Driving when on insulin or medications that increase the risk of hypoglycaemia

Driving with Diabetes

Having diabetes is not an issue for driving in Ireland but there are important rules and medical requirements, especially for those treated with insulin or medications that increase the risk of hypoglycaemia (low blood sugar) that you must meet. These regulations are in place to ensure both road safety and the well-being of you as a driver.

For more information on the early signs of hypoglycaemia and precautions to manage you condition and drive safely see the NDLS Diabetes and Driving Booklet Diabetes-and-Driving-Updated-jg-191124.pdf

When applying or renewing your driving licence, you must:

declare your diabetes to the NDLS (National Driver Licence Service)
inform NDLS if your treatment changes significantly or you have had recent severe hypoglycaemia episode (requiring third-party help in the past 12 months and;
you may need to supply a medical report initially and at renewal, depending on your treatment. This certification can be obtained from your Consultant (if you attend a hospital diabetes centre) or your General Practitioner. There may be a cost associated with completion of the medical report.

You must also inform your motor insurance company that you have diabetes but this will not affect the cost of your insurance policy. Failure to declare a relevant medical condition can affect your insurance and may be a legal offence.

Driving licences shall not be issued to, or renewed, for applicants or drivers who have recurrent severe hypoglycaemia, unless supported by the opinion of a specialist physician registered on the specialist register for Endocrinology & Diabetes Mellitus of the Medical Council and regular medical assessment.

For such recurrent severe hypoglycaemias during waking hours a licence shall not be issued or renewed until at least 3 months after the most recent episode. Driving licences may be issued or renewed in such exceptional cases, provided that it is duly justified by an opinion a specialist physician registered on the specialist register for Endocrinology & Diabetes Mellitus of the Medical Council and subject to regular medical assessment, ensuring that the person is still capable of driving the vehicle safely taking into account the effects of the medical condition.

Further information on RSA Guidelines for driving with diabetes can be found on pages 70-75 of Sláinte_Tiomáint_2025_WEB.pdf

Remember You Must Not Drive If:

You are experiencing severe hypoglycaemia
Your blood sugar is too low to concentrate or react safely
You’ve recently had a loss of awareness of hypoglycaemia

Safe Driving with Diabetes – Key Responsibilities

Monitor blood glucose before and during long journeys
Do not drive if your blood sugar is below 5 mmol/L
Always carry:
- Fast-acting glucose (e.g. glucose tablets or juice)
- Your blood glucose meter or CGM
- Identification stating you have diabetes

This is a reasonable summary of entitlements for people with diabetes. The information provided is for guidance only, please refer to the official sites for full details.

DI-

DRIVING AND TYPE 1 DIABETES

Having Type 1 diabetes is not an issue for driving but you must inform the National Driving Licence Service (NDLS) that you have diabetes that is treated with insulin. You must also inform your motor insurance company that you have Type 1 diabetes but this will not affect the cost of your insurance policy.

NDLS contact details: Tel (076) 1087 880 Email: info@ndls.ie Website www.ndls.ie.

See the NDLS Diabetes and Driving Booklet 2022 here

For further information, see the NDLS Medical Fitness to Drive Guidelines here

The fact that you are using medication that leaves you at risk of hypoglycaemia means you must take extra precautions.

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. Accidents caused by hypoglycaemia are because drivers carry on driving even though they get warning symptoms of hypoglycaemia occurring. If you get warning symptoms of hypoglycaemia whilst driving, you must always stop as soon as safely possible – do not ignore the warning symptoms.

If you are at risk of hypoglycaemia:

Drivers 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 and take appropriate action to correct glucose level.
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.

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 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, Lucozade 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.

You must also inform National Driver Licence Service when renewing your licence:

If you have suffered more than one episode of severe hypoglycaemia within the last 12 months. You must also tell us if you or your medical team feel you are at high risk of developing severe hypoglycaemia.
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 don’t meet the vision standards set out in these Guidelines (See Chapter 7 of Sláinte agus Tiomáint; Medical Fitness to Drive Guidelines for eyesight standards).
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.
If your doctor, specialist or optician tells you to report your condition to the National Driver Licence Service.

For people seeking a HGV licence (Group 2 drivers for bus/lorry) all of the above apply but in addition any episode of severe hypoglycaemia must be reported immediately.
In the interests of road safety, you must be sure that you can safely control a vehicle at all times.

Renewing your licence for a Class 1 licence – Cars and Motor Cycles

Each time a person with insulin treated diabetes wishes to renew their driving licence, they must present a completed medical form (completed within the previous month) stating their fitness to drive. If the medical standards as outlined in the medical fitness to drive guidelines are met a 1–3-year licence may be issued. Diabetes Ireland acknowledges that the shorter duration of licence imposes additional costs and are seeking the implementation of alternative practices.

Renewing your licence for a Class 2 licence – Trucks, Buses and Trailer Vehicles

As you are on medication (insulin) that leave you at risk of hypoglycaemia, you must present a completed medical form (completed within the previous month) stating your fitness to drive. If the medical standards as outlined in the medical fitness to drive guidelines are met a 1 year licence may be issued. The duration of the license is dependent on having appropriate understanding and awareness of hypoglyceamia, no episodes of “severe” hypoglyceamia, and you must demonstrate regular monitoring (at least twice daily and regularly at times relevant to driving) using a meter with memory capacity. For your medical review, you must have three month’s blood glucose readings.

Qualifying Conditions which also must be met include:

No episode of hypoglycaemia requiring the assistance of another person has occurred in the preceding 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 your condition has been stable for a period of at least one month.
Must regularly monitor your condition by checking your 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 you a danger when driving Group 2 vehicles.
You will be required to comply with the directions of doctors(s) treating your diabetes and to report immediately to the NDLS any significant change in your condition.

Medical Report

Guidelines from the Road Safety Authority (RSA) and the Royal College of Physicians of Ireland (RCPI) state that a driving licence application must be accompanied by a medical report form filled out by your doctor. See the following link for more information

Link: https://www.ndls.ie/medical-fitness/do-i-need-to-submit-a-medical-report.html

Interstitial Glucose Monitoring

In August 2019 the road safety authority medical fitness to drive guidelines were amended to recognise interstitial glucose monitoring for driving in certain circumstances.

For Group 1 drivers (car motorcycle, tractor), flash glucose monitoring such as Libre and continuous glucose monitoring devices can be used to monitor glucose levels prior to and during driving. Users of these devices however, must also carry a finger prick glucose monitor while driving as there may be times when it is necessary to confirm a blood glucose level such as when the glucose level is 4mmol/L or less, when the driver experiences symptoms of a hypo, or when symptoms that are experienced by the driver are not consistent with the readings displayed on the reader/continuous glucose monitor.

Group 2 licence drivers must continue to monitor glucose readings using a finer prick glucose monitor prior to and during driving. There is also a legal requirement for group 2 drivers to produce past blood glucose results data when attending for medical reviews prior to having their licences renewed.

For more information see the following link Pg 70-77

Link: https://www.ndls.ie/images/PDF_Documents/NDLS_Sla%CC%81inte_&_Tioma%CC%81int_2022_v8.pdf

Eyesight

See Chapter 7 of medical fitness to drive standards for visual disorders

https://www.ndls.ie/images/PDF_Documents/NDLS_Sla%CC%81inte_&_Tioma%CC%81int_2022_v8.pdf

Limb Problems

Limb problems/amputations are unlikely to prevent driving. They may be overcome by driving certain types of vehicles e.g. automatics or one with hand controls.

Please note: The above is taken from Driving Guidelines for people with Diabetes – source: Medical guidelines “Sláinte agus Tiomáint; Medical Fitness to Drive Guidelines”.

Read full guidelines report: https://www.ndls.ie/images/PDF_Documents/NDLS_Sla%CC%81inte_&_Tioma%CC%81int_2022_v8.pdf

NDLS Diabetes and Driving Booklet 2022, click here.

DRIVING AND TYPE 2 DIABETES

Having diabetes is not an issue for driving but if you are taking medications that leave you at risk of hypoglycaemia you must take extra precautions and you must inform the National Driver Licence Service.

CHECK WITH YOUR PHARMACIST IF YOUR MEDICATIONS LEAVE YOU AT RISK OF HYPOGLYCEAMIA e.g. Insulin or Sulphonylureas such as Gliclazide (Diamicron®) or generic versions such as Diabrezide, Diaglyc, Diacronal MR, Diaclide MR, Gliclazide, Zycron MR.or the post prandial regular Nateglinide (Starlix®).

If you are not at risk of hypoglycaemia you do not need to inform the National Driver Licence Service (NDLS). Medicine regimes change therefore remember to tell the NDLS if you start any of the medications that increase the risk of hypoglyceamia.

Drivers at risk of hypoglycaemia 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 and take appropriate action to correct glucose level.
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, Lucozade 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.

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 medications that increase your risk of hypoglycaemia (see list above). This may endanger your own life as well as that of other road users. Accidents caused by hypoglycaemia are because drivers carry on driving even though they get warning symptoms of hypoglycaemia occurring. 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.

You must also inform National Driver Licence Service when renewing your licence:
• If you have suffered more than one episode of severe hypoglycaemia within the last 12 months. You must also tell us if you or your medical team feel you are at high risk of developing severe hypoglycaemia.

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 don’t meet the vision standards set out in these Guidelines (See Chapter 7 of Sláinte agus Tiomáint Medical Fitness to Drive Guidelines
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.
• If your doctor, specialist or optician tells you to report your condition to the National Driver Licence Service.

For people seeking a HGV licence (Group 2 drivers for bus/lorry) all of the above apply but in addition any episode of severe hypoglycaemia must be reported immediately.

In the interests of road safety, you must be sure that you can safely control a vehicle at all times.

Diabetes & Roadside Drug Testing

Some diabetes medications e.g.. Metformin may cause a positive drug screening result however, the positive result is not an offence as in this case the medication is prescribed and a positive test is not an offence unless accompanied by impaired ability to drive. Download Medicines and Driving for more information or talk to your prescribing doctor

Tip

Carry some identification of the medication you are taking e.g. take a photo of the prescription or a letter from the pharmacist stating what your medicines are prescribed for.

Renewing your licence for a Class 1 licence – Cars and Motor Cycles
Each time a person with diabetes at risk of hypoglycaemia wishes to renew their driving licence, they must present a completed medical form (completed within the previous month) stating their fitness to drive. The duration of the medical certification of fitness to drive will determine the duration of licence you can apply for. If you are on medication that can potentially cause hypos, and you meet the medical standards as outlined in the medical fitness to drive guidelines a 1-3 year licence will be issued. Diabetes Ireland acknowledges that the shorter duration imposes additional costs and is seeking the implementation of alternative practices.

Renewing your licence for a Class 2 licence – Trucks, Buses and Trailer Vehicles
Only an issue if you are at risk of hypoglycaemia, which requires you to present a completed medical form (completed within the previous month) stating your fitness to drive. The duration of the license is one year and is dependent on having appropriate understanding and awareness of hypoglyceamia, no episodes of “severe” hypoglyceamia, and you must demonstrate regular monitoring (at least twice daily and regularly at times relevant to driving) using a meter with memory capacity. For your medical review, you must have three month’s blood glucose readings. Qualifying Conditions which also must be met include:

No episode of hypoglycaemia requiring the assistance of another person has occurred in the preceding 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 your condition has been stable for a period of at least one month.
Must regularly monitor your condition by checking 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 you a danger when driving Group 2 vehicles.
• You will be required to comply with the directions of doctors(s) treating your diabetes and to report immediately to the NDLS any significant change in your condition.

Medical Report

Link: https://www.ndls.ie/medical-fitness/do-i-need-to-submit-a-medical-report.html

Eyesight

See Chapter 7 of medical fitness to drive standards for visual disorders

Link: https://www.ndls.ie/images/PDF_Documents/NDLS_Sla%CC%81inte_&_Tioma%CC%81int_2022_v8.pdf

Limb Problems

Limb problems/amputations are unlikely to prevent driving. They may be overcome by driving certain types of vehicles e.g. automatics or one with hand controls.

Please note: The above is taken from Driving Guidelines for people with Diabetes – source: Medical guidelines “Sláinte agus Tiomáint; Medical Fitness to Drive Guidelines”.

Read full report: https://www.ndls.ie/images/PDF_Documents/NDLS_Sla%CC%81inte_&_Tioma%CC%81int_2022_v8.pdf

Diabetes and driving leaflet 2022

HSE-

Driving with type 2 diabetes

You can drive if you have type 2 diabetes. But there are things you should do before you drive.

Managing insulin-treated diabetes and driving (PDF, 1MB, 12 pages)

Tell the National Driver Licence Service (NDLS)

Information:

You need to tell the NDLS if you have type 2 diabetes and you are taking insulin or medicines which may cause hypoglycaemia (hypo).

You do not need to tell the NDLS if your type 2 diabetes is managed by diet alone, or with medicine which does not put you at risk of a hypo.

Ask your doctor or pharmacist if you are at risk of hypo.

Informing the NDLS about a medical condition – ndls.ie

Car insurance and type 2 diabetes

You must tell your car insurance company that you have type 2 diabetes. Most car insurance companies will not charge you more if you have diabetes.

If you think you are being discriminated against, speak to your insurance company.

Driving advice if taking insulin or diabetes medicines that put you at risk of hypo

It is very important you:

prepare yourself for any journey
make sure you are safe to drive

This is a legal obligation if you are at risk of hypo.

What to carry with you while driving

Always carry your glucose meter and blood glucose strips with you. Check your blood glucose before driving and every 2 hours while driving.

Always carry ID to show that you have diabetes in case of injury in a road traffic accident.

Measure your blood glucose

If your blood glucose is 5mmol/l or less, have a carbohydrate snack.

If it is less than 4mmol/l or you feel hypoglycaemic, do not drive. Take suitable action and then test yourself again to make sure your blood glucose is above 5.1mmol/l.

Stop driving if you feel hypo

If you develop hypoglycaemia while driving, stop your vehicle as soon as possible.

Wait 45 minutes

Switch off the engine, take the keys out of the ignition, and move from the driver’s seat.

Do not drive again until 45 minutes after your blood glucose level has returned to normal. It takes up to 45 minutes for the brain to recover fully.

Keep carbs in the car

Keep an emergency supply of fast-acting carbohydrates (for example, glucose tablets or sweets) within easy reach in your vehicle.

Take breaks and eat regularly

Always take regular meals, snacks and rest periods at least every 2 hours on long journeys.

Avoid drinking and driving

Always avoid alcohol.

Type 1

Check you’re safe to drive

When you are driving:

always carry your blood glucose meter and strips with you
carry ID to show you have diabetes in case of an accident
never drink and drive
make sure your blood glucose meter displays the correct time and date so you have a record

If you get the warning symptoms of a hypo whilst driving, you must always stop as soon as it is safe to do so. Do not ignore the warning symptoms.

If your blood glucose is 5 millimoles per litre (mmol/l) or less, have a snack.

If it is less than 4mmol/l or you feel hypoglycaemic (low blood glucose), do not drive.

Legal requirements for driving with type 1 diabetes

Legally, if you have diabetes and you drive you need to:

check your blood glucose is above 5mmol/l before driving
check your blood glucose every 2 hours if you’re on a long journey
carry a glucose meter, hypo treatment and carbohydrate snacks like a cereal bar or banana when driving

How to check your blood glucose levels

If you feel your levels are low: