driving and diabetes

Last edited 06/2019

Impaired awareness of hypoglycaemia

Impaired awareness of hypoglycaemia for Group 1 drivers is defined as 'an inability to detect the onset of hypoglycaemia because of total absence of warning symptoms'

Group 2 drivers must have full awareness of hypoglycaemia.

Severe hypoglycaemia

The law defines 'severe' as an episode of hypoglycaemia requiring the assistance of another person.

Group 1 drivers - episodes of hypoglycaemia occurring during established sleep are no longer considered relevant for licensing purposes unless there are concerns regarding their hypoglycaemia awareness.

Group 2 drivers - must report all episodes of severe hypoglycaemia requiring the assistance of another person.

Interstitial glucose monitoring systems

These devices are more widely known as flash glucose monitoring systems (FGM) and real-time continuous glucose monitoring systems (RT-CGM).

Group 1

These systems may be used for monitoring glucose at times relevant to driving Group 1 vehicles. Users of these systems must carry finger prick capillary glucose testing equipment for driving purposes as there are times when a confirmatory finger prick blood glucose level is required

If using an interstitial fluid continuous glucose monitoring system (FGM or RT-CGM), the blood glucose level must be confirmed with a finger prick blood glucose reading in the following circumstances:

• when the glucose level is 4.0 mmol/L or below
• when symptoms of hypoglycaemia are being experienced
• when the glucose monitoring system gives a reading that is not consistent with the symptoms being experienced (eg symptoms of hypoglycaemia and the system reading does not indicate this)
• if diabetes managed by insulin
• drivers who have any form of diabetes treated with any insulin preparation must inform DVLA
• diabetic drivers are sent a detailed letter of explanation about driving and their licence by the DVLA
• see the menu item for more details on diabetic patients treated with insulin

Group 2

• There is a legal requirement for Group 2 drivers to monitor their blood glucose for the purpose of Group 2 driving. FGM and RT-CGM interstitial fluid glucose monitoring systems are not permitted for the purposes of Group 2 driving and licensing.
• Group 2 drivers who use these devices must continue to monitor finger prick capillary blood glucose levels with the regularity defined below

Insulin-treated diabetes

Group 1:

• Must meet the criteria to drive and must notify the DVLA. All the following criteria must be met for the DVLA to license the person with insulin-treated diabetes for 1, 2 or 3 years
  • adequate awareness of hypoglycaemia
  • no more than 1 episode of severe hypoglycaemia while awake in the preceding 12 months and the most recent episode occurred more than 3 months ago (see recurrent severe hypoglycaemia guidance below)
  • practises appropriate glucose monitoring as defined in the box below
  • not regarded as a likely risk to the public while driving
  • meets the visual standards for acuity and visual field
  • under regular review

Group 1 requirements for insulin-treated drivers licensed on review

• Group 1
  • glucose testing no more than 2 hours before the start of the first journey and
  • every 2 hours after driving has started
  • a maximum of 2 hours should pass between the pre-driving glucose test and the first glucose check performed after driving has started
  • applicants will be asked to sign an undertaking to comply with the directions of the healthcare professionals treating their diabetes and to report any significant change in their condition to the DVLA immediately.
  • More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine)

Temporary insulin treatment - including gestational diabetes or post-myocardial infarction

• Group 1
  • May drive and need not notify the DVLA, provided:
    • under medical supervision
    • not advised by clinician as at risk of disabling hypoglycaemia
  • May continue to drive but must notify the DVLA if:
    • disabling hypoglycaemia occurs
    • treatment continues for more than 3 months - or in gestational diabetes, continues for 3 months after delivery

Impaired awareness of hypoglycaemia - 'hypoglycaemia unawareness'

Group 1

• Must not drive and must notify the DVLA.
• Driving may resume after a clinical report by a GP or consultant diabetes specialist confirms that hypoglycaemia awareness has been regained.

Diabetes complications

Group 1

Visual complications - affecting visual acuity or visual field

• May need to stop driving and notify the DVLA
• Refer to guidance for visual disorders

Diabetes treated by medication other than insulin

• Managed by tablets carrying hypoglycaemia risk
  • Group 1
    • Including sulphonylureas and glinides
      • May drive and need not notify the DVLA, provided:
        • no more than 1 episode of severe hypoglycaemia while awake in the last 12 months and the most recent episode occurred more than 3 months ago
        • should practise appropriate glucose monitoring at times relevant to driving
        • under regular review
      • It is appropriate to offer self monitoring of blood glucose at times relevant to driving to enable the detection of hypoglycaemia
      • If the above requirements and those set out in INF188/2 are met, the DVLA need not be informed. The DVLA must be notified if clinical information indicates the agency may need to undertake medical enquiries
        
        
• Managed by other medication, including non-insulin injectables
  • Excluding sulphonylureas and glinides
    • Group 1

• May drive and need not notify the DVLA, provided the requirements set out in INF188/2 are met and the driver is under regular medical review.
• May drive but must notify the DVLA if clinical information indicates the agency may need to undertake medical enquiries

 

Diabetes managed by diet/lifestyle alone

• Group 1
  • May drive and need not notify the DVLA. Must not drive and must notify the DVLA if, for example
    • relevant disqualifying complications develop such as diabetic retinopathy affecting visual acuity or visual fields
    • insulin treatment is required

Note:

• ...by law, a driver treated by tablets, diet or both must inform the DVLA if any of the following applies (the appendix INF188/2 outlines when a driver should inform the DVLA with respect to hypoglycaemia)
  • if you suffer more than one episode of severe hypoglycaemia within the last 12 months. You must also tell us if you or your medical team feel you are at high risk of developing severe hypoglycaemia. For Group 2 drivers (bus/lorry), one episode of severe hypoglycaemia must be reported immediately
• you develop impaired awareness of hypoglycaemia. (Difficulty in recognising the warning symptoms of low blood sugar)
• you suffer severe hypoglycaemia while driving....
• needs treatment with insulin
• needs laser treatment to both eyes or in the remaining eye if you have sight in one eye only
• problems with vision in both eyes, or in the remaining eye if you have sight in one eye only. By law you must be able to read, with glasses or contact lenses if necessary, a car number plate in good light at 20.5 metres (67 feet) or 20 metres (65 feet) where narrower characters 50mm wide are displayed
• if a patient develops any problems with the circulation or sensation in his/her legs or feet which make it necessary for him/her to drive certain types of vehicles only, for example automatic vehicles or vehicle a hand operated accelerator or brake. This must be noted on his/her driving licence
• an existing medical condition which gets worse or the patient develop any other condition that may affect him/her driving safely (1).

• the following hypoglycaemia incidences should be informed to DVLA:  
  • if more than one episode of disabling hypoglycaemia (low blood sugar) within 12 months, or if at high risk of developing disabling hypoglycaemia
• if develop impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood sugar)
• if suffer disabling hypoglycaemia while driving
• an existing medical condition gets worse or develops any other condition that may affect driving safely

For the most up to date and comprehensive details, guidance may be obtained from the publication "At a Glance Guide to the Current Medical Standards of Fitness to Drive" and the website www.dvla.gov.uk.

Reference:

• (1) DVLA (March 2019). At a glance guide to the current medical standards of fitness to drive