Driving

For the majority of people with diabetes, it will have very little impact on their capacity to drive. However, there are practical and regulatory considerations where your patient may require advice. In the UK, the DVLA have recently introduced several changes to the standards for driving for patients with insulin treated diabetes.

When does the patient have to inform the DVLA that they have diabetes?

If the patient has insulin treated diabetes there is a legal requirement to inform the DVLA at the earliest possible opportunity.

In addition, the patient must inform the DVLA if they have a number of other diabetes related conditions.

For group 1 (car/motorcycle) drivers these include:

1. More than one episode of hypoglycaemia sufficiently severe to require third party assistance in the last twelve months. Patients in this situation should be advised not to drive until they have contacted the DVLA.

2. Complete hypoglycaemia unawareness. 

3. Diabetes plus another relevant condition (e.g. Retinopathy, Neuropathy) even if the diabetes is only diet or tablet -treated.

For group 2 (Bus/lorry) drivers:

1. Any episode of hypoglycaemia sufficiently severe to require third party assistance in the last 12 months. Patients in this situation should be advised not to drive until they have contacted the DVLA.

2. Any degree of hypoglycaemia unawareness.

More detailed information is available on the DVLA website.

Patients on temporary insulin treatment (e.g. gestational diabetes) do not have to inform the DVLA unless they are deemed at high risk of hypoglycaemia by their doctor. More detailed information is availablel on the DVLA website.

Patients on tablets, even those known to carry a risk of hypoglycaemia (Sulphonylureas and Glinides), do not have to inform the DVLA so long as they fulfill criteria set out in DVLA leaflet INF188/2.

When is the patient not obliged to inform the DVLA that they have diabetes?

Patients on temporary insulin treatment (eg gestational diabetes) do not have to inform the DVLA unless they are deemed at high risk of hypoglycaemia by their doctor. More detailed information is available on the DVLA website.

Patients treated by diet alone, on tablets, even those known to carry a risk of hypoglycaemia (Sulphonylureas and Glinides) and patients on GLP1 agonists do not have to inform the DVLA so long as they fulfill criteria set out in DVLA leaflet INF188/2.

How does the patient inform the DVLA that they have diabetes?

By downloading the form DIAB1 from DVLA website, completing, and returning it.

What are the implications for car insurance? 

Many insurance companies will not enquire about a diagnosis of diabetes nor weight the premium. Some, however, do.

Patients should be advised to shop around to find a company that will not weight their policy if their usual insurer does do this.

It is always a good idea for patients to inform their insurer about their diagnosis.

What practical advice should I give my patient about driving with their diabetes?

Patients should be routinely advised to check their blood sugar before driving off; not to set off if it is below 5 mmol/L ("five to drive") and to keep a source of rapidly absorbed carbohydrate in the car.

On a long car journey, they should be advised to stop to check blood sugars periodically. 

Do patients with tablet-treated diabetes need to routinely test their blood glucose level before and during driving?

The short answer is 'no', not always. However, DVLA advice on this question is stratfied in to those OHAs with a recognised risk of hypoglycaemia (Sulphonylureas and Glinides) and others, including GLP1 agonists.

The advice is left a little vague in the former category stating: 'It may be appropriate to monitor blood glucose regularly and at times relevant to driving.' The advice is also subdivided in to category 1 and category 2 drivers, the latter always being required to test the blood glucose at times relevant to driving.

What about minicab drivers?

The DVLA recommends that insulin treated taxi and minicab drivers should be allowed to continue to drive.

However, the licensing of minicab drivers is the responsibility of the local authority where they work.

Regulations are quite variable around the country but many councils do not bar insulin treated patients from driving mini cabs.

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