Driving safely is something we all believe in. If you have diabetes and wish to drive, it is important to be aware of the legal requirements – especially if driving is part of your profession.
Irish and EU legislation requires that a driver should advise their driver licensing authority of any long-term or permanent injury or illness that may affect their safe driving ability.
People with diabetes are currently subject to a great variety of licensing requirements and restrictions.
These licensing decisions occur at several points and involve different levels and types of review, depending on the country and type of driving.
Some countries and local jurisdictions impose no special requirements for people with diabetes.
Other countries and jurisdictions ask drivers with diabetes various questions about their condition, including their management regimen and whether they have experienced any diabetes-related problems that could affect their ability to safely operate a motor vehicle.
In some instances, answers to these questions result in restrictions being placed on a person’s license, including restrictions on the type of vehicle they may operate and/or where they may operate that vehicle.
The Official Highway Code
In addition, the rules for operating a commercial motor vehicle, and for obtaining related license endorsements (such as rules restricting operation of a school bus or transport of passengers or hazardous materials) are quite different and in many ways more cumbersome for people with diabetes, especially those who use insulin.
Countries identify drivers with diabetes in a number of ways.
Drivers are either asked directly if they have diabetes or are otherwise required to self-identify if they have diabetes.
In other countries drivers are asked some variation of a question about whether they have a condition that is likely to cause altered perception or loss of consciousness while driving.
In most countries, when the answer to either question is yes, the driver is required to submit to a medical evaluation before he or she will be issued a license.
Driving And Hypoglycaemia
The licensing agencies are trying to ensure you are safe on the road. They will be concerned if you are unable to recognise or self-treat your hypos.
Drivers whose medical conditions can lead to significantly impaired consciousness are evaluated for their fitness to continue to drive.
For people with diabetes, this typically occurs when a person has experienced hypoglycemia behind the wheel.
Hypoglycaemia (also known as a hypo) is the medical term for a low blood glucose (sugar) level.
Severe hypoglycaemia means that the assistance of another person is required. The risk of hypoglycaemia is the main danger to safe driving and this risk increases the longer you are on medications that increase your risk of hypoglycaemia . This may endanger your own life as well as that of other road users.
Accidents caused by hypoglycaemia are because drivers carry on driving even though they get warning symptoms of hypoglycaemia occurring. If you get warning symptoms of hypoglycaemia whilst driving, you must always stop as soon as safely possible – do not ignore the warning symptoms.
Early Symptoms of Hypoglycaemia include:
Sweating, shakiness or trembling, feeling hungry, fast pulse or palpitations, anxiety, tingling lips. If you do not treat this it may result in more severe symptoms such as:
Slurred speech, difficulty concentrating, confusion, disorderly or irrational behaviour, which may be mistaken for drunkenness. If left untreated this may lead to loss of consciousness.
Drivers at risk of hypoglycaemia are advised to take the following precautions:
1. You must always carry your glucose meter and blood glucose strips with you. You must check your blood glucose before the first journey and every two hours whilst you are driving.
2. In each case if your blood glucose is 5.0mmol/l or less, take a snack. If it is less than 4.0mmol/l or you feel hypoglycaemic, do not drive and take appropriate action to correct glucose level.
3. If hypoglycaemia develops while driving, stop the vehicle as soon as possible.
4.You must switch off the engine, remove the keys from the ignition and move from the driver’s seat.
5. You must not start driving until 45 minutes after blood glucose has returned to normal. It takes up to 45 minutes for the brain to recover fully.
6. Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets, lucozade or sweets within easy reach in the vehicle.
7.You should carry personal identification to show that you have diabetes in case of injury in a road traffic accident.
8.Particular care should be taken during changes of insulin regimens, changes of lifestyle, exercise, travel and pregnancy.
9.You must take regular meals, snacks and rest periods on long journeys. Always avoid alcohol.
Each time a person with diabetes at risk of hypoglycaemia wishes to renew their driving licence, they must present a completed medical form stating their fitness to drive.
The duration of the medical certification of fitness to drive will determine the duration of licence you can apply for i.e. generally the licence for diabetics will only be issued for one,two or three years duration in countries such as UK and Ireland but if your doctor certifies you fit to drive for longer i.e. more than three years, apply for the longer time.
You must also inform your National Driver Licence Service when renewing your licence:
1.If you have suffered more than one episode of severe hypoglycaemia within the last 12 months. You must also report if you or your medical team feel you are at high risk of developing severe hypoglycaemia.
2. You have developed an impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood sugar).
3. You suffer severe hypoglycaemia while driving.
4. You don’t meet the vision standards set out in your National Driver Licence Service Guidelines.
5. You develop any problems with the circulation or sensation in your legs or feet which make it necessary for you to drive certain types of vehicles only, for example automatic vehicles or vehicles with a hand-operated accelerator or brake. This must be shown on your driving licence.
6.An existing medical condition gets worse or you develop any other condition that may affect your driving safely.
7. If your doctor, specialist or optician tells you to report your condition to the National Driver Licence Service.
For people seeking a HGV licence ( drivers for bus/lorry) all of the above apply but in addition any episode of severe hypoglycaemia must be reported immediately.
Renewing your licence for a HGV licence – Trucks, buses and trailer vehicles
If you are at risk of hypoglycaemia, you are required to present a completed medical form stating your fitness to drive.
The duration of the license is usually one year and is dependent on having appropriate understanding and awareness of hypoglyceamia, no episodes of “severe” hypoglyceamia, and you must demonstrate regular monitoring (at least twice daily and regularly at times relevant to driving) using a meter with memory capacity.
For your medical review, you must have three month’s blood glucose readings. Qualifying Conditions which also must be met include:
1.No episode of hypoglycaemia requiring the assistance of another person has occurred in the preceding 12 months.
2. Must have appropriate awareness of hypoglycaemia at appropriate glucose level.
3.Must demonstrate an understanding of the risks of hypoglycaemia.
4.Will not be able to apply until your condition has been stable for a period of at least one month.
5. Must regularly monitor your condition by checking blood glucose levels at least twice daily and at times relevant to driving. A glucose meter with a memory function to measure and record blood glucose levels must be used.
6.At the annual examination by a consultant endocrinologist, 3 months of blood glucose readings must be available.
7. Must have no other condition which would render you a danger when driving HGV vehicles.
8.You will be required to comply with the directions of doctors(s) treating your diabetes and to report immediately to the Licensing service any significant change in your condition.
In the interests of road safety, you must be sure that you can safely control a vehicle at all times.
Some countries specify that doctors may voluntarily report those patients who pose an imminent threat to public safety because they are driving against medical advice.
Doctors and others required to make reports to the licensing authority are usually provided with immunity from civil and criminal actions resulting from the report.
When licensing authorities learn that a driver has experienced an episode of hypoglycemia that potentially affected the ability to drive, that driver is referred for a medical evaluation and in many cases will lose driving privileges for a period of time until cleared by the licensing authority.
This period can range from 3 to 6 months or longer. Some laws allow for waivers of the rules when the episode is a one-time event not likely to recur, for example because of a change in medication .
Medical evaluation procedures vary in countries and range from a simple confirmation of the person’s diabetes from a doctor to a more elaborate process involving a state medical advisory board, hearings, and presentation and assessment of medical evidence.
Some countries have medical advisory boards with nurses and doctors of different specialties who review and make recommendations concerning the licensing of people with diabetes and other medical conditions.
In other countries, licensing decisions are made by administrative staff with little or no medical training and with little or no review by a medical review board.
What About Insurance?
When you apply for insurance, you will need to tell your insurance company that you have diabetes.
However, you should not be penalised with a higher insurance premium because of your condition. All members of the Insurance Federation have now agreed that they will not load their premiums for people with diabetes.
Remember that failure to disclose any change in your health could invalidate your cover.
Under the Disability Discrimination Act, you should not be refused car insurance purely on the basis of your diabetes.
People with diabetes should be assessed individually, taking into account each individual’s medical history as well as the potential related risks associated with driving.
For more information on DRIVING AND TYPE 1 DIABETES IN IRELAND refer to Diabetes Ireland website.
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