Advice for diabetic drivers

Driving is a complex activity which requires adequate vision,motor skill and proper judgement.It is required in day to day life.Diabetes can adversely affect driving by producing low blood glucose,decreased vision and neurological problems.

Following are the advice for diabetic drivers

1. Diabetic drivers should inform the licensing authority and motor insurer about the diabetes and its treatment.

2. If there is sudden deterioration in vision they should not drive.

3. Before starting journey they are advised to check the blood glucose (even before short journey) and in between long journey.

4. They should avoid alcohol.

5. Diabetic drivers should take frequent rests with snacks or meals.

6. For emergency use they are advised to keep fast and long acting carbohydrates in the vehicle.

7. All diabetic drivers should carry personal identification indicating that they are diabetic.

8. If they develop hypoglycemia they should stop driving ,switch off the engine and leave the driver seat for treatment.

9. They should not restart driving for 1 hour after  the blood glucose returned to normal level.

Reason for diabetic drivers to stop driving

1. Newly detected diabetic patients who are started on treatment particularly if on insulin shouldn't drive  unless they achieved diabetic control and proper vision.

2. If a diabetic patient develop recurrent severe daytime hypoglycemia.

3.If the diabetic patient has disabling unawareness of hypoglycemia.

4.Reduced vision in both eyes less than 6/12

5.Severe nervous system complication such as loss of pain and touch in limbs.

6.Severe peripheral blood vessel complication.

7. Lower limb amputation.

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What is osteoporosis and what are the risk factors

Osteoporosis is a condition in which there is weakness of bone strength. Although it is more common among postmenopausal women it can occur in any males and females with risk factors. The most common clinical manifestations are fracture of spine ad hip area, although  fracture can occur at any site. More than 10 million people in USA are affected by this disease but only a small proportion are identified and treated. Osteoporosis is defined as "bone density falls 2.5 standard deviation below the mean for young healthy adults of the same sex that is T score of  - 2.5".

After the age of 70 yrs the chance of hip fracture doubles every 5 yrs. Hip fracture is associated with increased risk of mortality during the year after the surgery.

Spinal fractures are associated with pain in back, bending of vertebral column and loss of height.

Osteoporosis and related fractures are more common in females.

1. Low peak bone mass.

2. Postmenopausal bone loss in women.

One fracture increases the risk of second fracture. For example spinal fracture increases the risk for other spinal fracture and wrist and hip fracture. Wrist fracture increase the risk of spine and hip fracture. Osteoporotic bone is at risk for developing fracture even with minor trauma. Irrespective of circumstances any fracture in people over the age of 50 yrs need evaluation of osteoporosis.

Following are the risk factors for osteoporosis

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Clinical features of osteoarthritis

Most common manifestation of osteoarthritis is joint pain and it is activity related pain occur during activity or immediately after the use of joint and it decreases gradually.

Site of pain - example

1. Hip and knee pain going up and down stairs.
2. Pain in weight bearing joints  while walking.
3. Hand osteoarthritis - pain while cooking.

Nature of pain.

Early in the disease, pain is present only when the affected joint is overused, but later the pain become constant and present even at night. This is associated with stiffness of joint. If early morning stiffness is present, it is very brief usually less than 30 minutes.

Osteoarthritis of knee joint.

In osteoarthritis of knee joint, pain occur on bending the knee. Some people experience buckling, catching and locking of the knee joint. Osteoarthritis of knee joint is the most common cause of chronic knee pain in persons over 45 yrs. In hip osteoarthritis restriction of hip movements will occur.

Investigation in osteoarthritis.

No blood test is required for evaluation of patients with osteoarthritis.

Tests that may be done.

1. Synovial fluid analysis.
2. Xray of joint.
3. MRI test.

Synovial fluid analysis.
If the WBC count more than 1000 it indicate inflammatory arthritis or gout

Xray

Correlate poorly with disease activity and joint pain .It may be normal in the early disease.It is indicated if the joint pain does not respond to usual management.

White arrow indicates joint space reduction compared to opposite side

MRI

Not a routine part of osteoarthritis evaluation.

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