For many Canadians, driving is an essential part of daily living and is often a requirement of employment. Drivers with diabetes need to take extra precautions to drive safely. 

Diabetes may affect driving performance due to chronic complications which may impair sensory or motor function (such as diabetic eye disease, nerve damage, amputation, and heart disease). Incidents of low blood sugar (hypoglycemia) can affect alertness while driving.

As the presence and extent of these factors vary from person to person, the Diabetes Canada maintains the following position on Driving and Licensing:

People with diabetes have the right to be assessed for a license to drive a motor vehicle on an individual basis in accordance with Diabetes Canada's guidelines for private and commercial driving.

Each province has its own rules regarding blood sugar control and being able to drive. All drivers with diabetes should have a medical examination at least every two years to document any complications and to assess blood sugar control, including the frequency and severity of any low blood sugar incidents.

Low blood sugar

Low blood sugar levels (hypoglycemia) can adversely affect driving performance and may contribute to some of the accidents that involve people with diabetes. The risk of severe low blood sugar is greatest in people who use insulin and/or pills that can cause low blood sugar (insulin secretagogues), especially those with a history of severe low blood sugar and/or hypoglycemia unawareness. The risk is lower in people with type 2 diabetes who are not using insulin or insulin secretagogues.

Definitions

Mild Hypoglycemia: When the body signals a blood sugar drop and the individual can self-correct with oral carbohydrates.

Severe Hypoglycemia: Low blood sugar that requires outside intervention to abort or that produces a loss of consciousness.

Hypoglycemia Unawareness: When the individual no longer recognizes the body’s usual signals of low blood sugar (e.g. sweating, increased pulse, rapid breathing, trembling) so the first signs of low blood sugar will often be confusion or loss of consciousness.

Guidelines

  • Fitness of persons with diabetes to drive must be assessed on a case-by-case basis. All drivers with diabetes should have a medical examination at least every two years to assess fitness to drive.
  • Persons with diabetes should take an active role in assessing their ability to drive by maintaining medical records, accurate blood sugar monitoring logs and a well-calibrated blood glucose meter.
  • Drivers should take an active role in learning how to avoid, recognize and treat low blood sugar. Their long-term goal should be to maintain optimal diabetes control without the development of hypoglycemia unawareness.

Safe driving for people with diabetes

If you take insulin or pills that can drop your blood sugar below 4 mmol/L:

  • Prepare: Keep fast-acting sugar (e.g. dextrose tablets) where you can reach it while driving. Keep your blood sugar monitoring equipment and other snacks nearby (e.g. attached to the visor).
  • Be Aware: Consider measuring your blood sugar level immediately before driving. If your blood sugar is below 4 mmol/L, do not start driving and treat your low blood sugar. For long drives, check your blood sugar every four hours. You can also wear a real-time continuous blood glucose monitoring device.
    • If there are factors that may increase your risk of low blood sugar, such as recent physical activity or a delay in eating or skipping a meal, consider measuring your blood sugar more frequently.
    • If you have a history of recurrent severe hypoglycemia or hypoglycemia unawareness in the past 12 months, you must measure their blood sugar level immediately before and at least every two hours while driving.
  • Stop the vehicle in a safe location and remove the keys from the ignition if you don’t feel well while driving. Treat the low blood sugar.
  • After treating a low, Wait until your blood sugar is above 5 mmol/L to start driving. Your brain might need up to 40 minutes to recover after you have treated a low before you can safely drive again.
  • On longer journeys, take regular meals, snacks and periods of rest.

If you experience any episode of severe hypoglycemia while driving, you must refrain from driving immediately and notify your health-care provider as soon as possible (no longer than 72 hours). You should also notify your health-care provider and your driving licensing body if you experience more than 1 episode of severe hypoglycemia while awake but not driving in the past 6 months if you are a private driver, or in the past 12 months if you are a commercial driver. 

Diabetes and commercial driving

Truck drivers with diabetes may be at an increased risk for highway accidents compared to private drivers because, on average, they spend a greater percentage of their time behind the wheel and travel longer distances, and because their job description may require intermittent heavy labor and shift work.

The following recommendations were published in the October 2015 issue of the Canadian Journal of Diabetes. You can also download and view the complete article entitled, Diabetes and Driving: 2015 Canadian Diabetes Association Updated Recommendations for Private and Commercial Drivers. These are general recommendations which may differ slightly depending on how you manage diabetes (i.e. diet alone, diabetes pills, insulin).

Initial application for a commercial license

  • The applicant must undergo a comprehensive medical examination by a physician or nurse practitioner competent in managing diabetes.
    • This should include an assessment of blood sugar control; and the presence of diabetic eye disease, nerve damage, kidney disease, amputation and/or vascular disease. The assessment should also include the completion of a questionnaire that assesses the risk for hypoglycemia, including the nature of the work, type of motor vehicle, flexibility of scheduling, recognition of symptoms of low blood sugar and ability to treat low blood sugar, and documents the frequency of mild and severe hypoglycemia in the last 12 months.
  • The applicant should have a full eye examination performed by an ophthalmologist or optometrist.
  • The applicant must have a log of blood sugar measurements, performed at a frequency deemed appropriate by the person with diabetes and their health-care team, that includes the last six months or since the diagnosis of diabetes if onset occurred within the last six months. A memory-equipped blood glucose meter or an electronic record of blood glucose measurements is recommended.

Exclusion criteria for obtaining or maintaining a commercial license

  • Any episode of severe hypoglycemia while driving in the last 12 months
  • More than one episode of severe hypoglycemia while awake but not driving in the last 12 months
  • Any evidence of hypoglycemia unawareness in the last 12 months
  • Visual impairment that does not meet the minimum standard for visual acuity in the jurisdiction in which the individual is licensed
  • Nerve damage, amputation or heart disease of sufficient severity to affect the ability to drive safely
  • Failure to complete an assessment (as outlined above) at least every two years
  • Inadequate record of self-monitoring of blood sugar
  • Inadequate knowledge of the causes, symptoms and treatment of low blood sugar

Annual renewal of a commercial license

For annual renewal of a commercial license, commercial drivers using insulin or certain diabetes pills (insulin secretagogues) should obtain:

  • Complete physical examination every two years or as per provincial/territorial requirements;
  • Complete eye examination by an ophthalmologist or optometrist every year or at the discretion of the ophthalmologist or optometrist;
  • Complete log of blood sugar measurements performed at a frequency deemed appropriate by the person with diabetes and their health-care team from the last application. Logs should be verifiable on request. 

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