Diabetes and the license to drive

People with diabetes are subject to restrictive licensing policies that bar them from driving certain types of motor vehicles. Discriminatory rules regarding the license to drive are based mainly on concerns that treatment with blood glucose-lowering agents, especially insulin--may induce episodes of altered consciousness due to hypoglycemia. The risk of hypoglycemia, however, differs greatly among insulin-requiring diabetics and it is not difficult to identify those few who present a substantial risk. Moreover, the advent of simple, portable devices for blood glucose self-monitoring allows diabetics to know when blood glucose levels are becoming low and to take prompt corrective action. Thus, it would seem that blanket rules prohibiting diabetics from driving certain types of vehicles are unfair and unwarranted. In view of these considerations, rules are being revised by some licensing agencies to eliminate blanket restrictions and to allow for case-by-case evaluations to determine medical qualifications of people with diabetes. Tight control of diabetes currently is being advocated widely as a means of preventing chronic complications, but it carries an increased risk of hypoglycemia. Physicians who institute tight control regimens must ensure that patients understand the potential risk of hypoglycemia and are capable of minimizing the risk. Physicians should report patients to the Department of Motor Vehicles (DMV) who, in their judgement, are unable to drive safely because of concerns about hypoglycemia. Wisconsin state law protects physicians who make such reports from liability.