Personal Note -- Drivers License Revocation
(Top Posts - Social/Legal - 042809, updated 060509)


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The following, the first of many posts I made
from April 28, 2009 -to- June 5, 2009 regarding
type 1 diabetes, changes to my insulin regimen,
the addition of blood glucose monitoring/testing,
possibilities regarding continuous glucose monitors,
and the psychological impacts of dealing with all
this.

Since April 28, 2009, I've not received a letter
stating my drivers license is revoked, but at the
time, I was fearful that the action iterated by a
particular local cop would lead to my license
being revoked (and it still may -- but to the best
of my knowledge, it hasn't yet).

For the remainder of those posts, refer to the
following post made on June 5, 2009:

Continuous Glucose Monitors (recent reports)
(060509)
  http://prohuman.net/science/continuous_glucose_monitors.htm

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The following, well, I could try to spin it as a posi-
tive, I could look on the bright side, I could condemn
myself as falling short of the type 1 diabetic 'ideal',
and I hesitate to offer this up, as I know, from posts
I made after a traffic accident back in (hold on, I'll
have to look that up) 2001 (a very bad year, for me
and for the country), that any low blood sugar event
at the wheel is held in low esteem, especially if per-
sons are hurt.

Reference to that event: A Daydream?
  http://prohuman.net/social_legal/daydream.htm

Understood. However, with all due respect to those
who are critical regarding type 1s falling short of per-
fection (and perfection, I suppose, would be someone
who never has lows, or who is *always* hypoglycemic-
aware, someone who *always* keeps his/her blood
sugar close to normal, and I dunno, maybe there is
a significant percentage that achieves that, but I sus-
pect, with current techniques, there is a very large per-
centage that falls short of that simply because current
techniques rely on treatments that are defective, heavily
dependent on the victim *always* doing the 'right' thing
and that 'right' thing only knowable with 20/20 hindsight,
and alarmingly prone to adverse side effects, *always*).

- - -

With me, two days ago, I had a low blood sugar on
the way home, and the cops arrived after a couple
hours. I was pulled off onto a side street. One of the
cops said my license was revoked, and suggested
I take a cab to work.

The next day, I took a cab to work, bought a bicycle,
and biked home. Not all that easy, as I'm less in shape
than I realized. The cops were all around, and even a
firetruck showed up at one point.

Any way, I have to get used to biking everywhere now,
and on occasion, I suppose when I need a lot of gro-
ceries, I'll take a cab. The cab costs $6 from home to
work, so that's a $12 round trip.

Not sure how I'll get my license back.  I suppose I'll
have to see a doctor, like I did last time, although it
may be much harder to get this time. I also need some
type of different way of dealing with the disease, both
to make the doctor and police happy, and to prevent
any low blood sugar events while at the wheel, although
even a low blood sugar event at work might be enough
to cause them to revoke my license again were I to suc-
ceed in getting a license in whatever amount of time that
would take.

Psychologically, I'm doing OK, I think, but in terms of
being pushed off my 'normal' course, and getting used
to being ostracized from the roadway, not sure what the
long-term psychological impact of that will be. This
disease has never been something I've accepted, or liked,
and these recent events don't positively impact how I feel
about that. I do understand why the cop revoked my license,
after a couple of recent low blood sugars. However, ironic-
ally, the net impact is an increase in the likelihood of recur-
rence, by biking home after 8 hours of work, although I'll
likely continue skipping the evening shot, and making sure
to drink some juice before leaving work. Oh well.

As for help, I'm not really all that good at motivating myself
to see a doctor, as evidenced by the fact I had to go to the
edge before my depression finally got me some help for that
problem, (part of an email post to my dad -- "so next time
you're in town, let me know, and maybe you can give me
a ride to a doctor, and maybe help me find a constant glu-
cose sensor that warns when the blood sugar is too low").

Not sure if I'll be able to adapt to that, but I'm open to sug-
gestions as to how to influence a doctor, the cops, and
others, that I will have a much lower chance of a low blood
sugar event.

On the other side of the coin, whatever I've been doing, must
have been something right in that being that I've lasted almost
50 years with the disease, something I think the ADA gives
awards for, so that's saying something positive about what the
doctors, cops, and (perhaps) judges and definitely employers
and spouses (and I guess it's a long list) view in a negative
light.

As always, not sure where I fit in to all this, or how to deal
with all this, and not sure how conforming to the rules and
dictates of society will set with my non-conformist nature, but
in any case, I could use your help in these matters. Of course,
until the disease is cured, I'll probably always feel like a 'freak',
and that's so deep, I doubt I'll ever outgrow that, but I sup-
pose, anything's possible. :-)

Otherwise, work is work, and apart from this recent license
revocation, things are going swell.

...

(follow-up)

The glucose sensor is a new development (several models)
but I was put off that they all say you have to test your
blood sugar manually in addition to relying on the contin-
uous blood sugar monitoring. Seems contradictory, a sen-
sor that continually monitors blood sugar but isn't depend-
able enough to be trusted or relied on. Either that, or the
makers simply worry about lawsuits and use the manual
blood sugar test instuction as a defense against anyone
who might sue them for failure to detect low blood sugar
or failure to detect high blood sugar.

In any case, when the artificial pancreas is developed (and
it's currently being tested), they'll have to have 100% relia-
bility or else the insulin dispensing device would be unable
to release the right amount of insulin to match to blood
sugar levels.

As for doctors, I'm amused that most put so much con-
fidence in them, when my experience has been so far short
of being impressed with them when it comes to type 1
diabetes (and until recently, and that doctor that prescribed
the medication that 'cured' my depression, I hadn't found a
psychologist/psychiatrist/doctor that could help with that
depression problem, although the one that prescibed Paxil
after the divorce depression, that helped snap me out of
depression but had an adverse sexually inhibiting side ef-
fect). I suppose it's hard to be impressed with doctors
when they do so little regarding what type 1 diabetics have
to do, manually, on their own, the eating/exercise/insulin-
giving thing, the constant 24by7by365 (366 every leap year)
manually taking over a critical body function thing.

The cop, he reflects not only the last two low blood sugar
events on the highway, but all the times the emergency peo-
ple were called at work (and I've lost count of how many
times that's happened -- a recent one involved EMS after I
had worked almost an extra hour to try to make up for having
my hours cut, and didn't drink juice, and had an insulin reac-
tion in the store, and the manager at the time and no one else
helped, as I suppose they've been told to, oh well, can't know
what they've been told -- this latest low blood sugar event, I
remember talking to a co-worker right before I clocked out,
and she noticed my blood sugar was low, but unfortunately,
she didn't know what to do about it, and I didn't respond to
her noticing that).

I was told last year, when I had a low blood sugar event and
ended up out in the boonies near town, that 'they' could re-
voke my license. Seems all it takes is a cop deciding I'm too
big of a risk. I suppose, if I had a job that paid more than
what I make, I'd be able to afford a cab, but anyway, I sup-
pose exercising on a bike, that's a good thing, as long as my
blood sugar doesn't go too low.

I suppose, ideally, I should live in a city with a mass transit
system, so I wouldn't have to drive at all, and I'm really not
all that confident about trying to convince others that low
blood sugars aren't a risk for a type 1 diabetic who tries to
meet the demands that blood sugar be kept close to what
normal people have, and that type 1s can, with enough effort,
avoid low blood sugar events while driving or working, *al-
ways*.

Doesn't add up, using a hormone designed to drive blood
sugar down, exercising which drives blood sugar down, and
the only counter being eating enough to keep blood sugar up
enough, but not too much. It's like walking on a tight rope,
24by7by365 (366 every leap year), which is fine if you're
good at that, or really into that, I suppose, but man, it really
sucks for some, like me.

Sometimes, I read about type 1s doing suicide, and I'm not,
with all due respect to Banting, who discovered insulin, really
all that convinced that living with the disease is, given the ad-
verse impacts of it, the loneliness caused by it, the negative
opinions held by most towards type 1s (either driving, or
being around them, if they require intervention), oh well, I
suppose the type 1 disease played a large role in my depres-
sion problems, but that's past me (knock on wood). I'm not
all that confident in much of anything when it comes to this
disease, right now, and I must say, the lack of positive sup-
port regarding dealing with this, I dunno, I suppose socially
active people get the support they need, but since I've never
been socially active, therein resides the explanation for my
feelings, I suppose.

I suppose being a home-body is condusive for this no driving
thing, and really, taking a cab on occasion, I suppose I can
afford that. I dunno, I might get really good at avoiding low
blood sugars while biking, and impress the powers that be
that if I can do that while biking, surely I can do that while
driving, but then again, I really get the feeling that people con-
sider someone like me to be a threat to them, that any low
blood sugar event is an avoidable event, that with 100 per-
cent dedication to sparing anyone the trauma of having to
deal with such an event should be the aspiration of anyone
with type 1 diabetes, that ...

I dunno, I feel really disconnected, and alone, and I've felt
that way my whole life, and it's really weird, the loneliness,
when surrounded by people, and always feeling like a 'freak',
different, inferior, judged, apart, a failure prone to having
events happen to me / not by me, just so totally apart from
what it's like to be 'normal'. I suppose other type 1s feel this
way, but I've never really connected with another type 1 (and
that magnifies the loneliness of the deal).

But enough about that. I go to work tomorrow, and I'll see
if my stamina begins to build up. Rode a little today, to get
a few groceries.

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Follow-up in reply to a poster who had replied
to the post above:

> i'm sorry to hear of your troubles :(

Thanks for the note, and thanks for the info
on diabetes and requirements to drive in Great
Britain (requirements which mean type 1 dia-
betics must test their blood glucose level every
time before they drive and every two hours
when driving).

The following, kind of summarizes where I'm
at, right now, and reflects my 'bummed out'
feelings. For 'bummed out' type 1s, I think it's
refreshing to see that you are not alone when
feeling in despair. I oft-times see upbeat type 1
articles, with famous people iterating how their
disease is manageable, or how they have a 'nor-
mal' life or how good they are at dealing with
their disease, but rarely (ever?) do I run across
very many who openly discuss their moments
of despair.

- - -

Hopefully, I'll get over this despair, and my hope
and optimism will return at some point, though
right now, I'd say the point of despair I was at
-4- years ago, a despair which led me to seek help,
this reminds me of that even though it's not nearly
as bad as that was, yet.

Oh well, if this continues, I'll seek help, and per-
haps, someone has some helpful advice, or words
of wisdom, or words of encouragement, or some-
thing else that might get me past this hopefully tem-
porary malady.

- - -

Negative feelings expressed in the following, but don't
take me too seriously, as I'm just now reacting to all that's
taken place, recently, with a strong dose of reality and
negativism that's probably over the top:

Interesting article included in this reply, which, at the end,
mentions the automatic glucose sensor as a possible solu-
tion for preventing low blood sugar events. The other sug-
gestions, testing blood sugar before driving, someone in
Britain (thanks, Tiger Lily) says she has to test before driv-
ing, and every two hours, as required by law. Of course,
with the Texas demand that all low blood sugar events be
avoided, I'd have to test (like a human pin cushion) all day
long to fit into that particular 'ideal'.

- - -
Reference: Texas, insulin-treated Diabetes, drivers license
  http://tinyurl.com/texas-laws-driving-insulin
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Psychologically, I'm struggling right now to try to adapt
to all this, and am by no means confident that I will be
able to do so.  It would appear that I'm going to have to
become what society expects (demands), or society
won't allow me to drive. Of course, the other option, just
giving up on trying to fit into society, that's there.

I'm afraid that this disease is going to get worse as time
passes, either via the demands of society or the long-term
consequences of having the disease, and it tempts one to
wonder at what point will the will to survive run out. Right
now, not really feeling all that into survival. At work, I'm
treated like a freak (as always, no invitations to parties, no
socializing, a loner), and I just don't see this diabetic night-
mare ever ending.

Hope? A cure is a nice thought, but as life worsens, I'm
not really all that sure I can survive, or even if whatever it
is that makes me me has a place on this planet. I expected
this, a depression, and it took a few days to happen, but I
must say, it's nothing like what happened last time, a result
of all the post-divorce problems. Oh well, I'll just have to
wade through this, and it remains to be seen if, in the remain-
ing quantum dot (surrounded by a hostile uncaring world in
which almost anything I do is looked at negatively) in which
I can survive, if my world will ever cease being an unending
nightmare.

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Hypoglycemia Unawareness
  http://www.ourdiabetes.com/hypoglycemia-unawareness.html
(That is; not recognizing low blood sugar levels)

Complete article:

The limiting factor when it comes to managing diabetes with
intensive insulin therapy (that is, usually four [sometimes more,
occasionally less] injections per day) is hypoglycemia ("low
blood sugar").  Most people on insulin are all too familiar with
what that is all about.  Hypoglycemia manifests as hunger,
sweating, tremulousness and, if severe, with confusion, disori-
entation and, on occasion, loss of consciousness.

Fortunately the great majority of insulin reactions are of the
mild type and readily dealt with by consuming a sugar-con-
taining product (preferably as glucose or sucrose tablets rather
than orange juice or glucose gel).

Severe hypoglycemia (by definition this is low blood sugar to
the point that the patient requires someone else to assist them)
occurs, generally speaking, in two circumstances:

1. In very longstanding diabetes sometimes the "warning system"
falters and the usual clues that hypoglycemia is occurring  are
absent.  This may be irreversible and safety necessitates running
the blood sugars higher than what would generally be considered
optimal.

2. In diabetes of virtually any duration, if one is on intensive man-
agement and trying valiantly to run "tight" blood sugars (i.e., in the
3.8-7.0 range) one has frequent, mild hypoglycemia (usually defined
as being under 3.6 to 3.8).

[reference -- In the U.S., that equates to blood glucose readings
from 70 to 180, approximately, as I don't have the exact conver-
sion information, just relying on a recent HbA1C test I had in
which the doctor said my
HbA1C level of 5.5 equated to what
would, on a blood glucose test, read as 115
]

These episodes are usually picked up readily for a time, but if occur-
ring excessively often, the warning system fails.  It is as if repeated
insults to the body make it say, "the heck with you-you've made me
hypoglycemic so often, I'm not even going to tell you the next time
you're low."

Thankfully, this is usually reversible.  The way to reverse this prob-
lem and restore hypoglycemia awareness (i.e., making one aware
again of when the blood sugar is low) is to let ALL the blood sugars
run in a significantly higher range for a couple of weeks.  Specifically,
this usually entails cutting back from 20 to 50 per cent on virtually
all insulin doses to let the sugars run about 7-12.  After a couple of
weeks, the insulin doses can be raised again, the sugar levels brought
back down to the aggressive target of 4.0-7.0 and awareness of low
blood sugar is generally restored.

I find the main reason this strategy fails is that the poor patient who
I've spent ages trying to convince about the hazards of high sugars
is just not going to readily accept this sudden request to run what
would generally be considered fairly crummy readings.  Please refer
to my disclaimer before you follow this advice.  It may not pertain to
your specific case.  Speak to your doctor or diabetes educator for
recommendations specific to your situation.
  http://www.ourdiabetes.com/disclaimer.htm

Because hypoglycemia can affect driving performance (even mild
low blood sugar can do this, by the way), if you are at all prone to
hypolycemia unawareness I would strongly (note the bolding) recom-
mend you test your blood sugar level EVERY time you are about to
drive. Before you put the key in the ignition, test your blood.  If it is
low, treat yourself and do not drive until your blood sugar is back to
normal.

Always make sure you have something to eat within easy reach in
the car (not in the trunk!) and if you are going to be driving for any
sort of extended period of time, periodically find an appropriate
place to pull over and retest your blood.  When it comes to driving:
if in doubt, test & treat!

For a general discussion of hypoglycemia, have a look here.
  http://www.ourdiabetes.com/what-is-hypolgycemia.htm

If you are prone to severe hypoglycemia you might wish to consider
using a glucose sensor.  Glucose sensors measure the glucose level
just under the skin surface (typically, of your abdomen) using a tiny
probe that you insert and leave in place for a few days.  The glucose
level is then displayed on a pager-size device you wear (or, if you
are using a certain type of pump, the result is displayed right on the
pump) and, basically, gives you a continuous readout of where your
glucose levels are at.

It has alarms so that if you are heading low it will alert you so that
you can take corrective action.  It (like all technologies) is not per-
fect, but it is typically very accurate and for some people with recur-
ring severe hypoglycemia, can even be life-altering.

A video I created that looks at both pumps and sensors is available
at:
  http://www.drblumervideo.com

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Summary of posts I made from April 30, 2009
-to- June 5, 2009, pertaining to Continuous
Glucose Monitors and how the event mentioned
above + the accumulation of almost 50 years of
treatment for type 1 diabetes have impacted yours
truly:

Continuous Glucose Monitors (recent reports)
(060509)
  http://prohuman.net/science/continuous_glucose_monitors.htm

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