Diabetes and DUI's

Fifteen to twenty percent of all drivers on the road are diabetic. Diabetes mellitus is not just a single disorder but rather a group of disorders that all have some sort of glucose intolerance involved. The World Health Organization has identified four major classes of diabetes mellitus. All are characterized by chronic hyperglycemia and involve some variation of a disturbance of carbohydrate, fat, and protein metabolism. The four classes are:

Type I

• Insulin-dependent diabetes mellitus (IDDM)

Type II

• Non-insulin-dependent diabetes mellitus (NIDDM)
• Malnutrition-related diabetes mellitus (MRDM)
• Other types (Secondary diabetes)

Diagnosis is based on a fasting plasma glucose level greater than 140mg/gl (more than one), elevated plasma glucose level in response to an oral glucose tolerance test, and random plasma glucose levels above 200 mg/dl combined with classic symptoms of frequent urination, excessive thirst, excessive hunger, and weight loss. Diabetes is controlled through three primary ways; insulin (for Insulin Dependent Diabetics), oral medications (for non-Insulin Dependent Diabetics) and diet (for both Insulin and Non-Insulin Dependent Diabetics).

There has been much discussion about the accuracy in correctly determining alcohol levels in diabetic patients. There have been cases where patients who had not been drinking had blood alcohol levels significantly above legal limits. Typically when blood sugar levels start to drop, the liver steps in and changes stored carbohydrates into glucose. This glucose is then sent out into the blood stream which either stops or slows down a low sugar reaction. When alcohol is introduced to the body, the liver’s first priority is to get rid of all the alcohol. So, if there is alcohol in a diabetic’s system and their blood stream is starting to drop, the liver will not respond to the lowering blood glucose level but will instead work on getting the alcohol out of the system. Therefore, the diabetic experiences low blood glucose level.

There are two issues in which the side effects of diabetes could affect the way one interprets the sobriety of a diabetic. The first is with hypoglycemia (low blood glucose level). Hypoglycemia is defined as blood glucose levels less than 60mg/100 ml. Most diabetics who take insulin experience hypoglycemia. These reactions can happen because of any of the following reasons:

• Overdose of insulin
• Omitting a meal or eating less food than usual
• Over exercising without enough carbohydrates ingested prior to exercise
• Nutritional and fluid imbalance as a result of nausea and vomiting
• Alcohol intake

Hypoglycemia is serious. It can lead to the destruction of brain cells causing permanent brain damage, memory loss, impaired learning ability and paralysis. These symptoms are not typically seen unless the hypoglycemia is allowed to progress to a serious state. Early signs of hypoglycemia include headache, weakness, irritability, lack of muscular coordination, and apprehension. Diabetics who are hypoglycemic can behave as if they are drunk.

Hyperglycemia (high blood sugar) in a diabetic can also have serious implications. Hyperglycemia is defined as a blood glucose level over 180mg. Hyperglycemia occurs when glucose is not able to be delivered to the cells because of a lack of insulin. When there are too many carbohydrates for the amount of insulin in the system to respond, the result will be hyperglycemia. If not checked, this condition can develop into a serious complication of diabetes called diabetic ketoacidosis. Early signs of hyperglycemia include; increased thirst, headaches, difficulty concentrating, blurred vision, frequent urination, and fatigue.

By reviewing some of the symptoms of hypoglycemia and hyperglycemia it is easy to understand how the side effects of diabetes, if not correctly interpreted, would cause police authorities to believe that one is intoxicated. It is important that when someone who is diabetic is believed to be driving under the influence that serum blood tests are used to correctly determine potential intoxication levels. The breathalyzer test has been identified as potentially giving a false positive if a diabetic is releasing ketones (like from hyperglycemia). When an individual is suspected of driving under the influence, blood tests should be followed up to prevent inaccurate test results and prevent not only misdiagnosis but malpractice.

Please see our website www.medicaljurisprudence.com for more information on diabetic ketoacidosis.

References:
Black, J. M. and Matassasin-Jacobs Luckmann and Sorenson’s Medical Surgical Nursing: A Psychophysiologic Approach. Pp. 1781-1782 & 1793-1797.

McCance, K.L. and Huether, S.E. Pathophysiology: the biologic basis for diseases in adults and children. Pp. 678 and 681.

Taylor, L. DUI or Diabetes? Diabetes Health (September 2006). Retrieved March 2007 from www.diabeteshealth.com

Sidhaye, A.R. Medical Encyclopedia: Glucose Test (February 2005). Retrieved from www.nlm.nih.gov/medlineplus/ency/article/003482.htm

American Diabetes Association Alcohol. Retrieved March 2007 from www.diabetes.org/type-1/alchohol

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