Parallel parking, left turns ... and glucose monitoring?
For a diabetic seeking a driver's license, a good bill of health is just as important as passing driver's ed.
A history of poor glucose control can be a red flag for diabetics, as extreme blood sugar levels can adversely affect driving.
And new drivers must be particularly aware of these added medical factors.
According to Carol Grafford, president of the Michigan Organization of Diabetes Educators, or MODE, blood glucose readings below 70 mg/dL can cause slower response times and affect a person's ability to make good road choices.
Other common symptoms for hypo- and hyperglycemia include feeling drowsy and confused, having blurred vision and being disoriented -- a hazardous list of problems for anyone who finds themselves behind the wheel of a car.
"It would be fair to say that having a very low or very high blood sugar is equivalent to drunk driving," she said.
Fortunately, a low blood-sugar incident while driving is a problem that can be avoided.
"People with diabetes, even people who take insulin, should have no problems with driving," Dr. Irl Hirsch, professor of metabolism, endocrinology and nutrition at the University of Washington School of Medicine in Seattle told ABCNEWSs.com's OnCall+ Diabetes Resource. "The key to driving and diabetes is being responsible, no different for any other chronic medical condition."
And being responsible, he said, means that those with diabetes should be certain to check their blood glucose levels before driving -- especially if they take insulin.
"What we encourage our patients to do is check the blood sugar if it has been more than one hour after eating," he said. "By the same token, if they are driving for more than an hour, they should stop the car and check the blood sugar to make sure it is not getting low."
Identifying the Problem
But dangers do exist. Mark Lippe, founder of Dad and Daughter (DAD) Innovations, knows this fact well. When he was 19 years old, Lippe became hypoglycemic while he was driving. He blacked out and hit a tree.
Though he wasn't badly hurt, he said responding officers "thought I was on drugs or had been drinking. ... I had three tickets in a matter of minutes!"
So three years ago, when his daughter was diagnosed with diabetes just shy of her 16th birthday, Lippe said they decided together that she needed some form of identification identifying her as a diabetic driver was necessary.
"The first thing she said was, 'Put something on the car!'" Lippe recalled.
Today, Lippe and his daughter run DAD Innovations. The company markets diabetic key chains and window decals. Like a Medic Alert bracelet for the vehicle, DAD products are used to notify others of the driver's condition in an emergency.
"A lot of kids today don't like to wear any ID. ... This is one more thing that would help identify the situation," Lippe said.
For many new drivers, it is easy to assume there will be time to stop for food if hypoglycemia begins to set in. However, Lippe warned, "by the time you get in line at a McDonald's it could be too late. ... You should always carry something fast-acting."
"Teens especially tend to believe they are fine, whether they [have a blood sugar of] 45 or 445," Grafford said. "Even though a lot of diabetics feel fine at 65 or even below, they're not fine," she said.
Seventeen-year-old diabetic Nicola Fiddes admitted, "I have had a few low blood sugars ... and it really is not a good experience.
"I always feel somewhat out of focus when I'm low, which obviously is not a good state to be in when driving."
Rules and Consequences
The Department of Motor Vehicles has various regulations for drivers whose medical conditions may prevent them from operating a motor vehicle. Most regulations vary by state.
Diabetic applicants in California, for example, "are required to report ... that they have been diagnosed with diabetes or any other disease or disorder ... characterized by a lapse of consciousness," said DMV spokesman Armando Botello.
Noncommercial drivers in California are also required to provide a medical report from their physician explaining the details of their treatment and control, Botello added.
Applicants may also be asked to participate in an interview with a driver safety officer to provide specifics about their condition.
And diabetes is no excuse for unsafe driving. Drivers who lose control of their vehicle and cause harm to themselves or others may suffer legal consequences.
According to the New York DMV Web site, drivers who have their license suspended for medical reasons will require a doctor's note to get it back.
In such cases, a physician must certify that the driver is treated and in good control of their health. The New York DMV Web site explains, "If the DMV does not receive the required certification, the DMV can suspend the driver's license [indefinitely]."
But a New York DMV spokeswoman said, "If [the driver has] never ever had a problem we don't require any medical statement."
In California, being able to return to the wheel requires a passing grade from doctors and the DMV.
A pass to the open road is something many teens look forward to. Diabetic teens are no different. However, for new drivers and their parents, there are important precautions to take to make driving safe.
"Check your blood sugar before you get behind the wheel," Grafford urged, adding that it is important for diabetic drivers to be prepared on the road, even if the ride is short.
In light of this, Grafford advises drivers to carry three things: a blood glucose monitor and supplies; some form of glucose that does not melt, such as glucose tablets; and any medication they may need.
"You would never leave your house without your pancreas; [with diabetes] these things become your pancreas," she said.
In addition to carrying glucose, parents like Rod Stephens, insist "the [insulin] pump is by far better" for those who are driving. Stephens' son Garrett is a type 1 diabetic who received his driver's license in November.
"If you were doing injections you would literally have to pull over ... and get out the vial and the syringes," Garrett Stephens said. Pumps, he added, make it much easier for drivers to get their insulin dosage without multitasking at the wheel.
Despite the risks and additional rules diabetic drivers face, the road can still be enjoyable if proper precautions are taken.
"I look at it as no different than making sure you are wearing a seat belt, making sure you are not drinking alcohol, and all of other things we should do to be responsible while driving," Hirsch noted.