Insulin-treated diabetes and driving

1. If this patient starts insulin he must report the fact to the DVLA and his licence for Group 1 vehicles will be on a short-term, renewable basis - 1,2, or 3 years at the discretion of the DVLA and subject to medical reports. He will be allowed to drive all Group 1 vehicles (cars and vans < 3.5 tonnes). He may be allowed to continue driving C1 vehicles (3.5-7.5-tonne lorries) subject to a rigorous annual medical review by a diabetic consultant, which includes an individualized assessment of diabetic monitoring and hypoglycaemia risk. He will not be allowed to drive a D1 vehicle (minibus 9-16 seats not for hire or reward), although a concession might be made by the DVLA if this is as a 'volunteer' driver. 2. Whether he can drive his private hire car depends on the local authority's licensing rules. Some rely on the DVLA Group 1 rules (he would be able to carry on driving his hire car as long as the DVLA renew his licence), some apply Group 2 rules (he would be barred from driving his hire car or a taxi), some have their own rules, often similar to DVLA C1 criteria and relying on an occupational health assessment locally. 3. For all practical purposes, under current legislation it would make no difference whether he was already driving C1 vehicles before starting on insulin or wished to start driving these after starting insulin, provided he could pass the annual medical assessment. 4. If, as a result of his coeliac disease, he permanently lost warning symptoms of hypoglycaemia, he would lose his licence to drive all vehicles. This reflects the importance of the clinical diabetes team in helping him control his diabetes in a stable fashion, recognize the importance of hypoglycaemia with respect to driving, take the necessary steps to avoid hypoglycaemic episodes while driving, and give him rational and dispassionate advice about the necessity to stop driving if the clinical circumstances dictate this. The fact that the great majority of driving licence assessments are undertaken by the patient's own clinic underlines the potential challenge of being firm and honest about this while maintaining a good clinician-patient relationship. 5. Current research suggests that there may be significant differences in risk between Type 1 and Type 2 patients on insulin. Does this patient have Type 1 or Type 2 diabetes? This may turn out to be an important question for Mr P.