DRIVING WITH DIABETES: MADE SIMPLE

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1 DRIVING WITH DIABETES: MADE SIMPLE For Group 1 and Group 2 licence holders Bayer, the Bayer Cross, Contour and the simplewins logo are trademarks of Bayer Bayer limited. All rights reserved. Bayer Limited, The Atrium, Blackthorn Road, Sandyford, Dublin /06/03/DRIVEDTPBKT

2 CONTENTS

3 Driving with Diabetes: Made Simple Page 2 Diabetes If Treated with Insulin Page 5 If Treated Temporarily with Insulin Page 7 If Managed by Tablets which Carry a Risk of Hypoglycaemia Page 9 If Managed by Other Tablets and Non-Insulin Injectable Medication Page 11 If Managed by Diet Alone Page 13 Appendices Page 14 Bayer USB Glucose Meter Page 20 Patient Consultation Record Page 22 1

4 DRIVING WITH DIABETES: MADE SIMPLE 2

5 Driving safely is something we all believe in. If you have diabetes and wish to drive, it is important to be aware of the legal requirements - especially if driving is part of your profession. This guide from Bayer provides guidance on what you need to know about driving with diabetes. This information is based on recent guidelines from the Road Safety Authority (RSA).* It is your responsibility to ensure you keep up to date and comply with all relevant requirements when driving with diabetes. For further information go to *RSA Publication: Slainte agus Tiomaint, Medical Fitness to Drive Guidelines, (Group 1 and Group 2 Drivers) available at 3

6 DIABETES IF TREATED WITH INSULIN If you have diabetes, it is vital that you inform the National Driver Licence Service (NDLS) unless stated otherwise in the text. Group 2 standards are minimum standards and employers may set higher standards to meet with the demands of a particular job. 4

7 IF TREATED WITH INSULIN (See appendix for advice to drivers) Group 1 Entitlement ODL (car, motorcycle and tractor), drivers may apply once the following criteria has been met: Must have relevant awareness of hypoglycaemia at appropriate glucose level*. Must not have had more than one episode of hypoglycaemia requiring the assistance of another person in the previous 12 months. Must maintain appropriate blood glucose monitoring. Must not be regarded as a likely source of danger to the public while driving. Must meet with the visual standards for acuity and visual field. Group 2 Entitlement ODL (buses and trucks), drivers may apply once the following criteria has been met: Must have experienced no episode of hypoglycaemia requiring the assistance of another person during the previous 12 months. Must have relevant awareness of hypoglycaemia at appropriate glucose level*. Must regularly monitor blood glucose at least twice daily, and at times relevant to driving, using a glucose meter with a memory function to measure and record blood glucose levels. At the annual examination by a consultant endocrinologist, 3 months of blood glucose readings must be available. Must demonstrate an understanding of the risks of hypoglycaemia. Must have no other debarring complications of diabetes, such as a visual field defect. Your driving licence application must be accompanied by a medical report form (D501). The medical report must be completed by a registered medical practitioner. *Impaired awareness of hypoglycaemia is defined as, an inability to detect the onset of hypoglycaemia because of a total absence of warning symptoms. 5

8 DIABETES IF TREATED TEMPORARILY WITH INSULIN If you have diabetes, it is vital that you inform the National Driver Licence Service (NDLS) unless stated otherwise in the text. Group 2 standards are minimum standards and employers may set higher standards to meet with the demands of a particular job. 6

9 IF TREATED TEMPORARILY WITH INSULIN E.g. Post-Myocardial infraction, participants in oral medication and insulin trials or gestational diabetes. (See appendix for advice for drivers) Group 1 Entitlement ODL (car, motorcycle and tractor), drivers may apply once the following criteria has been met: Provided these drivers are under medical supervision and have appropriate awareness of hypoglycaemia at appropriate glucose levels and have not been advised by their doctor that they are at risk of disabling hypoglycaemia, need not notify NDLS. If experiencing disabling hypoglycaemia, driver must notify NDLS. NDLS should also be notified if treatment continues for more than 3 months, or for more than 3 months after delivery for gestational diabetes. Group 2 Entitlement ODL (buses and trucks), drivers may apply once the following criteria has been met: Must have experienced no episode of hypoglycaemia requiring the assistance of another person during the previous 12 months. Must have relevant awareness of hypoglycaemia at appropriate glucose level*. Must monitor blood glucose at least twice daily and at times relevant to driving using a glucose meter with a memory function to measure and record blood glucose levels. At the annual examination by a consultant endocrinologist, 3 months of blood glucose readings must be available. Must demonstrate an understanding of the risks of hypoglycaemia. Must have no other debarring complications of diabetes, such as a visual field defect. *Impaired awareness of hypoglycaemia is defined as, an inability to detect the onset of hypoglycaemia because of a total absence of warning symptoms. Discuss with your health care professional the symptoms of disabling hypoglycaemia. 7

10 DIABETES IF MANAGED BY TABLETS WHICH CARRY A RISK OF INDUCING HYPOGLYCAEMIA. THIS INCLUDES SULPHONYLUREAS AND GLINIDES. If you have diabetes, it is vital that you inform the National Driver Licence Service (NDLS) unless stated otherwise in the text. Group 2 standards are minimum standards and employers may set higher standards to meet with the demands of a particular job. 8

11 IF MANAGED BY TABLETS WHICH CARRY A RISK OF INDUCING HYPOGLYCAEMIA. THIS INCLUDES SULPHONYLUREAS AND GLINIDES. (See appendix for advice for drivers) Group 1 Entitlement ODL (car, motorcycle and tractor), drivers may apply once the following criteria has been met: Must not have had more than one episode of hypoglycaemia requiring the assistance of another person within the previous 12 months. It may be appropriate to monitor blood glucose regularly and driver should monitor blood glucose at times relevant to driving to enable the detection of hypoglycaemia. Has appropriate awareness of hypoglycaemia at appropriate glucose level.* Must be under regular medical review. Group 2 Entitlement ODL (buses and trucks), drivers may apply once the following criteria has been met: Must have experienced no episode of hypoglycaemia requiring the assistance of another person during the previous 12 months. Must have appropriate awareness of hypoglycaemia at appropriate glucose level.* Must show adequate control of condition by regularly monitoring blood glucose at least twice daily and at times relevant to driving. Must demonstrate an understanding of the risks of hypoglycaemia. Must have no other debarring complications of diabetes, such as a visual field defect. Driver must contact the NDLS if any of the above points are not met. * Impaired awareness of hypoglycaemia is defined as, an inability to detect the onset of hypoglycaemia because of a total absence of warning symptoms. 9

12 DIABETES IF MANAGED BY OTHER TABLETS AND NON-INSULIN INJECTABLE MEDICATION If you have diabetes, it is vital that you inform the National Driver Licence Service (NDLS) unless stated otherwise in the text. Group 2 standards are minimum standards and employers may set higher standards to meet with the demands of a particular job. 10

13 IF MANAGED BY OTHER TABLETS AND NON-INSULIN INJECTABLE MEDICATION (See appendix for advice for drivers) Providing your diabetes is managed only by: Tablets that do not carry a risk of hypoglycaemia such as sulphonylureas and glinides Non-insulin injectable medication Group 1 Entitlement ODL (car, motorcycle and tractor), drivers may apply once the following criteria has been met: Need not notify NDLS unless develop associated conditions which are relevant to driving, e.g. diabetic eye problems affecting visual acuity or visual field, or if insulin is required. Group 2 Entitlement ODL (buses and trucks), drivers may apply once the following criteria has been met: Need not notify the NDLS unless they develop relevant disabilities, e.g. diabetic eye problems affecting visual acuity or visual fields, in which case not fit to drive or for short period licence. Drivers are advised to monitor their blood glucose regularly and at times relevant to driving. They must be under regular medical review. 11

14 DIABETES IF MANAGED BY DIET ALONE If you have diabetes, it is vital that you inform the National Driver Licence Service (NDLS) unless stated otherwise in the text. Group 2 standards are minimum standards and employers may set higher standards to meet with the demands of a particular job. 12

15 IF MANAGED BY DIET ALONE Group 1 Entitlement ODL (car, motorcycle and tractor), drivers may apply once the following criteria has been met: Need not notify NDLS unless develop associated conditions which are relevant to driving, e.g. diabetic eye problems affecting visual acuity or visual field, or if insulin is required. Must have relevant awareness of hypoglaecemia. if impaired awareness is confirmed, driving must stop. Driving May resume provided reports show awareness of hypoglcaemia has been regained and confirmed by a GP or consultant. Must not have any eyesight complications (chapter 7 renal disorders (chapter 8 or limb disability (chapter 10 Group 2 Entitlement ODL (buses and trucks), drivers may apply once the following criteria has been met: Need not notify NDLS unless develop associated conditions which are relevant to driving, e.g. diabetic eye problems affecting visual acuity or visual field, or if insulin is required. Must have relevant awareness of hypoglaecemia* (see page 7 of this booklet for full details if insulin is required) Must not have any eyesight complications (chapter 7 renal disorders (chapter 8 or limb disability (chapter 10 * Impaired awareness of hypoglycaemia is defined as, an inability to detect the onset of hypoglycaemia because of a total absence of warning symptoms. 13

16 APPENDICES The advice of the RSA is made within the context of best available medical evidence, best current international practice, and EU and Irish law. It represents a minimum level of advice. It is for others, e.g. employers or directors of emergency services, to decide whether or how those recommendations should be interpreted relevant to their specific circumstances. 14

17 APPENDIX A Guide for Drivers with Insulin Treated Diabetes or Oral Medications with Potential for Hypoglycaemia (such as sulphonylureas and glinides) who wish to apply for Group 2 Licences (trucks and buses with or without trailer) entitlements. Qualifying Conditions which must be met: No episode of hypoglycaemia requiring the assistance of another person has occurred in the previous 12 months. Must have appropriate awareness of hypoglycaemia at appropriate glucose level. Must demonstrate an understanding of the risks of hypoglycaemia. Will not be able to apply until their condition has been stable for a period of at least one month. Must regularly monitor their condition by checking their blood glucose levels at least twice daily and at times relevant to driving. A glucose meter with a memory function to measure and record blood glucose levels must be used. At the annual examination by a consultant endocrinologist, 3 months of blood glucose readings must be available. Must have no other condition which would render them a danger when driving Group 2 vehicles. They will be required to comply with the directions of doctors(s) treating the diabetes and to report immediately to the NDLS any significant change in their condition. 15

18 APPENDIX Drivers with Insulin treated diabetes are advised to take the following precautions: You must always carry your glucose meter and blood glucose strips with you. You must check your blood glucose before the first journey and every two hours whilst you are driving. In each case if your blood glucose is 5.0mmol/l or less, take a snack. If it is less than 4.0mmol/l or you feel hypoglycaemic, do not drive. If hypoglycaemia develops while driving, stop the vehicle as soon as possible. You must switch off the engine, remove the keys from the ignition and move from the driver s seat. You must not start driving until 45 minutes after blood glucose has returned to normal. It takes up to 45 minutes for the brain to recover fully. Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets or sweets within easy reach in the vehicle. You should carry personal identification to show that you have diabetes in case of injury in a road traffic accident. Particular care should be taken during changes of insulin regimens, changes of lifestyle, exercise, travel and pregnancy. You must take regular meals, snacks and rest periods on long journeys. Always avoid alcohol. Drivers who have diabetes and are treated with an insulin preparation must inform the NDLS. 16

19 What is Hypoglycaemia? Hypoglycaemia (also known as a hypo) is the medical term for a low blood glucose (sugar) level. Severe hypoglycaemia means that the assistance of another person is required. The risk of hypoglycaemia is the main danger to safe driving and this risk increases the longer you are on insulin treatment. This may endanger your own life as well as that of other road users. Many of the accidents caused by hypoglycaemia are because drivers carry on driving even though they get warning symptoms of hypoglycaemia. If you get warning symptoms of hypoglycaemia whilst driving, you must always stop as soon as safely possible do not ignore the warning symptoms. Early Symptoms of Hypoglycaemia include: Sweating, shakiness or trembling, feeling hungry, fast pulse or palpitations, anxiety, tingling lips. If you do not treat this it may result in more severe symptoms such as: Slurred speech, difficulty concentrating, confusion, disorderly or irrational behaviour, which may be mistaken for drunkenness. If left untreated this may lead to loss of consciousness. 17

20 APPENDIX Limb Problems (chapter Limb problems/amputations are unlikely to prevent driving. They may be overcome by driving certain types of vehicles, e.g. automatics or vehicles with hand controls You must inform NDLS if: You suffer more than one episode of severe hypoglycaemia (needing the assistance of another person) within the last 12 months. For Group 2 drivers (bus/lorry) one episode of severe hypoglycaemia must be reported immediately. You must also tell us if you or your medical team feels you are at high risk of developing hypoglycaemia. You develop impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood sugar). You suffer severe hypoglycaemia while driving. An existing medical condition gets worse or you develop any other condition that may affect you driving safely. 18

21 APPENDIX Information for Drivers with Diabetes Treated by Other Non-Insulin Medication, Diet or Both Drivers do not need to tell the NDLS if their diabetes is treated by tablets (other than sulphonylureas and glinides, check with your doctor if you are not certain), diet or both and that they are free of the complications listed below. Some people with diabetes develop associated problems that may affect their driving. Hypoglycaemia (low blood sugar) Hypoglycaemia (also known as a hypo) is the medical term for a low blood glucose (sugar) level. Severe hypoglycaemia means the assistance of another person is required. The risk of hypoglycaemia is the main danger to safe driving and can occur with diabetes treated with insulin or tablets or both. This may endanger your own life as well as that of other road users. Many of the accidents caused by hypoglycaemia are because drivers carry on driving even though they get warning symptoms of hypoglycaemia. If you get warning symptoms of hypoglycaemia while driving you must stop as soon as safely possible do not ignore the warning symptoms. 19

22 APPENDIX Early symptoms of Hypoglycaemia include Sweating, shakiness or trembling, feeling hungry, fast pulse or palpitations, anxiety, tingling lips. If you do not treat this it may result in more severe symptoms such as: Slurred speech, difficulty concentrating, confusion, disorderly or irrational behaviour, which may be mistaken for drunkenness. If left untreated, this may lead to loss of consciousness. You must inform the NDLS if any of the following applies: You have suffered more than one episode of severe hypoglycaemia within the last 12 months. You must also tell NDLS if you or your medical team feel you are at high risk of developing severe hypoglycaemia. For Group 2 drivers (bus/lorry), one episode of severe hypoglycaemia must be reported immediately. You have developed an impaired awareness of hypoglycaemia (difficulty in recognising the warning symptoms of low blood sugar). You suffer severe hypoglycaemia while driving. You need treatment with insulin. You don t meet the vision standards set out in complete list of Guidelines (Chapter 7 for eyesight standards), see online at You develop any problems with the circulation or sensation in your legs or feet which make it necessary for you to drive certain types of vehicles only, for example automatic vehicles or vehicles with a hand-operated accelerator or brake. This must be shown on your driving licence. An existing medical condition gets worse or you develop any other condition that may affect your driving safely. In the interests of road safety, you must be sure that you can safely control a vehicle at all times. Contact details for the NDLS: Tel:

23 NOTES 21

24 KEEP ON TOP OF YOUR GLUCOSE LEVELS USING A CONTOUR NEXT USB METER FROM BAYER. 22

25 Log onto to see if you are eligible* for a free Contour next USB or contact your nurse today! 3 simple steps to test Suitable for both Group 1 and Group 2 licence holders who want a longer view of their control. Makes it convenient to test your blood glucose at times relevant to driving* Large 2000 test memory on meter Allows a Group 2 licence holder to maintain 3 months-worth of driving records in line with NDLS standards Results cannot be deleted from the meter memory *eligible patients are those using insulin Full terms and conditions apply, see website for details.

26 PATIENT CONSULTATION RECORD 24

27 Driving with Diabetes: Patient Consultation Record To be filled in by patient and HCP. For HCP¹s records only¹ These forms can be used to create a record of the discussion between the Patient / Healthcare Professional (below) in relation to the NDLS requirements for record keeping. Name of Patient Patient s date of birth Name of Healthcare Professional Healthcare Professional job title Surgery/hospital Which type of driving licence does the patient hold? Yes Group 1 (cars and motorcycles) Group 2 (large lorries and buses) No What type of diabetes does the patient have? Type 1 Type 2 Gestational Other (please specify) What treatment(s) for diabetes does the patient receive? Diet and lifestyle advice Tablets from the sulphonylurea or prandial glucose regulator groups Tablets not from the sulphonylurea or prandial glucose regulator groups Non-insulin injections (e.g. exenatide) Insulin for Type 1 or Type 2 diabetes Temporary insulin for gestational diabetes Has the patient been advised of their individual legal rights and responsibilities in terms of driving with diabetes? Does the patient need to notify the NDLS as soon as possible? Has the patient agreed to notify the NDLS as soon as possible? Has the patient been told that, as treatment and health circumstances may change over time, they should regularly check their NDLS notification requirements and eligibility to drive? Patient s signature Healthcare Professional s signature Date Date Bayer HealthCare: supporting drivers with diabetes The information provided will not be shared with Bayer and is confidential between you and your health care provider. Drivers have a legal obligation to tell the NDLS about certain medical conditions that they have and treatments that they are receiving. Failure to do so could leave you open to prosecution for illegal driving. Use this form to record any actions you need to take, as agreed with your Healthcare Professional. If your Healthcare Professional advises you to notify the NDLS then it is your responsibility as a driver to do so. Bayer Diabetes Care is not responsible for any actions or outcomes arising from use of this form. This is an information note sponsored by Bayer. Only you and your Healthcare Professional will have records of these details.

28 Bayer, the Bayer Cross, Contour and the simplewins logo are trademarks of Bayer Bayer limited. All rights reserved. Bayer Limited, The Atrium, Blackthorn Road, Sandyford, Dublin 18.

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