An inquest is looking into the fatal 2023 crash in the regional Victorian town of Daylesford, when William Swale, 69, suffered a severe hypoglycaemic episode and drove into people sitting outside the Royal Daylesford Hotel.
Pratibha Sharma, 44, her nine-year-old daughter Anvi and partner Jatin Kumar, 30, their friend Vivek Bhatia, 38, and his son Vihaan, 11, were killed on November 5, 2023.
Mr Swale had left a shooting event in Clunes about 4pm when he checked his glucose monitoring device which recorded 7.2mmol/L.
That level dropped significantly by 5.17pm to the point he was becoming severely hypoglycaemic, so he stopped in Daylesford to get food but was turned away from a cafe because they were busy.
He then made "very stupid decisions" in not trying to source food, describing how his brain shut down because of hypoglycaemia moments before the crash.
The decision to administer insulin without eating was described by endocrinologist John Carter as "the most egregious conduct" that caused the fatal collision.Â
Coroner Dimitra Dubrow on Thursday heard from a panel of experts on measures that could help prevent similar incidents from happening.
Endocrinologist Sybil McAuley suggested investigating automated insulin delivery systems that can change the level of insulin based on user activity.
"If a person using the system is going to be more insulin-sensitive with exercise and more at risk of hypoglycaemia, the target glucose level can be changed with the press of the button," she said.
She pointed to a potential "driving mode" or even a "wish list" measure of utilising a vehicle's ignition integrated with a user's glucose monitoring device.
The experts all agreed health professionals' obligations to provide diabetic patients with crucial information should be more clearly articulated.
While many doctors filling out fitness-to-drive forms to satisfy their obligations of assessing hypoglycaemia and diabetes risks, the same could not be said for advising the patient on safe driving practices, endocrinologist Richard O'Brien said.
Associate Professor McAuley said some doctors struggled to balance their therapeutic relationships with long-time diabetic patients wanting to drive.
"If the rules aren't clear enough, they see it as a negotiation," she said.
There was also "misalignment" in safe driving assessment recommendations between the National Transport Commission and the National Diabetes Services Scheme, said David Simmons, chief medical officer of Diabetes Australia.
"We need to make sure that there is only one source of knowledge," he said.
Professor Carter suggested looking at short and simple messages similar to cigarette plain packaging to get the message across about the dangers of hypoglycaemia when driving.
"It's intentionally confronting, and it's 100 per cent true, and hopefully that would reduce the chances of events like we're discussing this week to occur," he said.
The inquest continues.
