7 - Diabetes - Hypoglycemia

7.1About diabetes and hypoglycemia

Diabetes

Diabetes is a chronic and progressive disease characterized by hyperglycemia (high blood glucose).  It appears in two principal forms*:

  • type 1 diabetes, formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes, and
  • type 2 diabetes, formerly called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes.

Type 1 and type 2 also differ in the underlying defect, and type of therapeutic control.

(*Other types of diabetes include gestational diabetes, other specific types (those due to genetic defects in β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas, drug or chemical induced diabetes, etc.), and pre-diabetes. These types of diabetes are less common than type 1 and type 2 diabetes and are not discussed in this chapter.)

Type 1 diabetes

Type 1 diabetes can occur at any age, but it primarily appears before age 30. It is characterized by the inability to produce insulin and often more marked fluctuations in blood glucose.  Daily insulin injections are always required to manage type 1 diabetes.

Type 2 diabetes

Type 2 diabetes usually occurs in individuals over the age of 40.  It is characterized by an impaired ability to recognize and utilize insulin, and eventually diminished insulin production.  Therapeutic control often is achieved by diet alone, or in combination with oral antihyperglycemic agents**,  but people with type 2 diabetes whose blood glucose cannot be controlled in this way require treatment with insulin.

(**Oral antihyperglycemics also may be referred to as oral hypoglycemics.)

Hypoglycemia

Anyone who requires treatment with insulin is at risk of hypoglycemia.  Those with type 2 diabetes treated with insulin secretagogues (oral medications that stimulate the secretion of insulin) or metformin (an oral medication that enhances the effect of insulin) also may experience hypoglycemia, although the frequency with this treatment is lower than with insulin

Hypoglycemia may occur for a number of reasons, including reduced food intake, unusual level of physical exertion, and alteration of insulin dose.

Hypoglycemia can result in two types of symptoms, neurogenic (autonomic) and neuroglycopenic.

Neurogenic symptoms of hypoglycemia

The body’s immediate response to low blood sugar is to secrete hormones that counteract insulin, including adrenaline. The presence of adrenaline causes neurogenic (or autonomic) symptoms such as tremulousness, palpitations, anxiety, sweating, hunger and paresthesias (tingling and numbness).  People with diabetes learn to recognize these symptoms as evidence of hypoglycemia and respond by consuming sugary liquids or starchy foods to increase their blood glucose level.

Neuroglycopenic symptoms of hypoglycemia

Neuroglycopenic symptoms are the direct result of impaired brain function due to low glucose levels. These symptoms include confusion, weakness or fatigue, severe cognitive failure, seizure and coma. As the blood glucose level falls, higher cortical function (insight, judgment, calculation, speech and memory) is the first to be affected.  Next, a person will experience stupor, characterized by confusion, slurred speech, slow reaction times, poor judgment and lack of coordination.  If the level continues to fall, there will be loss of consciousness, seizures and potentially brain damage or death.

Hypoglycemia unawareness

Another complicating factor is hypoglycemia unawareness, which is the inability to recognize the autonomic symptoms of hypoglycemia or a failure of such warning signs to occur prior to impaired brain function.  If the initial autonomic symptoms caused by the release of adrenaline are missed, a person experiencing hypoglycemia can only rely on the neuroglycopenic symptoms as an indicator of low blood glucose. Because these symptoms appear in the context of cognitive impairment, they are not easily recognized by the hypoglycemic individual and may delay or prevent self-treatment.

Severe hypoglycemia

Severe hypoglycemia is commonly defined as hypoglycemia that requires outside intervention to abort, or that produces an alteration in level of consciousness or loss of consciousness.  The altered or reduced level of consciousness prevents a person experiencing severe hypoglycemia from taking appropriate action.

7.2Prevalence

Diabetes

Based on research conducted by the National Diabetes Surveillance System, it is estimated that approximately 5% of Canadians aged 20 years and older have been diagnosed with diabetes.  Diabetes is somewhat more prevalent in males, and the

overall prevalence of diabetes increases with age, as shown in the figure below.  It is estimated that 5 to 10% of diagnosed diabetes is type 1, and 90 to 95% is type 2.

figure 1 prevalence of diabetes in Canada

Hypoglycemia

A study of people with type 1 diabetes conducted in 1993 estimated that the incidence of mild hypoglycemia (hypoglycemia for which a person is able to treat themselves) to be 28 episodes per person per year.  The incidence of severe hypoglycemia was estimated to be 0.31 episodes per person, per year.  Since the mid 1990’s there has been an increased therapeutic emphasis on tight glycemic control, which has been shown to significantly reduce the complications of diabetes.  Unfortunately, the use of more intensive treatment to maintain glycemic control has increased the risk of hypoglycemia by as much as two or three times.  This suggests that these estimates on the prevalence of hypoglycemia in type 1 diabetes may be low.

While people with type 2 diabetes who are treated with insulin are at risk of hypoglycemia, the frequency is lower than for those with type 1 diabetes.   The incidence of severe hypoglycemia for type 2 diabetes treated with insulin secretagogues is about 1 to 2% per year, with higher risk for longer use, older age, and the use of chlorpropamide and other long-acting secretagogues. The concomitant use of beta blockers and insulin previously has been thought to increase the risk of hypoglycemia; however, this theoretical concern is not often seen in practice.

For anyone with diabetes, a history of severe hypoglycemia, hypoglycemia unawareness, and low blood glucose levels are consistent predictors of future hypoglycemia.

Hypoglycemia unawareness

It is estimated that 25% of all those treated with insulin will experience one or more episodes of hypoglycemia unawareness.  In type 1 diabetes, hypoglycemia unawareness increases with the duration of diabetes and the likelihood increases if autonomic neuropathy is present.  In type 2 diabetes, hypoglycemia unawareness is relatively uncommon.

Factors that may be associated with hypoglycemia unawareness include older age, duration of diabetes, presence of autonomic neuropathy, species of insulin, degree of metabolic control, and number of hypoglycemic events.

7.3Diabetes and adverse driving outcomes

Over the last twenty years the scientific evidence on the relationship between diabetes and crash risk has evolved, in part as a reflection of better management and control. Although there is some variability in results of research on drivers with diabetes, there is clear evidence to show that both non-commercial and commercial drivers with diabetes are at an increased risk of motor vehicle crashes.

It has been shown that diabetes treatment modality is an important consideration in determination of risk for drivers. Study results consistently indicate that individuals taking insulin have an elevated risk of crashes.  Some studies have also shown an elevated risk of crash for drivers with type 2 diabetes who are treated with a combination of oral antihyperglycemics (secretagogues and non-secretagogues).  Those treated by diet alone or with a single oral antihyperglycemic agent have shown no elevated risk of crash.

A relationship between hypoglycemia and crashes has also been found.  Despite a lack of data from studies of large samples of people with diabetes, a number of small studies have shown a relationship between hypoglycemic reactions and motor vehicle crashes.

While research has established clear links between diabetes, hypoglycemia and motor vehicle crashes, the variable results of these studies indicate that decisions about driving should be based on assessment of individual medical history and circumstances including:

  • treatment modality
  • incidence of hypoglycemia
  • incidence of hypoglycemia unawareness, and
  • presence of chronic complications of diabetes.

7.4Effect on functional ability to drive

Condition Type of driving impairment and assessment approach Primary functional ability affected Assessment tools
Severe hypoglycemia Episodic impairment: Medical assessment – likelihood of impairment All – sudden incapacitation Medical assessments

For individuals with diabetes, both acute and chronic complications of the disease may affect fitness to drive.

Hyperglycemia may cause blurred vision, confusion, and eventually diabetic coma.  For the purposes of this standard, these are considered transient impairments.

The neuroglycopenic symptoms associated with severe hypoglycemia can significantly impair the sensory, motor and cognitive functions required for driving.  There are studies that suggest that mild hypoglycemia may also impair these functions.

While it is clear that the risk of hypoglycemia is an important consideration when assessing the fitness of drivers with diabetes, research indicates that the chronic complications of diabetes are more likely to be responsible for impaired fitness to drive than episodic incidents of hypoglycemia.  Over time, people with diabetes often develop co-morbidities caused by their prolonged exposure to hyperglycemia.  These complications of diabetes include retinopathy, neuropathy, nephropathy, cardiovascular disease and peripheral vascular disease.  Therefore, the effect of chronic complications always must be considered when assessing fitness to drive for people with diabetes.

7.5Compensation

As severe hypoglycemia is an episodic impairment, a driver cannot compensate.

7.6Guidelines for Assessment

7.6.1 Type 2 diabetes - All drivers

  • treated with diet and exercise alone or
  • oral medication - non insulin secretagogues medication, i.e. metformin or,
  • oral medication - insulin secretagogues i.e. glyburide, diamicron, etc
National Standard

All drivers eligible for any licence class if

  • has good understanding if their condition
  • routinely follows their physicians instructions about diet, medication, glucose, glucose monitoring and  hypoglycaemia prevention
  • conditions for maintaining a licence are met
BC Guidelines
  • RoadSafetyBC will not generally request further information.
  • If further information is required, RoadSafetyBC may request
    • A Driver’s Medical Examination Report, or additional information from the treating physician
Conditions for maintaining licence
  • Report to RoadSafetyBC if they begin insulin therapy, and
  • remains under regular medical supervision to ensure that any progression in condition or development of chronic complications does not go unattended
  • stops driving and treat themselves immediately if hypoglycemia is identified or suspected
  • does not drive until at least 45 minutes after effective treatment if glucose level is between  2.5 and 4.0 mmol/L
Reassessment

If on Oral Medications and Non-Insulin Secretagogues

  • RoadSafetyBC will re-assess every five years, or in accordance with the schedule for routine commercial or age-related re-assessment
  • RoadSafetyBC will re-assess if insulin or insulin secretagogue therapy is initiated

If on Oral Insulin-Secretagogues

  • For Commercial Drivers, RoadSafetyBC will re-assess annually.
  • For Non-Commercial Drivers, if blood glucose levels and treatment are not stable, RoadSafetyBC will re-assess annually until levels and treatment are stable.  If blood glucose levels and treatment are stable, RoadSafetyBC will re-assess every five years or in accordance with the schedule for age related re-assessment
Information from health care providers Description of treatment
Rationale
  • Drivers with diabetes who are not treated with insulin or insulin secretagogues are at little or no risk for hypoglycemia.  Because diabetes is a progressive condition, these drivers must remain under medical supervision and undergo a reassessment at the discretion of the authority
  • Drivers who begin insulin therapy are required to report because of the significant increase in risk for hypoglycemia associated with insulin therapy.  The requirement to report is intended to ensure that drivers on insulin therapy meet the more stringent driver fitness standards and conditions for driving
  • Although there is some increased risk of hypoglycemia from the use of insulin secretagogues, the risk remains less than the risk from insulin therapy

7.6.2 Type 1 or type 2 diabetes treated with insulin - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • They understand their diabetic condition and the close interrelationship between insulin and diet and exercise, and
  • Routinely follow their physician's instructions about diet, medication, glucose monitoring, and hypoglycemia prevention and management
  • Conditions for maintaining a licence are met
BC Guidelines

If further information is required, RoadSafetyBC may request

  • a Driver’s Medical Examination Report, or
  • additional information from the treating physician
Conditions for maintaining licence
  • Remains under regular medical supervision to ensure that any progression in their condition or development of chronic complications does not go unattended
  • Stops driving immediately if hypoglycemia is identified or suspected
  • Does not drive when glucose level is below 4.0 mmol/L
  • Does not begin to drive when blood glucose level is between 4.0 and 5.0 mmol/L unless you first take prophylactic carbohydrate treatment
  • Does not drive until at least 45 minutes after effective treatment if glucose level is between 2.5 and 4.0 mmol/L
  • When on long drives, tests blood glucose immediately before driving and approximately every 4 hours while driving, and have an available source of rapidly absorbable glucose
Reassessment If blood glucose levels and treatment are not stable, RoadSafetyBC will re-assess annually until levels and treatment are stable. If blood glucose levels and treatment are stable, RoadSafetyBC will re-assess every five years, or in accordance with the schedule for age-related re-assessment
Information from health care providers
  • Description of treatment
  • Opinion of treating physician whether the driver understands their diabetic condition and the close interrelationship between insulin and diet and exercise
Rationale Drivers with diabetes who are treated with insulin therapy are at risk for hypoglycemia.  In addition to the conditions regarding how to avoid severe hypoglycemia while driving that apply to drivers treated with insulin secretagogues, there are additional conditions for checking and monitoring blood glucose.  These conditions are based on guidelines published by the Canadian Diabetes Association

7.6.3 Type 1 or type 2 diabetes treated with insulin - Commercial drivers

National Standard

Commercial driver eligible for a licence if

  • ·They obtain and retain an initial certificate of competency in blood glucose measurement from a specialist in diabetic care (when required) or a treating physician
  • Blood tests do not indicate uncontrolled diabetes, which are: hba1c > 12% or, > 10% of bg levels < 4.0 mmol/l
  • There is no significant change in insulin therapy (i.e. insulin was introduced , change in insulin type or number of injections) or, if there has been a significant change in therapy, monitoring and assessment indicate stable and effective blood glucose control
  • No evidence of inadequate blood glucose self-monitoring (unreliable or no home blood glucose measurement) or inadequate knowledge regarding causes, symptoms and treatment of hypoglycemia and,
  • Annual medical review
  • Conditions for maintaining a licence are met
BC Guidelines
  • On  Original Application  and Upgrade; or On Renewal/ Duplicate Licence Issuance if condition is reported for the FIRST TIME,  RoadSafetyBC will require
    • a Doctor’s Report on Commercial Driver with Diabetes on Insulin completed by the treating physician (see a sample form in 7.6.11). To complete this form, the individual must have the results of an HbA1C test taken within the previous 3 months
    • a Driver’s Report – Commercial Driver with Diabetes on Insulin completed by the applicant (see a sample form in 7.6.12), and
    • an Examination of Visual Function form (see a sample form in 22.7.4) completed by an optometrist or ophthalmologist, or the results of a vision examination including testing of visual fields completed within the previous year
  • The individual must have available for the treating physician
    • records of medical care for the previous 24 months for initial assessment and 12 months for re-assessment, and
    • a log of blood glucose measurements performed at least twice daily for the previous six months or since diagnosis if diagnosed less than six months previous
  • On subsequent driver medical examination folIow-ups, if further information is required, RoadSafetyBC may request any combination of the following
    • additional information from the treating physician
    • a Doctor’s Report on Commercial Driver with Diabetes on Insulin, OR
  • an Examination of Visual Function form completed by an optometrist or ophthalmologist
Conditions for maintaining licence
  • their work schedule is approved by their treating physician as compatible with their insulin regimen
  • carries a blood glucose self-monitoring equipment and an available source of rapidly absorbable glucose
  • tests blood glucose concentration 1 hour or less before driving and approximately every 4 hours while driving
  • doesn't begin or continue to drive if glucose level falls below 6 mmol/L (108 mg/dl), and doesn't resume driving until glucose level rises above 6.0 mmol/L after food ingested
Restrictions

RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with diabetes mellitus requiring insulin to treat

  • R 22 (Code W) Class 1-4 Invalid in USA
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers
  • Description of treatment
  • Whether the driver has an initial certificate of competency in blood glucose measurement from a specialist in diabetic care (when required) or a treating physician
  • Opinion of treating physician whether the driver’s work schedule is compatible with their insulin regimen
  • Whether blood tests indicate uncontrolled diabetes
  • Whether there has been a significant change in insulin therapy  If there has been a significant change in insulin therapy, whether monitoring and assessment indicate a stable and effective blood glucose control
  • Whether there is evidence of inadequate self-monitoring of blood glucose or inadequate knowledge of the causes, symptoms and treatment of hypoglycemic reactions
Rationale
  • Commercial drivers who are treated with insulin are at increased risk of experiencing hypoglycemia while driving.  This is due to both their high level of driving exposure and to the nature of the driving task, which may make it more difficult for them to manage their blood glucose
  • The standard is focused on ensuring that these drivers have stable blood glucose levels and that they understand their condition and are able to effectively monitor and manage their blood glucose

7.6.4 Episode of severe hypoglycemia - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • Treating physician indicates stable glycemic control re- established and authority determines are fit to drive. Time required to re-establish glycemic control varies individually
  • No further hypoglycemic episodes within past 6 months
  • Conditions for maintaining a licence are met
BC Guidelines
  • For episode less than 6 months - Driver fitness determinations will be made by nurse case managers.
  • For episode greater than 6 months - Driver fitness determinations will be made by adjudicators

If further information is required, RoadSafetyBC may  request:   

  • additional information from the treating physician
Conditions for maintaining licence
  • must test blood glucose immediately before driving and approximately every hour while driving
  • doesn't begin or continue to drive if blood glucose falls below 6.0 mmol/L and doesn't  resume driving until blood glucose rises above 6.0 mmol/L after food ingested
Reassessment

RoadSafetyBC will re-assess as recommended by the treating physician. At that time, if the treating physician indicates that there have been no episodes of severe hypoglycemia within the past six months, the application guidelines for private drivers with diabetes will apply

Information from health care providers
  • Date of the hypoglycemic episode
  • Opinion of treating physician whether stable glycemic control has been re-established
Rationale Severe hypoglycemia indicates a lack of glycemic control and the potential for further hypoglycemic episodes.  Once control is re- established and driving resumes, more stringent glucose monitoring conditions are required temporarily to mitigate the increased risk of hypoglycemia

7.6.5 Episode of hypoglycemia unawareness within past year - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • Has been 3 months since the episode
  • Treating physician indicates glycemic awareness regained and have stable glycemic control
  • Conditions for maintaining a licence are met
BC Guidelines
  • For episode less than 6 months - Driver fitness determinations will be made by nurse case managers.
  • For episode greater than 6 months - Driver fitness determinations will be made by adjudicators.

If further information is required, RoadSafetyBC may  request:  

  • additional information from the treating physician
Conditions for maintaining licence
  • Must test blood glucose immediately before driving and approximately every hour while driving
  • Doesn't begin or continue to drive if blood glucose falls below 6.0 mmol/L and doesn't resume driving until blood glucose rises above 6.0 mmol/L after food ingested
Reassessment RoadSafetyBC will re-assess in one year. At that time, if the treating physician indicates that there have been no further episodes of hypoglycemia unawareness within the past year, the conditions listed above will be removed and the applicable guidelines for private drivers with diabetes will apply
Information from health care providers
  • Date of the episode
  • Opinion of treating physician whether glycemic awareness has been regained
  • Opinion of treating physician whether the driver has stable glycemic control
Rationale Hypoglycemia unawareness greatly increases the risk for hypoglycemia while driving.  This standard requires that glycemic awareness be re-established before driving resumes.  Once awareness and glucose stability are re-established, more stringent glucose monitoring guidelines are required temporarily to mitigate the increased risk of hypoglycemia

7.6.6 Persistent hypoglycemia unawareness - Non-commercial drivers

National Standard

Non-commercial drivers eligible for a licence if

  • It has been 3 months since the last episode of hypoglycemia
  • Treating physician indicated stable glycemic control and takes steps to ensure they do not become hypoglycemic while driving
  • Conditions for maintaining a licence are met
BC Guidelines
  • Driver fitness determinations will be made by nurse case managers

If further information is required, RoadSafetyBC may  request  

  • additional information from the treating physician
Conditions for maintaining licence
  • retains blood glucose log and reviews with treating physician at intervals physician feels necessary to monitor continued glycemic control
  • tests blood glucose levels immediately before driving and approximately every hour while driving
  • doesn't begin or continue to drive if blood glucose level falls below 6.0 mmol/L and doesn't resume driving until blood glucose rises above 6.0 mmol/L after food ingested
Reassessment
  • RoadSafetyBC will re-assess annually
  • If the treating physician indicates on two consecutive annual re-assessments that
    • awareness has been regained, and
    • there have been no episodes of hypoglycemia unawareness within the past year
    • the conditions listed above will be removed and the applicable guidelines for private drivers with diabetes will apply
Information from health care providers
  • Date of the last episode
  • Opinion of treating physician whether stable glycemic control has been re-established
  • Opinion of treating physician whether driver is willing and able to take steps to ensure they do not become hypoglycemic while driving
Rationale Persistent hypoglycemia unawareness presents the greatest risk for hypoglycemia while driving.  The standard permits non-commercial drivers to continue to drive provided they are able to maintain stable blood glucose levels and follow more stringent glucose monitoring requirements

7.6.7 Episode of severe hypoglycemia - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • Treating physician indicates stable glycemic control re- established and authority determines are fit to drive. Time required to re-establish glycemic controls varies individually
  • No further hypoglycemic episodes within past 6 months
  • Conditions for maintaining a licence are met
BC Guidelines
  • For episode less than 6 months - Driver fitness determinations will be made by nurse case managers.
  • For episode greater than 6 months - Driver fitness determinations will be made by adjudicators

If further information is required, RoadSafetyBC may request: 

  • additional information from the treating physician; or
  • a Doctor’s Report on Commercial Driver with Diabetes on Insulin completed by the treating physician  
Conditions for maintaining licence
  • driver provides treating physician with blood glucose log of at least 4 readings per day for 30 days, where less than 5% of readings are below 4.0 mmol/L
  • must test blood glucose immediately before driving and approximately every hour while driving
  • doesn't begin or continue to drive if blood glucose falls below 6.0 mmol/L and doesn't  resume driving until blood glucose rises above 6.0 mmol/L after food ingested
Reassessment RoadSafetyBC will re-assess annually
Information from health care providers
  • Date of the hypoglycemic episode
  • Opinion of treating physician whether stable glycemic control has been re-established
  • Statement from treating physician that driver has provided a blood glucose log of at least 4 readings per day for 30 days, in which less than 5% of the readings are below 4.0 mmol/L
Rationale Severe hypoglycemia indicates a lack of glycemic control and the potential for further hypoglycemic episodes.  Once control is re- established and driving resumes, more stringent glucose monitoring conditions are required temporarily to mitigate the increased risk of hypoglycemia

7.6.8 Episode of hypoglycemia unawareness in the last year - Commercial drivers

National Standard

Commercial drivers eligible for a licence if

  • has been 3 months since the episode
  • treating physician indicates glycemic awareness regained, has stable glycemic control and authority determines are fit to drive
  • conditions for maintaining a licence are met
BC Guidelines
  • For episode less than 6 months - Driver fitness determinations will be made by nurse case managers
  • For episode greater than 6 months - Driver fitness determinations will be made by adjudicators

If further information is required, RoadSafetyBC may request

  • additional information from the treating physician; or
  • a Doctor’s Report on Commercial Driver with Diabetes on Insulin completed by the treating physician
Conditions for maintaining licence
  • driver provides treating physician with blood glucose log of at least 4 readings per day for 30 days, where less than 5% of readings are below 4.0 mmol/L
  • must test blood glucose immediately before driving and approximately every hour while driving
  • doesn't begin or continue to drive if blood glucose falls below 6.0 mmol/L and doesn't resume driving until blood glucose rises above 6.0 mmol/L after food ingested
Reassessment RoadSafetyBC will re-assess in one year. At that time, if the treating physician indicates that there have been no episodes of hypoglycemia unawareness within the past year, the conditions listed above will be removed and the applicable guidelines for commercial drivers with diabetes will apply
Information from health care providers
  • Date of the episode
  • Statement from treating physician that driver has provided a blood glucose log of at least 4 readings per day for 30 days, in which less than 5% of the readings are below 4.0 mmol/L
  • Opinion of treating physician whether glycemic awareness has been regained
  • Opinion of treating physician whether the driver has stable glycemic control
Rationale Hypoglycemia unawareness greatly increases the risk for hypoglycemia while driving.  This standard requires that glycemic awareness be re-established before driving resumes.  Once awareness and glucose stability are re-established, more stringent glucose monitoring guidelines are required temporarily to mitigate the increased risk of hypoglycemia

7.6.9 Persistent hypoglycemia unawareness - Commercial drivers

National Standard Commercial drivers not eligible for a licence
BC Guidelines RoadSafetyBC will not generally request further information
Conditions for maintaining licence N/A
Reassessment N/A
Information from health care providers N/A
Rationale Persistent hypoglycemia unawareness presents the greatest risk for hypoglycemia while driving.  Given the increased driving exposure associated with commercial driving, individuals who have persistent hypoglycemia unawareness are not fit to drive

7.6.10 Summary table of diabetes conditions and driver medical standards

Type II Standard
Non-Commercial Eligible for licence
Commercial Eligible for licence
Type I or Type II Insulin-Treated Standard
Non-Commercial Eligible for licence
Commercial

Eligible for licence

  • Annual Medical
  • Treating physician confirms diabetes controlled
Severe Hypoglycemia Episode Standard
Non-Commercial

Eligible for licence

  • no episodes within past 6 months,
  • Treating physician confirms stable glycemic control
Commercial

Eligible for licence

  • no episodes within past 6 months,
  • Treating physician confirms stable glycemic control
Episode of Hypoglycemic Unawareness Standard
Non-Commercial

Eligible for licence

  • No episode in past 3 months,
  • Treating physician confirms glycemic awareness regained
Commercial

Eligible for licence

  • No episode in past 3 months,
  • Treating physician confirms glycemic awareness regained
Persistent Hypoglycemic Unawareness Standard
Non-Commercial

Eligible for licence

  • No episode of hypoglycemia within past 3 months,
  • Treating physician confirms stable glycemic control
Commercial Ineligible to Drive

7.6.11 Doctor's report on commercial driver with diabetes on insulin

copy of doctors report on commercial drivers with diabetes on insulin

copy of doctors report on commercial drivers with diabetes on insulin back

7.6.12 Driver's report - Commercial drivers with diabetes on insulin

copy of drivers report - commercial drivers with diabetes on insulin