Driving while under the influence of insulin.

Recognising dyslexia C Wales 153 Parents' expectations of symptom relief for their children R Sweeney 154 A survey of diabetes care in general practice in Northern Ireland C Kenny and M Pierce 154 Disadvantages of chronic disease templates in primary care consultations J N H Eisenberg 155 New GP contract and European definition T D Richards 155 Measuring consultation skills R C Fraser and R K McKinley 156 The role of GPs in medical student education A Kapoor 156 All letters are subject to editing and may be shortened. Letters should be sent to the BJGP office by e-mail in the first instance, addressed to [email protected] (please include your postal address). Alternatively, they may be sent by post (please use double spacing and, if possible, include a MS Word or plain text version on an IBM PC-formatted disk). We regret that we cannot notify authors regarding publication. LETTERS Driving while under the influence of insulin Dr Ian Hill-Smith's letter (December BJGP) raises several issues. Clearly, testing before driving is advisable and it is possible to predict whether blood glucose will rise or fall according to when food was last eaten and the time and dose of insulin. Surely doctors have a duty to advise this, and patients clearly have a duty to themselves and other road users to utilise the advice. I am interested to know why the diabetes nurse in question believed that to test every time before driving would be foolish. Clearly there may be exceptions, such as when diabetes is very stable and the patient has eaten within the past two hours or performed a test in the past two hours. Was this belief a result of not wanting to be presented with a battery of test results at the next clinic appointment, or concern regarding the cost of test-ing? The author commented that 80% of drivers would not have adequate strips prescribed to test before driving. This highlights the lack of adequate self care of many patients with insulin-treated diabetes. It is disconcerting that they are not testing frequently or that healthcare professionals are not encouraging them to do so. I believe this will have to change if we are to attempt to meet National Service Framework targets for gly-caemic control, as this will increase the risk of hypoglycaemia and will require increasingly intensive insulin regimens and self-adjustment of insulin. The increased risk of hypogly-caemia from …