Medical Assessment Forms
Driving and Diabetes
Driving and the EU law
Driving and hypoglycaemia – what are doctors being advised to do?
Driving Regulations in the UK
Insulin and Driving Taxis
Hypoglycaemia and Driving
Driving warnings in Insulin Products
Driving and Medicines
Driving and Visual Field Loss
Medical assessment forms
People with diabetes often have to ask their doctor to fill in forms to independently assess their health and more specifically, their diabetes. The most common form is for driving licence renewal but there are others ones that occur from time to time – for suitability for employment, for insurance policies and for mortgage applications.
in Diabetes Update [Summer 2000], Diabetes UK advised doctors and health professionals about the sort of information that he/she needs to fill in about their patients with diabetes. Perhaps we, as the patients, would also benefit from knowing the sort of information that is going to be provided about us once we have given written consent for this information to be passed on. So here are some of the points that doctors are being advised to make:
- Type of diabetes, duration and treatment [insulin, tablets, diet only].
- HbA1c results past and present.
- Any episodes of ketoacidosis [very high blood sugars] or severe hyperglycaemia.
- Hypos are a major concern for driving and for some employers.
- Weight, vision [with glasses if worn], blood pressure, lipids and smoking habit.
- Presence of diabetic complications – retinopathy, neuropathy and nephropathy.
- The patient’s involvement in their own care eg their clinic attendance record, knowledge about diabetes etc.
- The impact of diabetes on the ability to work or drive.
Decisions about the suitability for employment are made on two key points regardless of your diabetes and these are:
- Are you fit to carry out the required tasks within the acceptable risks of the job?
- Will the job itself adversely affect your health?
If you are treated with insulin and work in potentially hazardous occupations, you should realise that in assessing you for suitability for employment the doctor will be looking to see that:
- You are physically and mentally fit, to non-diabetic standards.
- Your diabetes is stable.
- You have no disabling hypos and no loss of awareness of hypos
- You have no advanced complications, no significant coronary heart disease or any other vascular disease.
As we all know hypoglycaemia affects cognitive function and co-ordination and therefore is important for both work and driving. The DVLA requires specific information about hypoglycaemia and so your doctor will want to know from you and from your records, the following information:
- Have you recently had any severe hypos?
- If so, how many have there been in the last 12 months and the last 3 months and have they occurred during the day or the night?
The fact sheet in Diabetes Update goes on to point out that while severe hypos can occur in anyone with insulin treated diabetes, recurrent severe hypos suggest that there is impaired hypo warnings and that this is a major driving hazard. For this purpose the article defines severe hypoglycaemia as a hypo which requires the help of someone else regardless of whether or not the person with diabetes is conscious or unconscious. It goes on to point out that:
It is inappropriate for people with recent severe hypoglycaemia to drive, to work in dangerous environments or to undertake hazardous tasks and that there should be an interval of perhaps 6 months without a severe hypo.
Loss of hypo warnings
If you have loss of hypo warnings, you should not drive or work in a dangerous situation, because not only could this be dangerous for you but it could also harm others. IDDT has always said that people who have lost or partially lost their warnings do not necessarily know that they have. So what are the signs that loss of hypo warnings may have occurred?
- Frequent severe hypos reduce warnings and even one mild hypo is enough to reduce them.
- If your hypo warnings are sweating, shaking trembling, then you are likely to have sufficient warnings, but if your warnings are confusion, slurred speech and difficulty walking or functioning in other ways, then you are likely to have impaired hypo warnings.
- If your spouse or partner recognises that you are hypo before you do.
- Regular blood glucose levels below 3mmols/l without symptoms.
- A ‘good’ HbA1c result ie within the normal range could mean that there have been hypos that haven’t been recognised – unawareness.
We have to remember that when a doctor signs forms on our behalf he/she is taking responsibility for saying we are able to carry out the employment tasks or drive a vehicle safely. It is right and proper therefore that all these questions have to be addressed by the doctor and that he/she is not just making life difficult for us!