You asked and we answered! We also asked and you answered — with lots more great questions for our new diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil takes on the DMV and diabetes, and what to do when your insurance isn't cooperating.

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Rose from Florida, type 1, writes: I am 15 going to be 16 this summer. I said something to my mom about Driver's Ed, and she said I need a note from my doctor saying that my BG is good.  I told her I don't know about this, but I don't want to wait till my next endo appointment and have to ask for a note. How does it work with diabetes and Driver's Ed?

Wil@Ask D'Mine answers: Every state in the Union is different when it comes to driver's licenses and PWDs. My state is one of the worst. If you are a person with diabetes in New Mexico, you must get a medical exam and have your doc sign off on you every frickin' year! Even if you are a type 2, well controlled with diet and exercise, you can only officially have your license for one year. (I say 'officially' because some extra paperwork on your doc's part can sometimes buy you more time.)

This is why PWDs in New Mexico suffer from unusually high rates of selective retinopathy. What? Really? There was a question on that form about diabetes? That's funny, I didn't see it....

But that's a separate issue than taking a driver's education class. Looking into it, I couldn't find much in the way of restrictions of any kind on Florida drivers with diabetes. Your state does have at least two forms that your doc can use to rat you out if you are a "clear and present danger" to everyone else on the highway. One is for "uncontrollable diabetes" and the other for "uncontrolled" diabetes (So the state imagines it's sometimes out of our hands? ... Personally I'd rather be consider "uncontrollable" than "uncontrolled," but that's just me.) In both cases the forms, and the laws that created them, shield the doc from liability in reporting you, but don't seem to require him or her to do so.

For teenage student drivers, Florida uses the Graduated Drivers Licensing system that grants young people incremental increases in their driving privileges as they gain experience.

At your age you can apply for the first step, which is a Learner's License. To do that you must first to complete a Traffic Law and Substance Abuse Course (taught by a private contractor licensed by your state), pass a multiple-choice written test about traffic laws and road sign recognition at DMV, and pass a vision and hearing test, both also at the DMV office. I couldn't find anything requiring teens with diabetes to have their docs sign off on their blood sugars, but I did see that if you are under 18 and get busted with tobacco products in your possession they'll revoke your license for up to a year. Harsh.

You can also get your license pulled for truancy. So stay in school and don't smoke if you want to drive in Florida!

But, a final requirement for a Learner's License in Florida is that mom or dad has to sign off on you via  a Parental Consent Form. That means no matter what the law is, no matter what the facts are, the buck stops with your mom. So it could be that she is miss-informed, or it could be that she's trying to use the ol' carrot and stick with the driver's license to motivate you to get your blood sugar to where she thinks it should be. Or.... as the first round of driver's training is handled by private contractors, I was thinking those folks  often have separate liability requirements beyond what states law requires.

Turns out that driver's license training is quite the industry in your state, with both big and small players making money (fully half the "certified" companies don't even publish an email address). So to get to the bottom of this, I emailed every one of them who had an email address and asked them if their companies had any special requirements for teen PWDs.

A typical answer was the one I received from Ilene Lieber, a communication specialist for the Florida Virtual School who told me that her school does not have any restrictions on diabetics. She seemed mystified that anyone would even ask why diabetes would be an issue for taking a class online. She went on to say, "Similarly, this is also not a policy of the Florida Safety Council in order for students to take their behind-the-wheel course."

At the other end of the spectrum, kid you not, a rep from an outfit called Lowest-Price-Traffic-School stated she was "unable to answer the question" about her company's policies. Huh. Well, I guess you get what you pay for.

Several of the schools said they had no restrictions and were pretty sure the state didn't either, and referred me to the state web sites I'd already studied. However, one was also nice enough to supply me with the email address for Sandra C. Lambert, who is the Director of the Division of Driver Licenses for the state of Florida. Ms. Lambert confirmed diabetes "is not an issue for us" unless the driver is having black-outs. One interesting tidbit she added is that her offices "do ask the question, 'Are you insulin dependent?' We ask this to determine if they want this on the face of their license." Apparently this is just an optional form of medic alert from Florida's perspective.

Which got me thinking, medic alerts are extraordinarily important--but I'm not sure they belong on government-issued ID cards like driver's licenses.  What do you readers think? Is having your diabetes stamped on your driver's license a good of medic alert, or is it like having a yellow Star of David sewed onto your clothing?


Jim from Michigan, type 3, writes: Our insurance seems to be pushing back on covering blood ketone strips.  This is the first time we are getting a prescription for them and I think we need to have them around. Any idea what to do if the insurance makes a fuss?

Wil@Ask D'Mine answers: Jim, you are right: you do need to have blood ketone strips around. Urine ketone strips may be cheaper, but peeing on a stick provides "old info," rather than your real-right-now-in-the-moment DKA risk shown by blood ketone testing. But of course, the blood ketone strips are not cheap at something like eight-bucks-a-strip. That's why your insurance doesn't want to pay for them.

So what to do when the insurance company makes a fuss? Make a fuss back. The bigger the fuss, the better. It sucks, but the squeaky wheel gets the grease. So fight. Fight loud. Fight dirty, if you need to. And don't be afraid to break out the nuclear weapons right at the start of the conflict. Take no quarter. Threaten to write to your state's public regulatory commission, then make good on your threat.

Appeal, re-appeal, then appeal again (in the meantime just buy a box of the damn strips out-of-pocket, because you do need them and this fight won't be won quickly). And don't be afraid to look for allies in your fight. Get in touch with your local ADA and JDRF chapters. Ask for letters of support from docs, pharmacists, and diabetes educators.

Start a petition.

Write to your state reps and state senators. Call the press. Light bonfires on the streets. Sharpen the pitchforks, and never let up. Until you win.

Or until the cure.

{Editor's note: we can help you lobby here. Keep us informed on your campaign efforts!}

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.