Driving Safely with Diabetes: Protecting yourself and others on the road

Why hypoglycaemia is a concern

When glucose levels (GL) drop too low, the brain does not receive enough fuel to function properly. This can affect your ability to:

• concentrate and focus on the road
• act quickly in response to unexpected events
• identify road hazards and make appropriate decisions

This may mean that a person experiencing hypoglycaemia could miss traffic signals, fail to identify hazards, or have slower responses to hazards.

Having high glucose levels for long periods can also affect these abilities. However, the effects of a hypo are usually more immediate and dangerous while driving.

Before you start driving with diabetes

1. Visit your doctor for a driving fitness check:  Your GP or diabetes specialist can review your overall health and confirm that you are fit to drive. Please note the rules differ for driving a private vehicle and a commercial vehicle.
2. Inform the driver licensing authorities: It is your responsibility to inform the driver licensing authorities that you have diabetes.

1. • Most people using insulin will be required to provide a medical certificate to their state driving authority every two years.
   • If you take a tablet for your diabetes, you must provide a medical certificate to your state driving authority every five years.
   • If you manage your diabetes with diet and exercise alone, it is still important to inform your state driving authority. If you don’t, you can be charged with a range of driving offences if you have an accident behind the wheel.

3. Report to your motor vehicle insurer: Failure to inform your motor vehicle insurer about your diabetes may create problems with insurance claims.
4. Monitor your glucose level: Before driving, check that your glucose level is 5.0 mmol/L or more. If you have impaired awareness of hypoglycaemia your glucose level needs to be 6.0 mmol/L or more. More on this below.
5. Always carry your glucometer or wear your Continuous Glucose Monitor (CGM) sensor, pull over and check your glucose level at least every two hours on long trips.

• Even if you are wearing a CGM, it is necessary to pull over, turn off your car engine and then check your CGM as it is illegal to touch a reader while driving.

6. Know the signs of a hypo:

• If you are driving and feel shaky, sweaty, light-headed, unable to concentrate, or have a headache, pull over immediately.
• Turn off your engine and check your glucose level.
• If your GL is below 4.0 mmol/L treat the hypo by eating or drinking 15g of fast-acting carbohydrates
• Do not restart your car until you have rechecked your GL, they are above 5.0mmol/L and your symptoms have gone. This can take 30 to 45 minutes.

When you can’t feel a low glucose level

Some people with diabetes have impaired awareness of hypos. This means not always being able to feel when your blood glucose levels are low (below 4mmol/L). Impaired awareness of hypos happens more often in people who regularly have hypos and increases the risk of a severe hypo. A severe hypo can cause confusion, loss of consciousness or seizures, making it extremely dangerous to drive.

People with impaired awareness of hypos should be under the regular care of a diabetes specialist, such as an endocrinologist, who can assess their ability to drive safely. It is possible to regain your symptoms of hypos with support from your diabetes team.

If you are experiencing impaired awareness of hypos, and you have type 1 diabetes, there is opportunity to participate in a research study supporting people to regain their hypo symptoms through education and/or diabetes technology, see more details here.

Preventing hypoglycaemia while driving

Important safety tips include:

• Checking your glucose level before driving
• On long trips, checking your glucose level every two hours during rest breaks
• Not skipping or delaying meals and snacks
• Taking regular breaks during long journeys
• Always carrying hypo treatment in the car
• Always carrying a glucometer or wearing a CGM sensor:
  • If you use a CGM, turn on your alerts. Refer to the trend arrows to decide if you need to eat some carbohydrates to keep your glucose level above your driving target.

You should not drive if:

• Your glucose level is 5.0 mmol/L or below (or 6.0 mmol/L or below if you have impaired awareness of hypos)
• You’ve just started taking insulin and your glucose levels are not yet within your target range.
• You have numbness or weakness in your limbs.
• Your doctor advises that diabetes-related complications, such as poor vision, nerve damage, or heart problems, make it unsafe for you to drive.
• You feel unwell. This can affect your glucose levels.

Severe Hypoglycaemia and Driving

Severe hypoglycaemia is when a person cannot treat an episode of hypoglycaemia by themself and they need help from someone else.

If you had an episode of severe hypoglycaemia, you should not drive until you have been reviewed and cleared by a diabetes specialist. Severe hypoglycaemia is a serious risk not only to the driver but also to passengers, pedestrians, and other road users.

Other important factors to consider

• High glucose levels can also impair your ability to drive safely. Don’t drive if you feel unwell and your glucose level is above your target range. High glucose levels can make you feel tired or make your vision blurry. You may also find it difficult to concentrate and all these factors can impact your driving skills.
• Have regular check-ups with your health professional. This includes having your HbA1c checked every 3 to 6 months, and your feet and eyes checked at least once every 12 months. Some diabetes related complications affect your vision and damage nerves in your feet. This can lead to vision problems when driving, difficulty feeling the foot pedals and reduced reaction time to hazards. Having regular check-ups can help you to identify these problems early.

Planning for safe and confident driving

The key to safe driving with diabetes is managing your glucose levels, regular monitoring, and recognising warning signs of low and high glucose levels early. With these simple precautions, people with diabetes can protect themselves and others while enjoying safe and confident driving.

Read more on driving and diabetes here.