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DVLA updated guide to insulin-treated diabetes and driving

The DVLA has updated the guidance on glucose testing prior to driving. This now permits the use of interstitial glucose readings eg using Flash Glucose Scanning (FreeStyle Libre) and Continuous Glucose Monitoring (CGM) systems for Group 1 drivers only. However, finger-prick tests are still required (even for Group 1 drivers) under certain circumstances.

Some things remain the same….

• Drivers who have any form of diabetes treated with any insulin must inform the DVLA
• If you get any warnings symptoms of a hypo, you must stop safely as soon as possible – do not ignore the warnings.
• Group 1 and Group 2 drivers must tell the DVLA if (i) they have a severe hypo while driving (ii) if you or your healthcare team think you are at high risk of developing hypoglycaemia or (iii) if an existing medical condition gets worse or you develop any other condition that may affect your driving ability.
• Group 2 drivers must stop driving and tell the DVLA if they have a single episode of hypoglycaemia requiring the assistance of another, even if this is during sleep. The DVLA must also be told if there I any degree of impaired awareness of hypos, that is loss or reduced hypo warnings.

What has changed?

The more widespread use of Flash Glucose Scanning (FreeStyle Libre) and Continuous Glucose Monitoring (CGM) has resulted in this advice from the DVLA which includes precautions that drivers taking insulin should follow and these include the following.

• You should ALWAYS carry your glucose meter and test strips with you even if you use the FreeStyle Libre or CGM system.
• You should check your glucose less than 2 hours before starting the first journey and every 2 hours after driving started.
• A maximum of 2 hours should pass between the pre-driving glucose check and the first glucose check after driving has started.
• More frequent testing may be needed if the is a greater risk of hypoglycaemia e.g. after physical activity or an altered meal routine.
• In each case, if your glucose is 5.0mmol/L or less, eat a snack and if it is 4.0mmols/L or you feel hypo, do not drive.
• Always keep an emergency supply of fast-acting carbohydrate within easy reach and carry ID to show that you have diabetes. Take extra care during any changes in regime, lifestyle, exercise, travel and pregnancy.
• You must eat regular meals and snacks.

Advice on hypoglycaemia relevant to driving – here are some changes

• If your glucose is 5.0mmol/L or less, eat a snack and if it is 4.0mmols/L or you feel hypo, do not drive.
• If a hypo develops while driving, stop safely as soon as possible. Turn off the engine, remove the keys and move from the driver’s seat.
• You should not start driving until 45 minutes after a finger prick test shows back to normal of at least 5.0mmol/L as it takes the brain 45 minutes to recover.
• If you use the FreeStyle Libre or CGM system and the reading is 4.0mmol/L or below you must stop driving and confirm your reading with a finger prick test.
• Your finger prick test must be at least 5.0mmol/L before returning to driving.

Appropriate glucose monitoring systems

• Group 1 drivers may now use finger prick glucose testing and continuous glucose monitoring systems for driving.
• Group 2 drivers MUST continue to use finger prick testing for driving. CGM and FreeStyle Libre are NOT legally permitted for Group 2 driving.
• As there are times when users of the FreeStyle Libre and CGMs are required to finger prick test, ALL users must also have finger prick glucose monitors and test strips available when driving.

Some things worth remembering

• If you are driving, the FreeStyle Libre is not a hands-free device so you will be liable to prosecution if you use it while driving.
• Modern meters of all types keep records of when finger prick tests are carried out, so the police can check if people follow, or do not follow, the DVLA advice.

The DVLA information can be found at the following link:
inf294-a-guide-to-insulin-treated-diabetes-and-driving.pdf (publishing.service.gov.uk)