Having diabetes does not mean you cannot drive a car, but some extra steps are needed to make sure you are driving safely!
How can diabetes affect my driving?
• Treatment with insulin and some oral anti-diabetes medications may cause low blood sugars leading to sleepiness, dizziness, confusion, blurry vision, loss of consciousness, or seizures.
• Having low blood sugar while driving is like driving drunk and can lead to serious injury to you or others.
o Avoiding low blood sugars is key to making sure you and those around you are safe while driving.
• Other complications of diabetes such as being unable to recognize when your blood sugar is low (hypoglycemia unawareness), loss of vision (retinopathy), or loss of feeling in your hands or feet due to nerve damage (neuropathy) may also impact your ability to drive.
How can I avoid low blood sugars while driving?
• Check your blood sugar before driving, even if you feel well!
• Your blood sugar goal before driving should be above 90 mg/dL. Here are some examples of what to do:
o If your blood glucose is <90 mg/dL, eat a 15-gram carb snack and recheck your blood sugar in 10-15 minutes. Repeat this until blood sugar is >90 mg/dL. Wait until blood sugar is >90 mg/dL before starting to drive.
o If you use a continuous glucose monitor (CGM) or sensor that indicates your blood sugar is falling AND your blood sugar will fall less than 90 mg/dL in the next 30 minutes to 1 hour, you should also consider eating a 10-15g carb snack. It is important to pay attention to the trend arrows in the CGM.
• Check your blood sugar every 1-2 hours of continuous driving. See the next question if your blood sugar is low.
What if I feel low or have a low blood sugar (even if feeling well) while driving?
• Do not ignore early symptoms of a low blood sugar or attempt to “ride out the low”
• Pull over the car as soon as it is safely possible and check your blood sugar.
o Treat your low blood glucose if needed following the same rules discussed above!
o Do not resume driving until your blood sugar is >90 mg/dL AND your low blood glucose symptoms have completely resolved.
Other considerations
• Be prepared:
o Make sure you have all your unexpired, working, diabetes supplies with you (e.g., meter, test strips, CGM receiver, etc.)
o Have plenty of 15g snacks that are a quick-acting source of carbs, easy to access (within reach and easy to see), and do not melt, expire, or go bad. Glucose tabs do not melt in the heat, and they will not freeze in the cold.
o Wear your medical alert ID (bracelet, necklace) and have a medical ID saved on your smartphone just in case you do get into trouble while driving. A visible medical ID will help alert others to check your blood sugar if you cannot do so.
• Always wear your seat belt!
• Just as you would not text and drive, do not check your blood sugar while driving.
• Talk with your diabetes provider if you have trouble feeling signs of low blood sugar.
• Good diabetes control can prevent you from developing complications that may make future driving difficult. Work with your diabetes team to help with this and make sure you have regular, yearly eye exams.
• Know your state’s driving laws!
o Laws about driving with a private driver’s license and having diabetes are different from state to state and not dictated by federal law. Some states may require your physician to sign a medical agreement when applying for or renewing a driver’s license application. Contact your local Department of Motor Vehicles (DMV) or visit their website to learn more.
▪ Forms that ask if applicants have mental or physical conditions that may interfere with safe driving may require you to answer “yes.”
▪ Forms may ask if an applicant has experienced convulsions, epilepsy, blackouts, paralysis, heart attack, heart disease, stroke, or “other” medical conditions within the preceding six months. If you can answer “yes” to any of these questions, you may need medical clearance from your diabetes doctor.
▪ A healthcare provider may refuse to sign the medical clearance form if they determine you are not checking your blood glucose as recommended. They may also recommend further evaluation for other complications of diabetes if these are present, as these conditions may need clearance from a different specialty healthcare provider to help determine your safety to drive.
• Suppose you drive as part of your job and need a commercial driving license. In that case, federal laws currently mandate medical evaluation for those with insulin-treated diabetes mellitus by a Nationally Registered Certified Medical Examiner. For more information, visit the American Diabetes Association (ADA – https://www.diabetes.org/) or the US Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA – www.fmcsa.dot.gov/regulations).
References:
1. American Diabetes, A. (2014). Diabetes and Driving. Diabetes Care, 37(Supplement 1), S97. doi:10.2337/dc14-S097
2. Commercial driver’s license. (n.d.). Retrieved November 04, 2021, from https://www.diabetes.org/resources/know-your-rights/discrimination/drivers-licenses/commercial-drivers-license
3. Driver’s license information. (n.d.). Retrieved November 04, 2021, from https://www.diabetes.org/resources/know-your-rights/drivers-license-information
4. Qualifications of Drivers; Diabetes Standard., Vol. 82, C.F.R. §391.49 (2018). https://www.fmcsa.dot.gov/regulations/rulemaking/2018-20161.
5. Washington University Diabetes Team. (2020). Driving and Diabetes. St. Louis, MO.