In the Driver’s Seat with T1D

February 22, 2019

We often get questions from our type 1 diabetes community (T1D) about driving and T1D. Driving gives us independence and can make getting around a whole lot easier, so it’s not surprising that it’s a topic close to your hearts! We have some resources on hand prepared by T1D experts, to help you navigate topics including driving. Here is an edited extract about all things behind the wheel with T1D.

Driving and the authorities

Just as wearing a seatbelt and driving within the speed limit are the law, there are laws about driving with T1D. Yes, you absolutely can get a driver’s licence if you have T1D. Keep in mind though, there are rules and restrictions in place and these rules need to be adhered to. With T1D, there is a risk that concentration and action could be impaired. As any driver will know, a moment’s inattention can have devastating outcomes.

The main concern of the licensing authorities is the possibility of a person with T1D having hypoglycaemia (a hypo) while driving. T1D complications like eye problems are also a concern. All states and territories use the national guidelines of medical fitness to assess people with T1D who wish to begin or continue driving. These guidelines are intended to protect your safety and the safety of the community. They attempt to balance the safety of all and any unfairness against you.

If you have been diagnosed with T1D, you should immediately inform your local licensing authority. If you don’t do this and continue to drive and have an accident, you could be charged with driving offences. There may also be problems with insurance claims if you haven’t reported your T1D. Once you have notified your licensing authority they will forward you a report form for your doctor to complete to say you are fit to drive. A medical review must be completed at least every two years and annually if you hold a commercial driver’s licence. Planning ahead for your medical review is important, such as having an eye check beforehand, and taking along other results including records of your recent home blood glucose results.

If you experience a hypo that results in you losing consciousness you will need to notify your licensing authority, and not resume driving until you have medical clearance to do so. In most casesyour licence will be temporarily suspended. You will need to undergo a medical review with your diabetes specialist to determine your fitness to safely resume driving before your licence is reinstated.

Above 5 to drive

You should check your blood glucose level before driving, as getting behind the wheel with low blood glucose levels can impair your ability to drive safely.

Australian educational material recommends that your blood glucose level be ‘Above 5 to Drive’. You should also ensure that you always have a fast-acting hypo fix and a long-acting carbohydrate snack easily accessible in your car e.g. glove box. If you are driving long distances, check your blood glucose before driving and every two hours, and plan for regular meal breaks.

If you feel your blood glucose level is low, STOP driving as soon as it is safe to do so and turn off the ignition or remove the key. Even a mild hypo can affect your reactions and concentration. Do not attempt to treat the hypo while driving. Check your glucose level and treat your hypo. After 15 minutes, recheck again and eat some long-acting carbohydrate. You shouldn’t restart the car until you have treated your hypo and feel absolutely normal.

It is recommended that you resume driving 30 minutes after symptoms have completely gone. Your blood glucose levels before driving again should be above 5 mmol/L.

While this may seem a nuisance, it is better to arrive late than not at all!

It is important to know that if you have a hypo while driving and cause an accident, you may be charged with reckless or negligent driving. The onus is on you to prove beyond a reasonable doubt that you were having a hypo at the time and not legally responsible for your actions. However, if it can be shown you knew you were having a hypo and neglected to treat it, the charges may still stand.

In case of an accident, you should always have something on you that identifies you as having T1D such as a MedicAlert® emblem (bracelet or necklace). There are also other options, such as carrying a card in your wallet and glove compartment.

Getting started for first time drivers

It’s one of the life events that parents and carers of teens with T1D approach with the most apprehension: letting them drive a car. It’s scary enough to think of any teen behind the wheel of a car but adding T1D to the equation may amplify that fear.

It is important for teens and their carers to realise that driving is not a right but a privilege. Even people without T1D must prove themselves before driving and can be stripped of that privilege at any time. The strong parent sets up rules of the road (in partnership with the diabetes team and the teen) and then insists that they be kept.

To get a Learner Driver Licence in Australia, your teen will need a medical report to show that they are fit to drive. This involves a doctor checking HbA1c, blood glucose monitoring, eyes, frequency of hypos and awareness of hypo onset. Like established drivers, you need to tell your State’s licencing authority that your teen has T1D and obtain a medical certificate every two years to confirm that they are fit to drive. You should also need to let your car insurance company know that a person driving the car has T1D.

When your teen has obtained their Learner Driver Licence, you will need to have your own ‘family driver’s education’ session. The first rule is simple: they must do a blood glucose check just before getting behind the wheel. Blood glucose readings must be above 5mmol/L before driving and this needs to be rechecked every two hours when they are on the road or driving intermittently.

When to say no

With a teen new to driving, parents really do need to hold the ultimate control for the first few years. Make sure your teen knows it is a ‘one strike and you’re out’ situation and that if they drive the car without checking their blood glucose level, they won’t be driving for a while. Remember, your action is for the safety of not only your teen but also for the public. Remind your teen that keeping blood glucose levels in a safe driving range is like wearing a seatbelt.

Acknowledge openly to your teen that it will not feel ‘cool’ to pull over to test levels or to treat a low. Let your teen know that you understand their frustration with having to think about these extra things. Encourage your teen to be open with their friends about it thus making it more likely that friends will understand when a situation arises. Teens need to understand that not pulling over because they don’t want to look bad in front of friends could lead to something far more serious should they have an accident.

The information in this article is taken from our resource guides Straight to the Point: A Guide for Adults Living with Type 1 Diabetes and JDRF’s Teen Toolkit for parents/carers of teens with T1D. Both are available online in a FREE digital download format.

The NDSS also offers a valuable resource on type 1 diabetes and driving