Diabetes Mellitus effects the evaluation for DWI in a variety of ways: It is very difficult to evaluate a diabetic for DWI because many of the indicia of intoxication are common to diabetes mellitus, and complications that arise from diabetes.
- Normal metabolism and blood sugar levels are affected by the disease. Normal metabolism and blood sugar levels are also affected by oral and parenteral hypoglycemic agents. This can affect demeanor, it can result in behavior that ranges from excitability and seizure to frank coma. The mental changes impact upon the ability to provide a truly knowledgeable and voluntary consent.
- Diabetes may result in the metabolism of fat which produces ketones. Ketones also can impart an odor to the breath, which may be mistaken for alcohol. In addition, Ketones can cause drowsiness.
- Low blood sugar or hypoglycemia, in Type I Diabetes can produce diabetic ketoacidosis. The ketones in diabetic acidoses are a form of acetone. “Acetone may be converted to isopropanol in physiological conditions…;” (Detection of Isopropanol In Acetonemic Patients Not Exposed to Isopropanol by David N. Bily, MD of the Division of Laboratory Medicine. Department of Pathology, University of California Medical Center, Sand Diego, California, according to the Article published in Clinical Toxicology, 28(4).459-466, (1990). The journal Clinical Toxicology is a peer reviewed journal. Additional publications in peer reviewed journals support these findings. For example. “… The detection of isopropyl alcohol may not represent an acute ingestion but, rather, a byproduct of acetone metabolism in certain disease states…” which appeared in Detection of Isopropyl Alcohol In A Patient With Diabetic Ketoacidosis by Alan E. Jones and Richard L. Summers, MD in the Journal of Emergency Medicine. Vol.19, No. 2 pps. 165-168, 2000, support these findings. The Journal of Emergency Medicine is also a peer review journal.
- Ketone bodies include acetone, acetoacetate and Beta-hydroxybutyrate “…Under certain circumstances acetone is reduced in the body to isopropanol by hepatic alcohol dehydrogenase (ADH) “A.W. Jones and S. Rossner False-positive breath – alcohol test after a ketogenic diet, International Journal of Obesity (2007) 31, 559-561. Isopropanol is an alcohol that can be detected by evidentiary breath testing equipment.
- Complications of diabetes include gastroparesis. This is a disorder of stomach motility such that there is a delay in gastric emptying. This would result in a prolonged presence of alcohol in the stomach which would affect absorption as well as reflux.
- Complications of diabetes include neurologic damage that can adversely impact upon an individual’s performance on psychophysical tests.
- The high sugar content and microvascular disease commonly leads to infections. These infections are more frequent and of longer duration. Infections typically affect the lower extremities. These infections can impair one’s use of their lower extremities which significantly affects field sobriety tests.
The usual indicia of intoxication are totally unreliable in people with this condition. Consent or refusal are also of dubious reliability.
{Observations /Psychophysical tests and Breath test}