONLINE actually says:

    "The patient does not have to report an episode of hypoglycaemia if they were conscious of it and able to take appropriate action independently"

    The doctor needs to consult the GMC for guidance in matters that they clearly don't fully understand.

    I would have thought the whole point of measuring one's BG before driving is to avert hypos by detecting low BG. Something the DVLA accepts can then be treated by the individual. Several of the documents I read talk about having a BG meter with a memory function for the police to see. Also waiting 45 minutes after the BG returns to 5.
     
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  7. rmz80

    rmz80 Type 1 · Well-Known Member

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    I was just thinking after posting to this forum. An opposite situation could also occur; if you get a reading of 4.5mmol/L you could yet be under 4.0!! (less 15% is 3.8).
    Off top of my head perhaps a solution is retest with a different branded meter and different test strips as the error may be in a batch of test strips or the meter itself. Calibration fluid is also an issue (and is rarely supplied!) as most meters are supposed to be re-calibrated with each new pack of test strips
     
  8. rmz80

    rmz80 Type 1 · Well-Known Member

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    I have the General Medical Council Guidelines in front of me. The guidelines for GP's state "Only disclose factual information you can substantiate". I would think a 10 second view of my BG log files does not fall into the category of this (especially as I didn't leave a copy)
     
  9. noblehead

    noblehead Type 1 · Guru
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    At any point have you told your Dr that your hypo unaware?

    No expert on this matter but I believe the meters are more accurate when reading lower bg levels than they are when bg levels are high, it's been discussed on the forum before by other members.

    It is supplied or they'll be a note inside the packaging to say you can ring the manufacturer and request the fluid, so I don't think the DVLA would take your point into consideration.

    Why don't you write to the DVLA and appeal if your licence has been revoked because of what your GP said about the hypo's, if your under the care of a hospital diabetes clinic they could support your appeal if they also believe that your GP was wrong. Good luck.
     
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  10. iHs

    iHs · Well-Known Member

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    Could I politely ask what your current hba1c is @rmz80 ? Many GP practices are now following revised guidelines due to many diabetics appearing to lose some degree of their awareness of a low bg level and have arrived at the conclusion that its safer to achieve an hba1c of between 6.7 to 7.5% than to try to achieve one that is 6.5 or far lower even if following a bernstein diet. Also, how many bg tests do you do every day as only doing 4 tests per day isnt really enough especially with the nature that multi injections follow where basal level of insulin needs to be adjusted and carb ratios and correction factor too.
     
  11. catapillar

    catapillar Type 1 · Well-Known Member

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    I think it's hugely risky to assume you monitor is innaccurate when you see readings below 4. When you see a reading below 4, you are hypo. There's no other way of operating. What other readings are you choosing to ignore on the basis of inaccuracy just because you don't like the look of it? If you see a reading under 4 and you don't have symptoms, then you are hypo unaware and your driving licence should be taken away.

    Since 2016, blood sugar monitors must meet the following standards 95% of the time:
    • Within 0.83mmol/l of lab tests at readings under 5.6
    • Within 15% of readings over 5.6
    So 95% of readings under 5.6 will be within 0.83 mmol/l of a lab test of the same blood. A much closer accuracy than the 15% you are under the impression applies. Even if your monitor is pre-2016, it will still have had to be within 0.83mmol/l of any reading under 4.2 95% of the time.

    Disregarding readings under 4 because you assume they are metre errors does suggest a rather reckless approach to diabetic management. You appear to assume that 100% of readings under 4 are metre errors, which just doesn't comply with the standard set for monitor accuracy.
     
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  12. urbanracer

    urbanracer Type 1 · Moderator
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    But the 'guidance' is to be at 5mmol or higher at the start of your journey. Meaning that even with meter error you will always be above 4.0mmol with a newer meter.
    Changing meters doesn't really work, because you don't know which one is right (or the most accurate). Are you going to drive when 1 meter records 4.5 and another 3.8? I think it best to get used to 1 meter and the way you 'feel' at whatever reading you get.
     
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  13. Cumberland

    Cumberland Type 1 · Master

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    One thing I remember from the DAFNE course that has stuck with me is that you have to be 'five to drive'
     
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  14. iHs

    iHs · Well-Known Member

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    From reading the posts on this thread, I presume that @rmz80 doesn't attempt to drive their car when bg levels are at 4mmol or below so is in no danger of having a hypo unless driving a vehicle all day long and not testing every 2hrs. I do think the GP has jumped the gun a bit but only a hospital consultant should have the final say and they should hopefully advise for bg levels to be higher so that a low bg level resulting in below 4mmol regularly, can be avoided.
     
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  15. rmz80

    rmz80 Type 1 · Well-Known Member

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    But a reading of 4.00 minus 0.83 = 3.17 which is 20% less. So is even worse than the 15% I quoted. The point is driving with a reading below 5.00 is asking for trouble.
     
  16. azure

    azure Type 1 · Expert

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    @rmz80 To my mind, the salient thing here is that your GP told the DVLA you were hypo unaware.

    Why would they think that just because they saw a 3.9, etc on your meter? Do they have other reasons to think you're not aware of hypos?
     
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  17. rmz80

    rmz80 Type 1 · Well-Known Member

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    My current reading for HbA1c is 31 mmol/mol. I don't know what this is on other scales. I do 5 readings a day on average. I didn't think the surgery would want to pay for more as I believe the test strips are the most expensive part of treating diabetes
     
  18. noblehead

    noblehead Type 1 · Guru
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    They can't restrict test strips for type 1's, have a look at the following from the Dept of Health, it was a letter sent to all gp surgeries in 2013:

    https://www.gov.uk/government/uploa.../Safe-care-of-people-with-type-1-diabetes.pdf

    It would be helpful to know if you've told your gp that your hypo unaware at any point.
     
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  19. iHs

    iHs · Well-Known Member

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    Mamma Mia..........31mmol is way too low and will account for the below 4mmol bg readings which is the reason for your GP to notify the DVLA, not because you have lost your awareness but will be in danger of doing so unless you mend your ways. Who recommended you to aim for a low hba1c?
     
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  20. catapillar

    catapillar Type 1 · Well-Known Member

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    A reading of 3.5 will, 95% of the time, be a blood sugar value between 2.67 and 4.33. So disregarding such a reading because you don't like the look of it does not seem like a sensible approach to diabetic management. It seems your just choosing to ignore the readings you don't want to see on the basis of not terribly valid arguments about metre accuracy. At the end of the day, the metre is all you've got to tell you what your blood sugar is, you're going to have to listen to its readings and not pick and choose which ones you want to believe.
     
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