What is your responsibility when it comes to driving?
Thursday, 21 February 2019
When you have been diagnosed with diabetes there seems to be so much information to understand and absorb. Finding clear and concise answers to questions regarding your health isn’t always straightforward. Trying to understand what your rights and responsibilities are regarding driving and diabetes is a perfect example.
Driving when you live with a chronic condition
Driving a motor vehicle brings with it major personal and legal responsibilities. It is a complex skill that requires both mental and physical ability; therefore, having a condition that may impair one’s ability to carry out this skill is a road safety consideration.
Diabetes is listed as a chronic medical condition that may affect your driving ability.
The main areas of concern are either severe hypoglycaemia (dangerously low blood glucose requiring help from another person) or long-term complications that effect vision, the heart, and nerves (particularly in the feet). With long term diabetes-related complications, there may be, for example, vision impairment or numbness in the feet, which affects the ability to see other vehicles on the road or feel the vehicle pedals, therefore reducing the ability to operate a vehicle safely. This places oneself and others at risk. Having systems in place to make sure each and every one of us are fit to drive is essential.
What do I have to do?
When you are diagnosed with diabetes your GP will conduct an assessment of your health to ensure you have no conditions that may affect your ability to drive. They will check your vision, for example, to ensure there are no complications that may make driving unsafe. If your GP is concerned you may be unsafe to drive you may be required to advise the Department of Transport.
Are you over 75 years of age? If you recently made it to the exclusive 75+ club then it is your responsibility to carry a Medical Certificate for Motor Vehicle Driver form (F3712). This form is available online, at Transport and Motoring Service Centres or at police stations in rural and remote areas. You are required to visit your GP every year and have this certificate reviewed.
The next question to ask yourself is, “How are you currently treating your diabetes?”
Below is three possible options to choose from. Select whichever option most closely fits with your current diabetes management.
Option A. I treat my diabetes with diet, exercise and lifestyle alone.
If you are currently managing your diabetes through healthy lifestyle measures, don’t have any known conditions discussed in step 1 and currently are not requiring either medications or insulin, you are not required to notify the Department of Transport in Queensland. This information is valid for both private and commercial licences.
Option B. I treat my diabetes by taking glucose lowering medication (not including insulin).
For those living with diabetes who are currently taking glucose-lowering medications (both oral and injectable), you may be required to contact the Department of Transport. Your GP will be the person to make recommendations if you need to and this will often depend on the type of oral medication and if it causes hypoglycaemia.
For a private licence this requires only a five-yearly review for your non-conditional licence. Your GP will ask you questions if you are at risk of having hypoglycaemia. With oral and injectable medications excluding insulin, hypos are generally only a risk with diabetes if you are taking a certain class of medications called Sulphonylureas.
For commercial licences you are also required to contact the Department of Transport and will require an annual review with a treating doctor (when taking Metformin alone) or a specialist (Endocrinologist/Consultant Physician specialising in diabetes) depending on the type of medication you are on.
Option C. I treat my diabetes by using insulin.
For those who are using insulin to manage their diabetes, for both private and commercial licenses, the Department of Transport must be notified. For private licences, your treating doctor will conduct two-yearly reviews, while for commercial licences a specialist needs to perform an annual review.
When taking insulin you are at risk of hypoglycaemia. Hypoglycaemia affects your ability to drive at that moment (and for 30 minutes after a hypo), because there is a lack of glucose getting to the brain reducing the ability for the brain function properly, let alone operate a vehicle.
Checking your glucose level before driving is recommended to assist in avoiding a hypo. Taking hypo treatment and snacks in your car is recommended for unforeseen circumstances, like traffic jams.
If you do experience a severe hypo (where you need another person to assist with treatment) there is a significant period of time where you should not drive.
According to the Assessing Fitness to Drive document, the minimum time before returning to driving is often six weeks. It can often take many weeks to re-establish safe patterns of glucose levels and you may have a reduced awareness of hypos. This period of time is determined by the treating specialist.
- Driver assessments
Occasionally your GP may require you to undertake a driver assessment to help determine if you are fit to drive. This is conducted by an occupational therapist and will incur a fee which is your own responsibility to pay. For more information on this please contact Occupational Therapy Australia on (07) 3852 6755 or email firstname.lastname@example.org.
It is highly recommended to inform your motor vehicle insurer when you are diagnosed with diabetes. If you choose not to report this, you may have issues in the future with insurance claims.
GPs are required to look at an individual’s diabetes management holistically before making a decision regarding one’s fitness to drive, while addressing an extended hyperglycaemic state (high blood glucose levels generally above 15mmol/l).
- 5 to drive – where does this fit?
“Above 5 To Drive” was a guideline originally published in 2011 by a working party from the Australian Diabetes Society and the Australian Diabetes Educators Association and funded by the National Diabetes Services Scheme. It was developed to create an awareness for people living with diabetes that if they were at risk of hypoglycaemia, then having blood glucose levels above 5mmol/L before they get in the car is a priority and a matter of safety.
As has been mentioned in this article, not all people living with diabetes are at risk of hypoglycaemia. Being 5 to Drive is relevant for those who take a class of medication called Sulphonylureas or inject insulin for the management of their diabetes.
Take home message
You may have the sense, after reading this article, that the answers to your questions are not black and white or straightforward.
If you still have doubts about what you are required to do in your situation we recommend you speak with your trusted GP or contact the Diabetes Queensland Helpline on 1300 136 588 to speak with a health professional informed on this topic.
Austroads & National Transport Commission (2016). Assessing fitness to drive. Retrieved 20th Dec, 2019 from https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/17bc68dd-2414-496c-86fe-dcd5d689882e.pdf
Queensland Government (2018). Safe driving. Retrieved 20th Dec, 2019 from https://www.qld.gov.au/seniors/transport/senior-drivers/safe-driving
Queensland Government (2018). Medical fitness to drive. Retrieved 20th Dec, 2019 from https://www.qld.gov.au/transport/licensing/update/medical/fitness
By Linda Uhr, Accredited Practising Dietitian and Diabetes Educator