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Diabetes and Driving

Low Blood Glucose Symptoms may include:

trembling
confusion
sweating
difficulty concentrating
hunger
tiredness or drowsiness
anxiety
vision changes
nausea
dizziness
heart palpitations
weakness
tingling
headache

You have just learned that you have diabetes. As long as you can keep it under control, it may seem that diabetes is your own business. However, once you choose to get behind the wheel, your condition has the potential to affect others.

Is it necessary to tell anyone about the diagnosis? Traffic safety laws require you to notify the registrar of your provincial motor vehicle licensing authority about any disease that could interfere with you driving safely. Diabetes is one condition that must be reported.

Licensing authorities can request a medical assessment of any licensed driver’s fitness to drive. If safety is a concern, licenses can be issued with conditions, suspended or denied.

The Canadian Diabetes Association (CDA) believes everyone with diabetes has a right to be individually assessed for a license to drive. Check out www.diabetes.ca for more information on diabetes and driving.

Maintaining your driver’s license

To keep your driver’s license, you must meet certain requirements. You must properly manage your diabetes and make sure your blood glucose (sugar) levels are high enough to safely operate your vehicle. Poor blood glucose control can affect your judgement while driving. If you cannot recognize and treat early warning signs of low blood glucose, or prevent low blood glucose from occurring, you risk your own safety and the safety of others.

Poor management of diabetes increases your chance of developing complications affecting your eyes, blood vessels, heart, kidneys and nerves. These complications can also interfere with your ability to drive safely.
Your doctor also has responsibilities in regard to your diabetes. You must be taught to prevent situations that can affect your ability to drive safely, and how to recognize a severe low blood glucose reaction. Your doctor must also monitor your condition, and in most provinces and territories, report it if you become unfit to drive.

Commercial Drivers

Those who use insulin to treat their diabetes can only be considered for a class 1, 2, 3, or 4 commercial license if they meet the following conditions:

No episodes of low blood glucose requiring others to help treat it in the last two years.
The ability to identify the symptoms of a low blood glucose reaction
Well controlled diabetes, with an A1C less than twice the upper limit of normal, and less than 10 per cent of blood glucose levels under 4 mmol/L.
Adequate blood glucose testing, along with an up-to-date logbook that can be verified.
An understanding of how to care for diabetes, as well as the causes, symptoms, and treatment of low blood glucose.
No other medical problems affecting the ability to drive safely.
An annual medical review, including an eye (ophthalmologic) exam.

Commercial drivers treated with insulin must keep a blood glucose meter and a source of fast-acting sugar within reach in their vehicle, as well as keeping equipment they use to deliver insulin with them at all times.

Blood glucose must be tested within an hour of starting to drive, and every four hours while driving. As with standard drivers, commercial drivers must stop the vehicle if their blood glucose falls below 6 mmol/L. They should eat, and not drive again until blood glucose measures above 6 mmol/L. Their family doctor must approve the work schedule, and consider it to be compatible with insulin treatment.
Criteria for initial application and annual recertification of a commercial license must be met. Other criteria can exclude a driver from maintaining the license.

In the United States, those who require insulin are not allowed to drive commercially.

Type of diabetes treatment and driving

The way your diabetes is treated can affect the type of license you are allowed to carry.

Treatment with diet: Those whose diabetes is well controlled by diet alone can hold any class of license. They must not have any other medical problems that could affect their ability to drive safely.

Treatment with oral medications: Those whose diabetes is well controlled with medications taken by mouth can also hold any class of license. Again, there must be no other medical problems that could affect driving ability. They also must not be at risk of having low blood glucose reactions while driving.

Treatment with insulin: Those whose diabetes is well controlled with insulin can hold a class 5 license (private license). They may be eligible for a class 1, 2, 3, or 4 license (commercial licenses) if they meet specific conditions. They must not have any other medical problems that affect their ability to drive safely. They also must not be at risk of having low blood glucose reactions while driving.

Symptoms of low blood glucose

Low blood glucose is a major concern if you have diabetes and drive. Knowing more about low blood glucose can help keep you safe behind the wheel. Low blood glucose is a reading of less than 4 mmol/L on a blood glucose meter. Signs and symptoms can vary greatly from person to person. You must be able to recognize the symptoms you have when your blood glucose gets low. (See sidebar for a list of symptoms.) If you cannot recognize your own warning signs of low blood glucose, your blood glucose could drop so low that you pass out while driving.

How can I continue to drive safely?

Learn all you can about diabetes. If you have not been to a diabetes education class lately, go for an update. The way diabetes is managed changes as new research findings become available.

Test your blood glucose regularly at different times of the day. Readings taken immediately before you eat, two hours after you begin eating, and before your bedtime snack can tell you how well your blood glucose is being managed. Know what your glucose level should be at these times.

Know how your diabetes medications work. Balance your food, medications, and activity to keep blood glucose in your target range.

Medications and risk for low blood glucose

Certain types of medication give you a higher chance of experiencing low blood glucose. Both insulin and oral medications that cause the pancreas to release insulin can put you at risk of low blood glucose. Such medications include:

glyburide (Diabeta™)
gliclazide (Diamicron™, Diamicron™ MR)
glimepiride (Amaryl™)
repaglinide (Gluconorm™)
nateglinide (Starlix™)

Some heart pills, called beta blockers, may hide the symptoms of low blood glucose. Talk to your doctor and pharmacist to find out if any of your medications put you at risk of having a low blood glucose reaction.

Certain situations also increase your risk of having a low blood glucose reaction. They include:

not eating regularly
skipping meals
eating meals later than usual
eating less at a meal than you usually eat
doing more activity than you normally would
drinking alcohol on an empty stomach
having certain gastrointestinal (digestive system) problems
having liver or kidney function problems
having a history of severe low blood glucose reactions.

Always carry your blood glucose meter. An accurate meter reading is your best indication of a blood glucose problem. Keep a logbook of your readings. A lab/meter comparison should be done each year.

Make sure you always have a treatment for low blood glucose and a snack on hand if you take medication to manage your diabetes. You may be stuck in traffic or delayed on your way home. Prepare for the unexpected!
If you suspect your blood glucose is low, pull over and test. Do not drive if your blood glucose is less than 4 mmol/L. If your blood glucose measures between 4 and 5 mmol/L, do not drive without eating extra food. Commercial drivers should have a blood glucose level greater than 6 mmol/L.

If your blood glucose is less than 4 mmol/L, treat it with 15 grams (about 1 tbsp) of fast-acting carbohydrate, probably in the form of glucose or sucrose tablets. Wait 15 minutes, then retest. If it is still below 4 mmol/L, treat again. If it is greater than 4 mmol/L, you can have some carbohydrate and protein. Do not resume driving for 45 to 60 minutes after treating a low blood glucose reaction. Ask your doctor or diabetes education team for more information on managing hypoglycemia.

Measure your blood glucose level immediately before driving, and at least every four hours while driving (more often if needed).

Certain factors give you a higher chance of having a severe low blood glucose reaction while driving. They include experiencing a severe low blood glucose reaction within the last year, having difficulty recognizing such reactions, or having a marked drop in A1C or an A1C within the normal range (A1C is a test that measures blood glucose control over the last two to three months.). Your family doctor can help by ordering recommended testing for your diabetes and screening for complications.

Managing your diabetes well and making certain your blood glucose levels are within target range helps keep you healthy. By making sure that you have your diabetes well under control before driving, you help to keep everyone on the road safe.

FAMILY HEALTH is written
with the assistance of

While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6 [MDa06]

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