Diabetes and Driving: Staying safe on the road without losing independence

By Dr. Tariq Jagnarine
Fam Med, Endocrinology/Diabetes

For many people, driving represents freedom, independence, and livelihood. For individuals living with diabetes, however, driving also comes with unique responsibilities that are often misunderstood or ignored. Diabetes itself does not prevent someone from driving, but poorly- controlled blood sugar can impair judgment, reaction time, and consciousness, creating serious risks for both the driver and the public.
Across Guyana and the wider Caribbean, diabetes rates continue to rise. As more people of working age live with the condition, understanding how diabetes interacts with driving safety has become an important public-health issue, not one of restriction, but of awareness, preparation, and responsibility.

Why diabetes and driving are connected
Driving requires constant alertness, coordination, quick decision-making, and visual accuracy. Diabetes can interfere with these abilities primarily through fluctuations in blood sugar levels, especially hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar).
Low blood sugar is the greatest immediate danger when driving. It can develop suddenly and may lead to confusion, blurred vision, slowed reactions, dizziness, or even loss of consciousness. High blood sugar, especially when prolonged, can also cause fatigue, poor concentration, dehydration, and visual disturbance. In both cases, driving becomes unsafe.

Understanding hypoglycaemia: The biggest risk on the road
Hypoglycaemia occurs when blood sugar falls too low, often due to:
• Skipping or delaying meals
• Taking too much insulin or diabetes medication
• Increased physical activity without food
• Alcohol consumption
• Long drives without breaks
Early-warning signs include sweating, shaking, hunger, anxiety, headache, and palpitations. As blood sugar drops further, drivers may experience confusion, poor judgment, slurred speech, drowsiness, or blackouts.
Clinically, hypoglycaemia can impair driving ability as severely as alcohol intoxication, yet many drivers underestimate the risk or attempt to “push through” symptoms.

Hyperglycaemia and driving
While less sudden, high blood sugar can still affect driving safety. Drivers may feel extremely tired, develop blurred vision, have difficulty concentrating, or feel unwell. Dehydration and frequent urination can also make long drives uncomfortable and distracting. Persistently high-blood sugar may worsen eye disease (diabetic retinopathy), further affecting driving ability.

Who is most at risk?
Not all people with diabetes face the same driving risks. Higher-risk groups include:
• Individuals using insulin
• Those with a history of severe hypoglycaemia
• People with reduced awareness of low blood sugar symptoms
• Drivers with long or irregular driving schedules
• Commercial drivers or those who drive for work
That said, any person with diabetes can experience unsafe blood-sugar changes, making preparation essential.

Safe driving starts before turning the key
From a clinical perspective, diabetes management and driving safety are closely linked. Drivers with diabetes should always check their blood sugar before starting a journey, especially for long trips. A safe pre-drive blood sugar level is generally above 5.0 mmol/L (90 mg/dL).
If blood sugar is low, driving should be delayed until it is corrected and stabilised. It is not enough to “feel better”, blood sugar must return to a safe range.
Drivers should always carry:
• A glucometer
• Fast-acting sugar (glucose tablets, sweets, juice)
• Snacks for longer journeys
• Medical identification indicating diabetes

What to do if blood sugar drops while driving
If symptoms of low blood sugar occur while driving, the correct response is immediate:
Pull over safely, switch off the engine, and remove the keys. Treat the low blood sugar with fast-acting sugar and wait at least 15-20 minutes before rechecking levels. Driving should only resume once blood sugar has fully recovered and mental clarity is restored.
Continuing to drive during hypoglycaemia puts lives at risk, including your own.

Medical fitness to drive: a shared responsibility
Clinicians play an important role in advising patients about driving safety, medication timing, and risk awareness. Patients, in turn, must be honest about symptoms, episodes of low blood sugar, and treatment adherence.
Diabetes alone should never be a reason to deny someone a driver’s licence. Instead, fitness to drive should be assessed based on:
• Blood-sugar control
• Hypoglycaemia awareness
• Vision status
• Ability to self-monitor and manage diabetes responsibly.
With proper management, most people with diabetes can drive safely for many years.

Complications that can affect driving
Long-term diabetes complications may also influence driving safety. These include:
• Diabetic retinopathy affecting vision
• Neuropathy affecting foot sensation and pedal control
• Cardiovascular disease increasing risk of sudden illness
• Cognitive impairment from recurrent hypoglycaemia
Regular medical checkups help identify and address these risks early.
Prognosis: Independence and safety can co-exist
Living with diabetes does not mean giving up driving. In fact, maintaining independence often improves mental health, employment opportunities, and quality of life. The key lies in consistent diabetes control, honest self-assessment, and responsible driving habits.
Most diabetes-related driving incidents are preventable. Education, planning, and awareness make the road safer for everyone.

Dos and Don’ts for Drivers with Diabetes
Do:
• Check blood sugar before driving
• Carry glucose and snacks
• Take regular breaks on long trips
• Wear medical identification
• Follow medication instructions carefully
Don’t:
• Drive if blood sugar is low or symptoms are present
• Skip meals before driving
• Ignore warning signs
• Assume “you’ll be fine”
• Drive immediately after treating hypoglycaemia
Driving with diabetes is not about restriction; it is about responsibility. With knowledge, preparation, and good glucose control, people living with diabetes can safely share the road with confidence.
Your health is part of road safety.
Protect yourself. Protect others.
And always drive with awareness.

3 tips for safe driving with diabetes

Driving is an important aspect of our society. But there is quite a bit to keep in mind before and while on the road – especially when you have diabetes.
Diabetes is a chronic condition in which the body doesn’t make or properly use insulin, which regulates blood glucose and process sugars and starches to give you energy. When low blood sugar hits out of the blue, it can be dangerous.
With a little planning and preparation, you can manage your diabetes anywhere you go. Here are three tips to help you drive safely with diabetes.
1. Always bring a diabetes tool kit. Whether you’re making a trip around the corner or going on a road trip, a diabetes tool kit can be a lifesaver. This kit should include supplies to manage your blood glucose when you’re away from home. In a small travel bag, include:
Diabetes alert identification card
Fast-acting carbohydrates, such as glucose tablets, juice boxes or snacks
Insulin pen or syringe, if necessary
Logbook
Medications
Spare glucose meter
Test strips
Keep your kit where you can easily access it when you’re in the car, like the centre console or driver’s side door. Avoid leaving your tool kit in the car, though, as excessive heat and sunlight can damage diabetes medications, glucose meters and insulin.
2. Check your blood glucose before driving. You want your glucose levels to be at least 80 mg/dL before getting behind the wheel, because it’s unsafe to operate a vehicle with low blood glucose. Also known as hypoglycaemia, low blood glucose can make it hard to concentrate, delay reaction time and cause blurry vision. If your levels are below 80 mg/dL, have a fast-acting carbohydrate snack, such as a full-sugar soda, jellybeans or gummy bears. Wait 15 minutes after having your snack and then check your levels again.
3. Watch for low glucose symptoms while driving. Your blood glucose can dip at any point, even while traveling. Pull over safely and check your blood glucose levels if you start to feel:
A headache
Clumsy
Dizzy, lightheaded or confused
Hungry
Irritable or cranky
Shaky or jumpy
Sleepy
Sweaty
Weak
Use snacks from your tool kit to raise your levels. Don’t start driving again until your blood glucose is in a normal range between 80 mg/dL and 180 mg/dL.

Takeaway
Driving is a big part of a lot of our lives. When you have diabetes it’s important to keep your blood glucose levels in mind before and while you’re behind the wheel. Keep your diabetes tool kit with you and stay aware of how you’re feeling while driving so you can safely get from point A to point B. If you have any other concerns or questions about driving with diabetes, talk with your primary care provider or a diabetes educator.