Hypoglycaemia and Driving
Driving and Diabetes
Driving and the EU law
News release: EU changes night-time hypos driving rules for people with diabetes
Driving and hypoglycaemia – what are doctors being advised to do?
Test Strips – Department Of Health Warning For Doctors And Pharmacists
Vehicles You Can Drive
Insulin and Driving Taxis
Hypoglycaemia and Driving
Driving and Medicines
Driving and Visual Field Loss
Hypoglycaemia and driving
The concerns for people with diabetes driving are largely based on the possibility of hypos occurring whilst driving. The presence of hypo warnings and the ability to recognise them is very important if people with diabetes are to be safe drivers and this applies to driving any vehicle.
Tips for safe driving:
- Always drive with glucose or sweets to hand – not in the glove compartment.
- Carry out a blood glucose test before driving and test every 2 hours on long journeys.
- If you feel a hypo coming on, pull off the road, get out of the car or move into the back seat. (So that you are obviously seen not to be driving the car if the police should come along.)
- Treat the emergency hypo immediately, wait until blood glucose levels have risen and then drive on and stop for a proper meal.
- Remember that following a hypo your judgments may be impaired for an hour afterwards even though you feel OK and your blood glucose levels are back to ‘normal’.
- Consider raising the blood glucose levels a little while driving.
- Remember that diagnosis of diabetes treated with insulin or tablets that may cause hypoglycaemia means that you must inform both the DVLA and your motor insurers. This is a material change in your circumstances and failure to inform the DVLA could result in prosecution and your insurance being invalid.
Driving and loss of warnings of hypoglycaemia
Some years ago, IDDT received a letter from a lady whose husband was killed in a motor accident by a driver with diabetes who went hypo at the wheel. He was acquitted of dangerous driving because he had a hypo at the time. This emphasises the need to raise awareness of the need for blood glucose testing before driving.
But it really is not as simple as that, as we all know. Blood testing itself does not stop you going hypo, it tells you what your blood sugars are at that moment in time so that you can eat if necessary. Equally, many of us know that they can drop quite quickly, especially under a stressful situation – the M6 on a Friday afternoon! So it is essential to be vigilant all the time and to test before driving and at frequent intervals on a long journey. But the real problem when driving is loss of hypo warnings, reduced warnings or sometimes you have warnings and sometimes you don’t. Loss of hypo warnings or reduced warnings is dangerous and if this is the case, then driving should cease.
Driving and diabetes poses conflicts
A person with Type 1 diabetes writes:
"People with insulin dependent diabetes who want to keep their driving licences may feel that any disclosure to their GP or consultant about hypos could affect the renewal of their licence. There have been times in the past when I would very much have liked to discuss problems with hypos with my doctors but disclosure may have jeopardised my driving licence and so my livelihood. I am sure that most people with diabetes take sensible and appropriate precautions when driving. But being placed in this situation where discussions of hypos may lead to the doctor having to inform the DVLA of hypos, means that we are probably not receiving help and advice from them that we need to improve the situation. I can see the sense in both the DVLA questionnaire about hypos and the need for disclosure but we do seem to be in a vicious circle. If we have hypos and tell the truth, then we risk losing our driving licences but if we don’t seek the advice of our doctors on prevention of hypos, then nothing will change."
This highlights the very real conflicts that arise – the doctor is the person from whom we need help to try to resolve the problems with hypos but he/she is also the person that says ‘yes’ or ‘no’ to our driving licence renewal. Unless we resolve this conflict so that patients feel able to discuss with their doctors ways of trying to avoid hypos and/or regain their hypo warnings, then the risks of traffic accidents will continue.
"Good control is not just the avoidance of hyperglycaemia but also the avoidance of hypoglycaemia."
This statement was made by Professor Stephanie Amiel at IDDT’s annual meeting some years ago but it is one that perhaps we all need to remember, patients, doctors and healthcare professionals.
The achievement of ‘excellent’ HbA1cs may be at the expense of increased frequency of hypos which in turn, increases the risk of loss of warnings. We have to remember that the HbA1c test does not measure low blood sugars, only the highs, so a good result could mean that there are frequent undetected mild/moderate hypos.
Diabetes poses many conflicts and driving is certainly one of them:
- the conflict between ‘good’ control that reduces the risk of long-term complications but increases the risk of hypos and perhaps relaxing control a little to avoid hypos.
- the conflict of quality of life now against the unknown quality of life in the future if blood sugar levels are relaxed.
The effect of loss of driving licence should not be underestimated in terms of quality of life – it can affect self-esteem, jobs, income and pleasure and therefore the quality of life of the whole family.