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VOLUME 10 NUMBER 1 • MARCH 2013
PATIENTS AS PARTNERS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
HYPOGLYCAEMIA AND DRIVING
The main concern is the consequences of hypoglycaemia on driving abil-
ity. Low blood glucose severely impairs cognitive function, affecting driv-
ing capability and road safety. The impact of diabetes on driving should
be discussed regularly with patients, perhaps as part of the annual review
process. Patients need to know that suffering a hypoglycaemic attack at
the wheel is not only extremely dangerous but the courts are unlikely to
be sympathetic if they are involved in an incident, and a custodial sen-
tence could well be the result. Patients have to take responsibility to keep
themselves and other road users safe, although healthcare professionals
also have a duty to make patients aware of the facts.
WHAT TO DO IF HYPOGLYCAEMIA OCCURS
Accidents occur when drivers ignore the warning signs of hypoglycaemia
and continue to drive. Patients need to stop the car as soon as safely pos-
sible, and in a suitable location. The keys should be removed from the igni-
tion and the driver needs to move out of the driver’s seat. They should take
fast-acting glucose, in the form of glucose tablets (three tablets are usually
sufficient), or a glucose drink, for example, 100 ml of Lucozade original.
Glucose taken orally will act faster than products containing sucrose,
fructose, lactose or other forms of sweeteners, as it will be absorbed
much quicker. This should be followed up with a meal or substantial
snack before resuming driving. As it takes about 45 minutes for the brain
to fully recover from hypoglycaemia, driving should not be resumed until
45 minutes after the blood glucose has returned to normal.
HYPOGLYCAEMIA AWARENESS
Make sure that patients are aware of their particular signs of hypogly-
caemia and warn them most people experience symptoms at blood glu-
Advice to drivers using insulin
• Test blood glucose before driving, even before a short journey
• Have a snack before driving if blood glucose is below 5 mmol/l
• Retest every two hours if driving long distances
• Keep a supply of glucose tablets or Lucozade in the car
• Glucometers and strips should be carried in the car
• Don’t ignore early warning signs of hypoglycaemia
• Take particular care during treatment changes, changes in lifestyle,
exercise, travel or pregnancy
• Do not drive if diabetes is unstable and hypoglycaemia is likely
• Regular snacks and meals should be taken on long journeys. Always
avoid alcohol
• Wearing an identification bracelet for diabetes, or other alert, is
advisable.
cose levels of around 4 mmol/l. Some patients lose their warning signs
if glucose levels are allowed to drop below 4 mmol/l on a regular basis,
and may be unaware this is happening. If symptoms are experienced at
glucose levels as low as 2 or 3 mmol/l, then the risk is that deterioration
could be rapid and sudden, which would be much more likely to end in
disaster on the road. The DVLA will withhold a driver’s licence if there is
impaired awareness of hypoglycaemia. A driver is obliged to inform the
DVLA if this happens, or if they suffer hypoglycaemia requiring assistance
either at the wheel or otherwise.
INFORMING THE DVLA
People using insulin must inform the DVLA, including women with gesta-
tional diabetes treated with insulin. Any deterioration in eyesight, whether
involving field of vision, laser treatment for retinopathy or any other rea-
sons that might affect a patient’s vision, should also be reported. Any
other complications of diabetes should be reported to the DVLA. This
does not necessarily mean that a licence will be refused, but the details
might be considered more closely and the DVLA may liaise with the prac-
tice for further details.
LORRY AND BUS DRIVERS
Drivers treated with insulin holding a licence for group 2 vehicles will no
longer be able to drive these vehicles. Group 2 vehicles include heavy
goods vehicles and passenger carrying vehicles, in other words, large
lorries and buses. This has huge implications for lorry and bus drivers and
does, understandably, deter them from using insulin.
NON-INSULIN-TREATED DIABETES AND THE DVLA
Diabetes managed by diet alone or tablets needs to be reported to
the DVLA only if relevant complications occur, for example, if retino-
pathy develops or hypoglycaemia is experienced. People using exena-
tide and gliptins in combination with a sulphonylurea are included in
this group.
