Have you ever wondered what the exact rules are, when it comes to diabetes and driver's license restrictions? We sure do, every time news stories pop up about unsafe driving involving PWDs (people with diabetes).
We looked into this, and essentially learned that state laws differ; a comprehensive review by the American Diabetes Association (ADA) a few years ago shows that roughly half the states at the time had no required restrictions, while the other half had restrictions that were enacted into law.
Before we get into the specific laws, I'd like to share the fact that twice in my own life, I've gone low while driving and experienced dangerous scares that made me question whether I should even have a license and be on the road at all.
The first was in my late teens not long after my high school graduation in 1997, long before I became an insulin pumper. I ended up swerving on the road and eventually getting pulled over by police in a parking lot. Thankfully, no accident occurred and no one was hurt.
The second incident was about a decade ago, still before my CGM (continuous glucose monitoring) days. As a result of a fast-dropping blood sugar that didn't show itself with an in-the-moment fingerstick at work, I had a "sudden" hypo that led me wandering from my office in a daze into the parking garage. I apparently climbed into my my red Ford Escape and began driving towards home. I ended up in front of my subdivision in a ditch, after taking out a street sign with my car. Luckily (incredibly so!), no one was injured that time either. The latter inspired me to get a CGM, and ever since, I've not been behind the wheel without knowing where my blood sugars stand.
While all of that motivated me to make some changes in the name of safety, I've still never been forced to go through a medical review to renew my driver's license, and have never been discriminated against -- which not all PWDs can say.
So just what are the official rules here?
Road Rules for Diabetes, State By State
As with most things in life and in diabetes, your specifics may vary depending on where you call home.
For example in my state of Michigan, the law's pretty limited. The forms require only that a person indicate whether they've had any any medical issues or specific instances of unconsciousness in the past six months. If so, you are required to get a doctor's evaluation saying you're OK to drive.
Previously, while I was living in Indiana, the state law was even more broadly worded to ask if the driving applicant is "subject to fainting spells or seizures of any kind, or has a condition that makes him or her appear intoxicated." Because I'd had a past experience there of going low behind the wheel, I always had an endo's note on file saying I was OK to drive -- but fortunately, this stated restriction never actually came up when I was renewing my license.
Other states actually require medical evaluations and/or agency reviews if an applicant has a history of health issues or demonstrates the potential for such. California puts the requirement at the past five years of any issue while driving, while New York is one of the most strict, requiring applicants to report whether they have EVER received treatment or taken meds for a "condition which causes unconsciousness or unawareness." Well, yeah... hello, insulin! In that state, you must adhere to a medical evaluation and review before getting a license.
Many of these laws are at least a few years old, if not more, and the ADA doesn't appear to regularly update its driving and diabetes state law page. In 2012, the org published its first-ever position statement focused on driving with diabetes and that remains the group's go-to response to questions about this issue currently. The six-page document advises against "blanket bans or restrictions." Rather, the organization recommends that individual PWDs who might pose a driving risk (hypoglycemic unaware?) be assessed by an endocrinologist.
The ADA also offers an online tool -- dubbed the Risk Assessment for Diabetic Drivers (RADD) test -- for the D-Community to use in gauging whether they might be subject to driver's license restrictions. It focuses on the past two years specifically for any diabetes or related issues that might impact a PWD behind the wheel. I took the test and scored an "Average Risk," meaning I may be subject to some additional limitations but good to know I'm not a high risk these days! Whew...
Oh and just in case you were wondering about how the rest of the world outside the USA deals with driver's license regulations -- a global survey published earlier in 2017 examined the regulations in 85 countries worldwide, finding roughly 70% have no limitations while the rest do in varying degrees.
Here's a synopsis of that study:
Another interesting study from the EU back in 2014 found that more PWDs were not reporting hypos to their healthcare professionals as a result of stricter driving rules passed in 2012. That may be something to chew on here in the U.S., where our individual state rules vary so much. Are PWDs hiding the BG control issues they're having in order not to be penalized when it comes to driving?
Of course, none of this delves into those pursuing commercial driver's licenses or even airplane pilot wannabes -- just the more general every-day experiences PWDs face on the highways and streets in their own personal vehicles.
ADA Driving Updates?
We reached out to the ADA to get the skinny on the current state of affairs on driving with diabetes, and were told that not much has significantly changed on a national level over the past five years. Sure, there have been some individual attempts in different states to change the laws, but nothing rising to the level of a national advocacy campaign or media story.
When it comes to the notion of driver discrimination, the Association says they
"have not evaluated changes in a manner that could provide insight on this. Courtney Cochran, the ADA's senior media relations manager tells us, "Our Legislative & Regulatory priorities allow us to engage on efforts that would be harmful to people with diabetes, and we are actively working on federal commercial driving rulemaking."
We wondered if the increase in CGM use over the years and big push to go #BeyondA1C in looking at diabetes management plays into this issue, but the ADA wasn't able to offer much insight there. Cochran says, "It’s difficult to comment on situations that only exist hypothetically. The Association will continue to support changes that will ensure fair treatment for people with diabetes, and voice concerns over any efforts that might be harmful."
You're in the Driver's Seat!
So where does that leave the typical PWD on the road or wondering about these issues, or coming up to the time for a new driver's license or renewal? Safety pretty much comes down to common sense:
- Check your blood sugar before starting any commute. If it's 70 mg/dL or lower, eat or drink something that will raise it quickly. Then wait until your blood sugar is back to normal before starting the drive.
- Always have fast-acting glucose and snacks or drinks in the vehicle -- not to mention blood sugar testing supplies close by.
- Follow all the advice that goes along with D-Management 101, such as being aware of meal and exercise or insulin changes that could impact BG levels and throw off your safe driving.
- CGMs are a great tool for staying safe on the road that many have these days (but certainly not all have access to one).
These are safety tips for any PWD behind the wheel, but clearly they're even more critical for those who might be driving as part of their job.
In my world, diabetes accidents sometimes happen, so I want every possible tool to help keep me safe and to protect others on the road. I think of that as my absolute responsibility of having the privilege to possess a driver's license.
Yes, the privilege. If I'm not willing to take every precaution to assure that my possible hypo brain won't cause harm, then I shouldn't be out driving in the first place. Right?