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When you live with diabetes, particularly if you take insulin, there’s always a need to think about safety behind the wheel. You need to ensure that your blood sugar levels won’t dip into a danger zone that could cause you to lose control of your vehicle.

Most people with diabetes (PWDs) are well aware of this, and conscientious about checking their glucose levels before driving. But you never know…

That’s why there’s a market for window decals, seat belt straps and an array of other items designed to flag the fact that the person driving a car has diabetes.

While these items could be extremely helpful in an emergency, not everyone is “on board” with the idea of advertising their medical condition on their vehicle for all the world to see.

There are pros and cons to be sure, and we at DiabetesMine looked into them by querying our community on social media, and interviewing several healthcare professionals in the diabetes space.

First off, we wondered if there are any official rules beyond applying for a driver’s license that mandate disclosure of your illness while driving.

Laws regarding driving and diabetes vary by state, but it appears that even in the strictest jurisdictions, a medical ID placed on a vehicle isn’t required or even recommended for PWDs.

Be aware, however, that if you do have a driving issue caused by hypoglycemia, you will lose your license immediately in most states.

Of course there’s always a personal imperative to make sure that police or paramedics responding to an emergency know about your condition in order to treat you properly. That’s often addressed by wearing a medical ID bracelet or other med alert jewelry (or a tattoo). But there’s no guarantee that first responders or bystanders will see your personal ID.

So, on the pro side, some people believe these vehicle decals are an excellent choice to alert authorities in a medical crisis or emergency situation. There’s also a benefit to bystanders or fellow drivers seeing the sticker, who may be able to notify EMTs about an emergency if they notice erratic driving or anything out of the ordinary. These decals also can certainly help avoid having a diabetes emergency being mistaken for a drug or alcohol issue.

But the other side of the coin is a touchy subject: Who wants to “advertise” their illness and open themselves up to possible judgement or stigma?

The cons of choosing to publicly display your diabetes are clear. Why do strangers need to know? Some PWDs worry that police could target them and use that as an excuse to pull them over, or other drivers could point to the diabetes alert even if it’s not a factor in an accident or other driving incident (i.e. “It’s not MY fault I hit her!“).

More than 100 people responded to our DiabetesMine social media query about whether displaying diabetes on your vehicle is a good idea or not. Roughly 73 percent of commenters said “no,” while only 14 percent said “yes.” The rest offered an answer somewhere in between, describing how it depends on the particular situation or circumstance.

Victoria Cassedy, who’s lived with type 1 diabetes (T1D) for many years in Virginia, said she has displayed stickers stating, “I’m not drunk, I’m diabetic” ever since she saw a news story about a woman pulled over and forced by police to lay face down on the hot asphalt while being handcuffed. It turned out the woman had T1D and was having a severe hypoglycemic episode.

“(Police) treated her like total trash because they thought she was drunk. She could have died in the time it took them to treat her like a human being,” Cassedy shared with DiabetesMine.

Lauri Salsbury, who lives with T1D and autism in Arkansas, was also a “yes” to putting a diabetes decal on her car. “I do!! For 2 reasons: 1) I’m proud of who I am, 2) If I am in an accident, MAYBE someone will see the sticker and know to give me glucose,” she wrote.

But it’s a strong “no” from T1D Allison Marx in Georgia, who doesn’t see a reason to call out one’s health condition on your vehicle unless it’s required by law.

“While it may be somewhat common to put ‘student driver’ on a car for the safety of others, I don’t see any medical conditions being regularly called out,” she said. “We don’t ask elderly people to badge their car ‘elderly driver,’ so why would we expect diabetics or people with other diseases to? If I want an emergency responder to know I’m diabetic, my medical alert bracelet, phone medical alert, pump and CGM (continuous glucose monitor) should be plenty. I don’t need it otherwise advertised on my car for people to judge.”

Kathy Marmolejo was also against it, writing: “No, because some people (already) believe that diabetics shouldn’t be able to have a license because we’re a risk. I have a medical ID and an alert card on me.”

DiabetesMine reached out to several endocrinologists and diabetes care and education specialists (DCES) across the United States. Interestingly, most of them said the topic rarely ever came up in conversations with patients.

They said most conversations with patients around driving had to do with state laws, and they usually advise patients to contact their state driving agency or consult the American Diabetes Association resources available on driving rules per state.

Well-known DCES Gary Scheiner in Pennsylvania (who lives with T1D himself) said it comes down to a personal choice whether patients are comfortable using a car sticker.

Though he’s not a personal fan of labeling a vehicle with a diabetes alert, Scheiner says that in his practice they teach patients to always have a medical ID card front and center in their wallet and also wear one if possible. They hand out a business card-sized alert made by Ascensia Diabetes Care that says, “I have diabetes” and “Please call 911” in big, bold print on the font. The back has one’s personal information for first responders, bystanders, or medical professionals.

In Ohio, pediatric endocrinologist Dr. Jennifer Dyer says her state’s Bureau of Motor Vehicles asks each person if they have diabetes when applying for a license. If so, they must then have their doctor complete a diabetes history and assessment to sign off on whether that PWD is “adherent” to their particular management routine. Specifically, the doctor is asked on the form if that person should maintain their license and when that HCP believes the patient should be re-assessed.

Dyer says she’s refused to sign a few teenagers’ forms, particularly when they have “recklessly stopped checking their blood glucose, as I am legally responsible for any damage they do while driving related to their diabetes.” She notes that teens are highly motivated to drive: She’s seen many change their behaviors and consent to start wearing a continuous glucose monitor (CGM) or check their sugars much more often to get her to sign off on the form. “It’s a bit of a bargaining tool that works really well with teens.”

When it comes to the topic of using diabetes car decals, Dyer says: “It would be helpful to have more obvious signage about diabetes on a vehicle, so that when EMT workers arrive at a scene they would know that a person in the car has diabetes.”

Even so, the approach varies by region. Dyer says that in her particular Ohio county, paramedics always assume that any injured or unconscious driver has diabetes and they do a glucose check, unless told otherwise. So, a driver’s vehicle ID might be less impactful there, compared to other places.

I personally have been driving with T1D since 1996, and have gone low and experienced dangerous scares that made me question whether I should even have a license. This happened at two key points in my life:

  1. The first was in my late teens not long after my high school graduation in 1997, long before I became an insulin pumper. I ended up swerving on the road and eventually getting pulled over by police in a parking lot. Thankfully, no accident occurred and no one was hurt.
  2. The second incident was in roughly 2009, just before starting on a CGM. As a result of a fast-dropping blood sugar that didn’t show itself with an in-the-moment fingerstick test at work, I had a “sudden” hypo that led me wandering from my office in a daze into the parking garage. I apparently climbed into my red Ford Escape and began driving towards home. I ended up in front of my subdivision in a ditch, after taking out a street sign with my car. Luckily (incredibly so!), no one was injured that time either.

In that second experience, when paramedics arrived on the scene I was stunned, but still behind the wheel. Unsure of my surroundings but able to see my subdivision entrance, I tried to get away. A paramedic leaned into the open window and pulled the keys from the ignition to stop me from trying to flee.

That incident inspired me to get a CGM, and ever since, I’ve not been behind the wheel without knowing where my blood sugars stand.

In addition, that motivated me to start displaying a decal on my front windshield, rear window, and driver’s side window. For years, I also carried a medical alert on my keychain, along with a plastic case for 4 glucose tablets.

As a white man who has never been profiled or targeted, I didn’t have any concerns with displaying a medical alert on my vehicle. But I recognize my privilege — especially now, in 2021.

Of late, my newest vehicle (and keys) haven’t had any diabetes alerts displayed for two reasons: I’ve been working from home full-time since 2012 and therefore don’t drive often, and as mentioned, I now wear a CGM and automated insulin delivery device that keeps my glucose levels in range more than 60 percent of the time. Those two points lead me to be less immediately concerned about diabetes driving emergencies.

Clearly the choice whether to use a car decal is a personal one. I would just remind my fellow T1Ds that driving is a privilege, and please take precautions to stay safe — with or without a car sticker.

There are many different ways to display diabetes on your vehicle. Some are decorative, some less so. Some resources are: